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Practical Oncology Round Cell Tumors

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Presentation on theme: "Practical Oncology Round Cell Tumors"— Presentation transcript:

1 Practical Oncology Round Cell Tumors
Wendy Blount, DVM

2 Round Cell Tumors Lymphoma Mast Cell Tumor Plasma Cell Tumor Extramedullary Plasmacytoma Multiple myeloma Histiocytic Disease Transmissible Venereal Tumor

3 Diagnosis Generally diagnosed with cytology, as they exfoliate well May need histopathology if anaplastic Immunohistochemistry if markedly anaplastic Gives information about prognosis

4 Plasmacytoma Round, button like tumors on the skin and mucous membranes Technically malignant Usually behave benignly if extramedullary Surgery is curative if borders clean Radiation curative if not resectable

5 Plasmacytoma

6 Plasmacytoma

7 Multiple Myeloma Malignant plasma cells proliferate in bone marrow and are released into circulation Malignant cells found in Skeleton Lymph nodes and spleen Kidney and liver Produce large amounts of a specific Ig or part of an Ig Mono or biclonal gammopathy Bence Jones protein is the light chain heavy chain or paraprotein also possible

8 Multiple Myeloma Clinical Signs Lethargy, anorexia weight loss
Lameness + pathologic fracture PU-PD Hyperesthesia Hyperviscosity Syndrome Immunosuppression – cytopenias & inhibition of humoral immunity anemia more common than leukopenia or thrombocytopenia Hypercalcemia Azotemia - hypercalcemia, renal infiltration, hyperviscosity

9 Multiple Myeloma Hyperviscosity syndrome (TP >10) Heart failure
Reduced flow through small vessels plasma volume expansion volume overload Myocardial hypoxia Neurologic signs due to hypoxia Seizures, disorientation, ataxia Peripheral neuropathy

10 Multiple Myeloma Hyperviscosity syndrome (TP >10)
Bleeding diathesis Capillary damage from hypoxemia Inflammatory coagulopathy Epistaxis, gingival bleeding Retinal detachment, hyphema, secondary glaucoma, blindness Renal ischemia

11 Multiple Myeloma Diagnosis – 2 of 5
Paraproteinemia (monoclonal gammopathy) Serum protein electrophoresis Also caused by rickettsial disease Osteolytic bone lesions (punched out) Generalized osteopenia Pathologic fractures More common in dogs than cats Radiograph spine, ribs and limbs Biopsy lytic lesion and take bone marrow sample

12 Multiple Myeloma Diagnosis – 2 of 5
>20% plasma cells in the bone marrow DDx – atopy, rickettsial infection, FIP, Leishmania spp, heartworm disease Bence Jones proteinuria Not detected on urine dipstick Infiltration of liver, spleen and skin with plasma cells (cats)

13 Multiple Myeloma Treatment Treat hyperviscosity diuresis
Whole blood or platelet rich plasma for bleeding diathesis Treat hypercalcemia (pamidronate) Plate pathologic fractures Treat secondary infection Treat renal failure Chemotherapy melphalan and prednisone, with or without 1 dose cyclophosphamide

14 Multiple Myeloma Rescue Therapy – 3 week cycle
Week 1 – doxorubicin 30 mg/m2 IV Start prednisone 1 mg/kg PO SID Week 2, 3 – vincristine 0.7 mg/m2 Wean off prednisone of possible

15 Multiple Myeloma x

16 Multiple Myeloma Prognosis Short term prognosis is good
median survival 540 days (2.5 years) with treatment Long term prognosis poor, as recurrence is expected Bone pain and pathologic fractures main cause of morbidity and mortality Negative prognostic indicators: Hypercalcemia Bence Jones proteinuria Extensive bony lysis

17 Histiocytic Disease Histiocytoma Cutaneous histiocytosis Systemic histiocytosis Localized histiocytic sarcoma Malignant histiocytosis aka disseminated histiocytic sarcoma

18 Histiocytoma Single alopecic button like mass Usually young dogs Usually spontaneously regresses Can take 2-3 months Aspiration can induce regression If large, may need to be resected If >2 yrs old, remove for histopath Rare in cats Cytology – small lymphocytes may be more numerous than histiocytes

19 Histiocytoma

20 Cutaneous Histiocytosis (dogs)
Single mass or multiple masses May regress spontaneously May wax and wane over years, requiring multiple surgeries or immunosuppressive therapy Prednisone 2 mg/kg PO SID, and taper as signs regress over 2-3 months Cyclosporine 5 mg/kg PO SID-BID, taper Leflunomide 2-4 mg/kg PO SID Goal is trough level 20 mcg/ml, taper Side effect vomiting

21 Systemic Histiocytosis
Familial in Bernese Mountain Dog Slowly progressive disease Cutaneous masses Sometimes other organs are affected Localized histiocytic sarcoma Also retrievers and Rottweilers Nodules occur around and infiltrate joints

22 Malignant Histiocytosis
Multi-system, rapidly progressive disease Bernese Mountain dogs, retrievers, Rottweilers Histiocytic infiltration of spleen, lymph nodes, lung, bone marrow, skin Usually leads to death in weeks Clinical signs Weight loss, lethargy, anorexia Coughing, dyspnea Seizures, weakness, lameness No effective treatment

23 TVT The only known naturally occurring tumor that can be transplanted as an allograft Transmitted by transplantation of cells onto abraded mucous membranes During breeding Nose to butt contact In the nose, on the perineum, or on/in the reproductive tract Begins as hyperemic papules Progresses to multilobulated, ulcerated, bleeding mass

24 TVT If untreated, can metastasize
Eye, skin, lips, oral and nasal cavities Regional lymph nodes Lungs, liver, brain Abnormal karyotype with 59 chromosomes Dogs normally have 78 May occasionally spontaneously regress Usually recur if surgically removed

25 TVT Treatment Vincristine 0.7 mg/m2 IV weekly
Continue 2-3 weeks past resolution of disease Usually 3-5 injections are required If no response, doxorubicin 30 mg/m2 IV q3 weeks x 3 treatments Radiation is also effective, but often reserved for those that do not respond to chemotherapy Spay-neuter and do not allow to roam

26 TVT

27 TVT

28 TVT

29 TVT

30 Round Cell Tumor Cytology
Covered Lymphoid Cells Histiocyte – larger than lymphoblast Round to indented nucleus Scant to Moderate pale cytoplasm Mast Cell – histiocyte w/ purple granules TVT – histiocyte with clear vacuoles Plasma Cells Dark blue cytoplasm with central pallor Perinuclear clear zone (Golgi zone) Eccentric nucleus

31 Cytology Rottweiler, sick with enlarged lymph nodes, spleen and liver – LN cytology Dx – large cell lymphoma

32 Cytology Button like alopecic skin mass

33 Cytology Button like alopecic skin mass Dx - Plasmacytoma

34 Cytology Button like alopecic tumor Dx – mast cell tumor

35 x

36 Cytology Golden Retriever, sick with enlarged lymph nodes, spleen and liver Dx – malignant histiocytosis

37 Cytology Recurring button like alopecic masses Dx – cutaneous histiocytosis

38 Cytology alopecic tumor protruding from the naris, bleeds when bumped
Dx – TVT

39 Cytology Infiltrative plaque-like skin masses Dx – Multiple Myeloma

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