Page 1909 - Cote clinical veterinary advisor dogs and cats 4th

955.e4 Systemic Inflammatory Response Syndrome

TREATMENT • Median survival: 28-36 months after limb van Kuijk L et al: Peri-articular histiocytic sarcoma
amputation alone, with or without adjuvant and previous joint disease in Bernese mountain
dogs. J Vet Intern Med 27(2):293-299, 2013.
Treatment Overview
VetBooks.ir Pain control and limb amputation are the • Prognostic factors for survival of dogs ADDITIONAL SUGGESTED
chemotherapy
mainstays of treatment.
with SCS treated with amputation include
Acute General Treatment clinical stage (no metastases: > 48 months; READINGS
Fox DB, et al: Canine synovial sarcoma: a retrospec-
metastases: 3 months), histologic grade (grade
• Analgesic and/or nonsteroidal antiinflamma- I or II: 36 months; grade III: 7 months), tive assessment of described prognostic criteria in
tory drugs are indicated for pain palliation. and cytokeratin staining (negative: > 48 16 cases (1994-1999). J Am Anim Hosp Assoc
• Limb amputation months; positive: 4 months). Periarticular 38:347, 2002.
• Local resection followed by external beam histiocytic sarcoma frequently has a more Liptak JM, et al: Metastatic synovial cell sarcoma in
two cats. Vet Comp Oncol 2:164, 2004.
radiation therapy to the tumor bed with indolent clinical course. Loukopoulos P, et al: Canine biphasic synovial
curative or palliative intent can be attempted sarcoma: case report and immunohistochemical
if the animal is not a candidate for limb PEARLS & CONSIDERATIONS characterization. J Vet Sci 5:173, 2004.
amputation. Efficacy of radiation therapy is Vail DM, et al: Evaluation of prognostic factors for
not known. Comments dogs with synovial sarcoma: 36 cases (1986-1991).
• Histopathologically, most cases exhibit a J Am Vet Med Assoc 205:1300, 1994.
Chronic Treatment biphasic pattern resembling both mesenchy-
Efficacy of chemotherapy has not been deter- mal and epithelioid origins. Because of these RELATED CLIENT EDUCATION
mined for canine SCS. For dogs with high- features, pathologists have to discriminate SHEETS
grade tumors or those that present with overt among a poorly differentiated carcinoma,
metastasis, adjuvant chemotherapy with drugs histiocytic sarcoma, and SCS. Consent to Perform Abdominal Ultrasound
such as doxorubicin, platinum-based drugs (i.e., • SCS is rarely diagnosed in cats. Among nine Consent to Perform Amputation
cisplatin or carboplatin), or ifosfamide may reported cases of feline SCS, there have been Consent to Perform Computed Tomography
prove beneficial. CCNU (lomustine) for dogs six reports of malignant SCS and three (CT Scan)
with histiocytic sarcoma should be considered. reports of benign synovioma. Consent to Perform Fine-Needle Aspiration
Special handling requirements and potentially of Masses
severe, life-threatening adverse patient effects Technician Tips Consent to Perform Radiation Therapy
exist for these drugs. Consultation with a The entire joint capsule should be submitted Consent to Perform Radiography
veterinary oncologist is recommended. for histologic evaluation. Partial submission in
these cases can result in misdiagnosis of cell AUTHOR: Ravinder S. Dhaliwal, DVM, MS, DACVIM,
Recommended Monitoring type. The owners should be made aware that DABVP
Periodic evaluation for distant metastasis (e.g., special stains are often necessary to confirm EDITOR: Kenneth M. Rassnick, DVM, DACVIM
thoracic radiographs) and local recurrence the diagnosis. Decision about adjuvant therapy
depends on the final histologic diagnosis.
PROGNOSIS & OUTCOME
SUGGESTED READINGS
• Clinical outcome is excellent after limb Craig LE, et al: The diagnosis and prognosis of
amputation in cases with no detectable synovial tumors in dogs: 35 cases. Vet Pathol
metastatic disease. 39:66, 2002.

Systemic Inflammatory Response Syndrome

Clinical Presentation
BASIC INFORMATION a pronounced release of proinflammatory
HISTORY, CHIEF COMPLAINT mediators (e.g., cytokines) in excess of
Definition History may include previously diagnosed endogenous antiinflammatory capacity.
Systemic inflammatory response syndrome underlying disease or an acute event associated • Microvasculature disruption, vascular hypo-
(SIRS) is the term for widespread systemic with systemic inflammation. responsiveness, and endothelial damage alter
inflammation caused by underlying infectious organ perfusion and activate coagulation.
or noninfectious disease processes. Hallmarks PHYSICAL EXAM FINDINGS • High levels of circulating cytokines and
of SIRS include perfusion abnormalities, • SIRS is a constellation of physical exam vasoactive mediators play an important role
disruption of the microcirculation, and organ findings (see below). in the mechanism of SIRS.
damage. Untreated SIRS can lead to multiple • Specific physical exam findings depend on Common causes of SIRS in animals:
organ dysfunction syndrome (MODS) and the underlying cause of SIRS. • Sepsis
death. • Generally, physical exam parameters are • Pancreatitis
consistent with hypoperfusion and shock. • Heat stroke
Epidemiology • Acute abdominal signs such as pain, disten- • Immune-mediated disease
SPECIES, AGE, SEX tion, retching, or vomiting may be observed. • Trauma
No species, age, or sex predisposition. • Evidence of coagulopathy and/or thrombo- • Burns
embolic disease may be identified.
ASSOCIATED DISORDERS
SIRS can be a consequence of many disease Etiology and Pathophysiology
processes. The most common sequela is single • SIRS can develop due to infectious or
or multiple organ dysfunction (MODS). noninfectious causes and is the result of

www.ExpertConsult.com