Page 879 - Cote clinical veterinary advisor dogs and cats 4th

426 Hemangiosarcoma

○ Diastolic collapse of right ventricular wall • Noncutaneous (either species) PROGNOSIS & OUTCOME
if severe tamponade ○ If evidence of recent or ongoing hemor- • Cat and dog (cutaneous): < 30% of patients
VetBooks.ir ing tumor may be seen bobbing in fluid ○ Pericardiocentesis (p. 1150) if cardiac with dermal (stage I) HSA develop metasta-
rhage: IV fluids ± oxygen ± transfusion
○ Tumor mass or blood clot from bleed-
(p. 430)
ses, and complete surgical excision is often
adjacent to or involving a thickened
(infiltrated) right atrial/auricular wall.
curative.
tamponade is present
○ Diminished right atrium, right ventricle, ○ Diuretics: contraindicated in acute • Dog and cat (noncutaneous and stage II
left ventricle volume pericardial effusion/cardiac tamponade cutaneous HSA)
○ Swinging motion of the heart within the ○ Highly metastatic; with surgery alone,
anechoic pericardial fluid Chronic Treatment median survival is often 2-3 months.
○ Mass seen occasionally on/in the wall • Cat and dog (cutaneous): surgery alone Despite occasional reports of several
of the right atrium, especially at the may be curative in most patients with months’ survival, survival to/beyond 1
right atrial/right ventricular junction or dermal HSA. Margins should be at least year is very uncommon.
the right auricle; absence of mass does 1-3 cm wide and one or more fascial planes ○ If all grossly detectable neoplastic tissue
not exclude HSA because of limitations deep. can be removed surgically, adjuvant
of imaging right auricle with routine • Cat and dog (noncutaneous and stage II chemotherapy may extend survival to a
(transthoracic) echocardiography. cutaneous HSA) median time of 6 months.
○ Doppler evaluation of pulmonic flow ○ Surgery to remove the tumor ○ If grossly apparent neoplastic tissue persists
shows large variation in beat-to-beat peak ○ Chemotherapy with a protocol of five in postoperative period, median survival
velocities. doses of doxorubicin given every 3 time approximates 2 months.
2
• Electrocardiogram if an arrhythmia is found weeks 30 mg/m IV. Special handling ○ Adjuvant radiation therapy considered for
on physical exam and if splenic involvement, requirements and potentially severe or patients with incompletely excised stage
cardiac involvement, or recent hemorrhage life-threatening adverse patient effects exist II cutaneous HSA, but there are limited
is evident. Most common arrhythmias with with this chemotherapeutic drug; these data regarding benefit.
cardiac HSA are ventricular arrhythmias, concerns and rapid evolution of protocols ○ Right auricular ablation plus chemotherapy
supraventricular tachycardia, atrioventricular warrant consultation with/referral to an may prolong life (median survival for eight
block, and right bundle branch block. oncologist. dogs with right auricular ablation alone:
• Fine-needle aspiration cytology of regional ○ Consider adjuvant radiation therapy 42 days vs. eight other dogs with right
lymph node in patients with cutaneous for patients with incompletely excised auricular ablation plus chemotherapy: 175
HSA subcutaneous stage II HSA. days).
○ Dog cardiac HSA: repeated pericar-
Advanced or Confirmatory Testing diocenteses or subtotal pericardectomy PEARLS & CONSIDERATIONS
• Surgical biopsy for histopathologic evaluation (usually performed after second event of
is gold standard for diagnosis. With splenic tamponade). If possible, right auricular Comments
HSA, the entire spleen should be submitted; ablation ± chemotherapy (see Prognosis • Large size of a splenic mass as identified
some laboratories request it to be shipped & Outcome below). by exam or imaging does not imply
chilled on ice (not frozen), whereas others ■ Yunnan Baiyao ± epsilon-aminocaproic greater chance of malignancy than smaller
request it be fixed in a 10 : 1 ratio of formalin/ acid have not been shown to 1) decrease mass.
tumor for 24-48 hours, after which the fixed the need for repeat pericardiocentesis • Most often, HSA of the liver is due to
tissues can be sent to the laboratory in a or 2) prolong survival time in dogs metastatic disease because primary hepatic
small amount of formalin. with right atrial masses and pericardial HSA is uncommon.
• Contrast ultrasonography may be helpful in effusion. • Nodules of ectopic splenic tissue on the
assessing the nature of ultrasonographically omentum and regenerative hepatic nodules
identified splenic and hepatic nodules. Possible Complications are benign, dark red/brown tissue that must
Metastatic liver nodules have a hypoechoic • Disease complications not be misinterpreted as HSA metastases
appearance, in contrast to benign nodules, ○ Metastasis, hemorrhage leading to hypo- during laparotomy in a patient with a
which are isoenhancing. volemia and anemia, cardiac tamponade, splenic mass. Biopsy is advised to avoid
• Fine-needle aspiration cytology or cytologic DIC, death misdiagnosis.
evaluation of hemorrhagic fluids is rarely • Chemotherapeutic complications • Although rare in cats, this tumor has a
diagnostic. Aspiration cytology of visceral ○ General chemotherapy toxicoses: myelo- similarly aggressive biological behavior.
masses may result in hemorrhage and is not suppression, GI upset • Fine-needle aspiration/cytologic evaluation
recommended in suspected noncutaneous ○ Specific doxorubicin toxicoses: hypersen- and core biopsy are often unrewarding due
HSA. sitivity during administration, perivas- to poor cellular yield and blood dilution,
cular sloughing with drug extravasation, and both carry the real possibility of causing
TREATMENT cumulative myocardial toxicosis and heart rupture of the tumor and potentially life-
failure (dogs), cumulative nephrotoxicosis threatening hemorrhage. These procedures
Treatment Overview (cats) are therefore contraindicated for evaluation
Therapeutic goals: of masses when HSA is on the differential
• Reduce tumor burden and prevent/minimize Recommended Monitoring diagnosis list: masses of splenic, hepatic,
future hemorrhagic episodes. • Cat and dog (cutaneous): recheck physical renal, or cardiac origin that on ultrasound
• Relieve cardiac tamponade (palliative), if exam every 3-4 months exam are of mixed echogenicity and may
present. • Cat and dog (noncutaneous): weekly be highly vascularized based on color-flow
• Control metastatic disease. complete blood count initially, thoracic Doppler assessment.
• Prolong survival. radiographs every 1-2 months, abdominal • Fine-needle aspiration and cytologic evalua-
ultrasound every 1-2 months tion may be considered for evaluation of skin
Acute General Treatment • Echocardiography 24 hours after pericar- masses for which HSA is on the differential
• Cutaneous (either species): surgery to remove diocentesis; 1 week after pericardiocentesis, diagnosis list, but diagnostic yield is limited
tumor monthly thereafter for the same reasons.

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