Hemangiosarcoma

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Hemangiosarcoma
Splenic hemangiosarcoma.JPG
Hemangiosarcoma of the spleen in a dog, removed after surgery
Specialty Veterinary medicine

Hemangiosarcoma is a rapidly growing, highly invasive variety of cancer that occurs almost exclusively in dogs, and only rarely in cats, horses, mice, [1] or humans (vinyl chloride toxicity). It is a sarcoma arising from the lining of blood vessels; that is, blood-filled channels and spaces are commonly observed microscopically. A frequent cause of death is the rupturing of this tumor, causing the patient to rapidly bleed to death.

Contents

The term "angiosarcoma", when used without a modifier, usually refers to hemangiosarcoma. [2] However, glomangiosarcoma (8710/3) and lymphangiosarcoma (9170/3) are distinct conditions (in humans).

Dogs

Hemangiosarcoma of the skin in a dog Hemangiosarcoma of skin.JPG
Hemangiosarcoma of the skin in a dog

Hemangiosarcoma is quite common in dogs, and more so in certain breeds including German Shepherds and Golden Retrievers. [3] It also occurs in cats, but much more rarely. Dogs with hemangiosarcoma rarely show clinical signs until the tumor has become very large and has metastasized. Typically, clinical signs are due to hypovolemia after the tumor ruptures, causing extensive bleeding. Owners of the affected dogs often discover that the dog has hemangiosarcoma only after the dog collapses.

The tumor most often appears on the spleen, right heart base, or liver, although varieties also appear on or under the skin or in other locations. It is the most common tumor of the heart, and occurs in the right atrium or right auricular appendage. Here it can cause right-sided heart failure, arrhythmias, pericardial effusion, and cardiac tamponade. Hemangiosarcoma of the spleen or liver is the most common tumor to cause hemorrhage in the abdomen. [4] Hemorrhage secondary to splenic and hepatic tumors can also cause ventricular arrhythmias. Hemangiosarcoma of the skin usually appears as a small red or bluish-black lump. It can also occur under the skin. It is suspected that in the skin, hemangiosarcoma is caused by sun exposure. [4] Occasionally, hemangiosarcoma of the skin can be a metastasis from visceral hemangiosarcoma. Other sites the tumor may occur include bone, kidneys, the bladder, muscle, the mouth, and the central nervous system.

Clinical features

Presenting complaints and clinical signs are usually related to the site of origin of the primary tumor or to the presence of metastases, spontaneous tumor rupture, coagulopathies, or cardiac arrhythmias. More than 50% of patients are presented because of acute collapse after spontaneous rupture of the primary tumor or its metastases. Some episodes of collapse are a result of ventricular arrhythmias, which are relatively common in dogs with splenic or cardiac HSA. [5]

Most common clinical signs of visceral hemangiosarcoma include loss of appetite, arrhythmias, weight loss, weakness, lethargy, collapse, pale mucous membranes, and/or sudden death. An enlarged abdomen is often seen due to hemorrhage. Metastasis is most commonly to the liver, omentum, lungs, or brain.

A retrospective study published in 1999 by Ware, et al., found a five times greater risk of cardiac hemangiosarcoma in spayed vs. intact female dogs and a 2.4 times greater risk of hemangiosarcoma in neutered dogs as compared to intact males.[ citation needed ] The validity of this study is in dispute. [6]

Clinicopathologic findings

Hemangiosarcoma can cause a wide variety of hematologic and hemostatic abnormalities, including anemia, thrombocytopenia [7] (low platelet count), disseminated intravascular coagulation (DIC); presence of nRBC, schistocytes, and acanthocytes in the blood smear; and leukocytosis with neutrophilia, left shift, and monocytosis. [8] [9] [10] [11]

Diagnosis

A definitive diagnosis requires biopsy and histopathology. Cytologic aspirates may be inconclusive with studies reporting various specificity, and negative results may not correlate with absence of disease, as one study concludes "cytological diagnosis of splenic neoplasia is reliable, but a negative result cannot be used to exclude the possibility of splenic neoplasia." [12] This is because of frequent blood contamination and poor exfoliation. [13] Surgical biopsy is the typical approach in veterinary medicine.

