Page 878 - Cote clinical veterinary advisor dogs and cats 4th

Hemangiosarcoma 425

• Noncutaneous Cats: intoxication), exudative/infectious pericar-
○ Often nonspecific complaints (e.g., mild • Cutaneous or subcutaneous lesions are ditis, congestive heart failure (right sided),
VetBooks.ir appetite, weight loss) commonly attributed Visceral disease is often evident on abdominal hydropericardium due to hypoalbumin- Diseases and Disorders
typically readily identified on physical exam.
exercise intolerance, mild decrease in
peritoneopericardial diaphragmatic hernia,
at first to old age, environmental change
emia, pericardial cysts, diseases that cause
palpation. Other possible findings include
(weather) or other factors, but then culmi-
silhouette (e.g., dilated cardiomyopathy,
nating in subacute (days before presenta- pale mucous membranes and weak pulses. radiographic enlargement of the cardiac
tion) or acute (hours before presentation) Etiology and Pathophysiology severe atrioventricular endocardiosis/valvular
deterioration with lethargy, weakness, • Cutaneous HSA is associated with UV light heart disease)
tachypnea, inappetence/anorexia, and/ exposure. Cutaneous HSA is less likely to Cats:
or abdominal distention metastasize and is not usually associated with • Subcutaneous: abscess, other neoplasia such
○ Acute onset of weakness or collapse is underlying visceral disease/involvement; as injection-site sarcoma, fibrosarcoma
often mentioned and associated with subcutaneous HSA may metastasize and may • Splenic: splenic mast cell tumor, lymphoma,
tumor rupture and hemorrhage. be a marker for underlying visceral disease/ nodular hyperplasia, other sarcoma
○ Collapse may be self-resolving by the time involvement.
the patient is presented for veterinary • Malignant vascular endothelial cells form Initial Database
attention, but physical signs of hemor- abnormal vascular channels. • Careful abdominal palpation, assessment for
rhage, abdominal mass, and/or arrhythmia • Microangiopathic disease (abnormal blood a fluid wave
persist. vessels in the neoplasm) results in platelet • Auscult heart and check pulses (for quality
○ Cardiac: overlap or combination of the aggregation, erythrocyte morphology changes, and synchronicity); check for jugular pulse.
following is possible: and DIC. • Complete blood count, serum biochemistry
Acute collapse with pallor; may have • Tumor rupture leads to anemia, weakness, profile, urinalysis, coagulation profile
■
partially resolved over preceding hours and inappetence/anorexia. ○ Anemia (regenerative or nonregenerative,
or days • Cardiac HSA is most often a right atrial/ depending on acuity) and hypoprotein-
Vomiting is common (>50%) in dogs auricular infiltration of neoplastic cells that emia are common due to blood loss (e.g.,
■
with pericardial effusion grow on the epicardial surface and ultimately abdominal hemorrhage)
General malaise, lethargy, anorexia, cause rupture of superficial myocardial vessels ○ Schistocytosis may occur as a result of
■
exercise intolerance of various sizes, triggering bleeding into microangiopathic damage of red blood
Visible abdominal distention the pericardial space. The result is cardiac cells traveling through abnormal vessels
■
Cats: tamponade when intrapericardial pressure in the neoplasm.
• Cutaneous: bleeding from the mass in a exceeds right atrial and ventricular filling ○ Prolongation of prothrombin time (PT)
patient that is otherwise well may be the pressures. and activated partial thromboplastin time
chief complaint. • Metastatic disease occurs in the lungs, (aPTT) may be secondary to aberrant
• Noncutaneous: typically, nonspecific signs mesentery, and throughout the body. procoagulant tissue factor expression on
such as inappetence/anorexia, weight loss, • Death is often due to uncontrollable bleeding hemangiosarcoma tumor cells and DIC
lethargy, and vomiting from tumor rupture. • Thoracic and abdominal radiographs
○ Mass effect is commonly apparent on
PHYSICAL EXAM FINDINGS DIAGNOSIS abdominal radiographs; detail may be
Dogs: obscured by abdominal effusion.
• Cutaneous Diagnostic Overview ○ Pulmonary metastasis of HSA can involve
○ Single or multiple cutaneous masses, HSA is typically first suspected when signs of hundreds to thousands of 1-2 mm nodules,
typically on the ventral abdomen. Usually hemodynamic compromise (most commonly which appear as pulmonary interstitial
raised, hairless, smooth, and dark red, due to hemoabdomen or cardiac tamponade) pattern.
although they may also appear as polypoid, are associated with a mass lesion in an organ ○ Cardiac silhouette may be enlarged
hairless lesions that are the same color as commonly affected by hemangiosarcoma. Less (globoid), indicating pericardial effusion,
surrounding skin. commonly, a mass may be found incidentally but lack of globoid cardiac silhouette does
• Noncutaneous (e.g., on the skin, during routine abdominal not rule out pericardial effusion.
○ Most often, findings are related to tumor palpation, during an abdominal ultrasound ○ Cardiac silhouette is rarely affected by
rupture and hemorrhage into a body exam performed for another reason) or in the presence of a mass lesion.
cavity. The most common physical course of evaluation of a cardiac arrhythmia. • Abdominal ultrasound if suspected splenic
findings include lethargy, pale mucous Noninvasive tests do not confirm hemangio- or hepatic involvement (abdominal effusion/
membranes, abdominal fluid wave, sarcoma, and a definitive diagnosis must be distention, abdominal mass). Utility of
sinus tachycardia (reflex), and weak obtained through histopathologic exam of ultrasound for patients with a palpable
pulses. affected tissue. abdominal mass
○ A palpable intraabdominal mass is often ○ Confirm presence of the mass, its organ
present, and the masses should be palpated Differential Diagnosis of origin, and likelihood of resectability
with great care to avoid further damag- Dogs: ○ Identify lesions suggesting metastasis
ing fragile blood vessels on the surface • Cutaneous: hemangioma, soft-tissue sarcoma, ○ Identify abdominal fluid and guide needle
of the neoplasm and inducing further mast cell tumor abdominocentesis (if small volume)
hemorrhage. • Splenic: splenic torsion, lymphoma, hemangi- ○ Identify internal structure of mass, indicat-
○ Soft heart sounds, cardiac arrhythmia, oma, hematoma, extramedullary hematopoiesis, ing feasibility of fine-needle aspiration/
and signs of circulatory failure may be nodular regeneration, other sarcoma core biopsy (contraindicated if mixed
present as a result of a ruptured abdominal • Hepatic: hepatocellular adenoma/adenocar- echogenicity and high vascularity)
HSA or a cardiac HSA and subsequent cinoma, hematoma • Echocardiography (see Video)
pericardial effusion, or both. • Cardiac: idiopathic benign pericardial ○ Right atrial wall collapse (sail sign; the
• In some cases, jugular distention, pulsus effusion, other neoplasia (chemodectoma, right atrial wall motion seen in pericardial
paradoxus, or positive hepatojugular reflux mesothelioma, lymphoma), hemopericardium tamponade resembles a sail flapping in the
may be observed. (atrial rupture, anticoagulant rodenticide wind)

www.ExpertConsult.com