Practical Oncology Round Cell Tumors
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Transcript of Practical Oncology Round Cell Tumors
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Practical OncologyRound Cell Tumors
Wendy Blount, DVM
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Round Cell Tumors
• Lymphoma• Mast Cell Tumor• Plasma Cell Tumor
• Extramedullary Plasmacytoma• Multiple myeloma
• Histiocytic Disease• Transmissible Venereal Tumor
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Diagnosis
• Generally diagnosed with cytology, as they exfoliate well
• May need histopathology if anaplastic
• Immunohistochemistry if markedly anaplastic• Gives information about
prognosis
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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
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Plasmacytoma
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Plasmacytoma
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Plasmacytoma
Becky Hairgrove – Timpson TX
Jennifer Cornish – Houston TX
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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
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Multiple MyelomaClinical 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
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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
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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
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Multiple Myeloma
Diagnosis – 2 of 51. Paraproteinemia (monoclonal gammopathy)
• Serum protein electrophoresis • Also caused by rickettsial disease
2. 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
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Multiple Myeloma
Diagnosis – 2 of 53. >20% plasma cells in the bone marrow
• DDx – atopy, rickettsial infection, FIP, Leishmania spp, heartworm disease
4. Bence Jones proteinuria• Not detected on urine dipstick
5. Infiltration of liver, spleen and skin with plasma cells (cats)
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Multiple MyelomaTreatment• 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
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Multiple MyelomaRescue 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
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Multiple MyelomaPrognosis• 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
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Histiocytic Disease
• Histiocytoma• Cutaneous histiocytosis• Systemic histiocytosis• Localized histiocytic sarcoma• Malignant histiocytosis
• aka disseminated histiocytic sarcoma
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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
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Histiocytoma
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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
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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
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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
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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
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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
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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
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Merry Vann – Coldspring TXSean Penn – Lufkin TX
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TVT
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TVT
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TVT
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TVT
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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
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Cytology• Rottweiler, sick with enlarged lymph nodes,
spleen and liver – LN cytology• Dx – large cell lymphoma
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Cytology
• Button like alopecic skin mass
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Cytology
• Button like alopecic skin mass• Dx - Plasmacytoma
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Cytology• Button like alopecic tumor• Dx – mast cell tumor
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Cytology• Golden Retriever, sick with enlarged lymph
nodes, spleen and liver• Dx – malignant histiocytosis
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Cytology• Recurring button like alopecic masses• Dx – cutaneous histiocytosis
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Cytology• alopecic tumor protruding from the naris,
bleeds when bumped• Dx – TVT
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Cytology
• Infiltrative plaque-like skin masses• Dx – Multiple Myeloma