1 / 39

Practical Oncology Round Cell Tumors

Practical Oncology Round Cell Tumors. Wendy Blount, DVM. Round Cell Tumors. Lymphoma Mast Cell Tumor Plasma Cell Tumor Extramedullary Plasmacytoma Multiple myeloma Histiocytic Disease Transmissible Venereal Tumor. Diagnosis. Generally diagnosed with cytology, as they exfoliate well

nika
Download Presentation

Practical Oncology Round Cell Tumors

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Practical OncologyRound 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. Plasmacytoma Becky Hairgrove – Timpson TX Jennifer Cornish – Houston TX

  8. 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

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

  10. 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

  11. 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

  12. 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

  13. 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)

  14. 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

  15. 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

  16. Multiple Myeloma Prognosis • Short term prognosis is good • median survival 540 days 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. Merry Vann – Coldspring TX Sean Penn – Lufkin TX

  27. TVT

  28. TVT

  29. TVT

  30. TVT

  31. 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

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

  33. Cytology • Button like alopecic skin mass

  34. Cytology • Button like alopecic skin mass • Dx - Plasmacytoma

  35. Cytology • Button like alopecic tumor • Dx – mast cell tumor

  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

More Related