Imaging modalities may include one ore more of ultrasound, CT, MRI [14] [15] and FDG-PET/CT. [16] [17] FGD-PET/CT may show some benefit over traditional CT for staging and detection of metastasis. [17] [18]

Symptoms

Dogs rarely show symptoms of hemangiosarcoma until after the tumor ruptures, causing extensive bleeding. Then symptoms can include short-term lethargy, loss of appetite, enlarged abdomen, weakness in the back legs, paled colored tongue and gums, rapid heart rate, and a weak pulse. [19]

Treatments

Treatment includes chemotherapy and, where practical, removal of the tumor with the affected organ, such as with a splenectomy. Splenectomy alone gives an average survival time of 1–3 months. The addition of chemotherapy, primarily comprising the drug doxorubicin, alone or in combination with other drugs, can increase the average survival time by 2–4 months beyond splenectomy alone.

A 2012 paper published the University of Pennsylvania Veterinary School, in dogs treated with a compound derived from the Coriolus versicolor (commonly known as "Turkey Tail") mushroom showed a favorable response to the agent compared to historical controls of dogs treated with splenectomy and Doxorubicin .:. [20] A controlled, randomized study in 101 dogs was later conducted by the University of Pennsylvania Veterinary School which showed that the Coriolus versicolor mushroom did not have the same outcome noted in the 2012 paper with 15 dogs. In the 2022 paper by Gednet et al. dogs treated with splenectomy followed by Doxorubicin did better than dogs treated with splenectomy and mushroom agent. Combination of Doxorubicin with the Turkey Tail mushroom also did not improve survival when compared to Doxorubicin alone. However, as noted in the 2012 study, the Turkey Tail mushroom extract did not cause any systemic adverse reactions, even when combined with Doxorubicin.:. [21]

Immune therapy based on cultivation of tumor tissue is being developed for dogs. [22] A preventive vaccine based on several proteins commonly found in dog cancers, including hemangiosarcomas, is also being developed. [23]

In the skin, it can be cured in most cases with complete surgical removal as long as there is not visceral involvement. [4] Median survival times for stage I is 780 days, where more advanced stages can range from 172 to 307 days. [24]

Related Research Articles

<span class="mw-page-title-main">Gastric dilatation volvulus</span> Medical condition in dogs

Gastric dilatation volvulus (GDV), also known as gastric dilation, twisted stomach, or gastric torsion, is a medical condition that affects dogs and rarely cats and guinea pigs, in which the stomach becomes overstretched and rotated by excessive gas content. The condition also involves compression of the diaphragm and caudal vena cavae. The word bloat is often used as a general term to mean gas distension without stomach torsion, or to refer to GDV.

<span class="mw-page-title-main">Splenectomy</span> Surgical removal of the spleen

A splenectomy is the surgical procedure that partially or completely removes the spleen. The spleen is an important organ in regard to immunological function due to its ability to efficiently destroy encapsulated bacteria. Therefore, removal of the spleen runs the risk of overwhelming post-splenectomy infection, a medical emergency and rapidly fatal disease caused by the inability of the body's immune system to properly fight infection following splenectomy or asplenia.

Neutering, from the Latin neuter, is the removal of a non-human animal's reproductive organ, either all of it or a considerably large part. The male-specific term is castration, while spaying is usually reserved for female animals. Colloquially, both terms are often referred to as fixing. In male horses, castrating is referred to as gelding. An animal that has not been neutered is sometimes referred to as entire or intact.

<span class="mw-page-title-main">Angiosarcoma</span> Cancer of the lining of the blood or lymphatic vessels

Angiosarcoma is a rare and aggressive cancer that starts in the endothelial cells that line the walls of blood vessels or lymphatic vessels. Since they are made from vascular lining, they can appear anywhere and at any age, but older people are more commonly affected, and the skin is the most affected area, with approximately 60% of cases being cutaneous (skin). Specifically, the scalp makes up ~50% of angiosarcoma cases, but this is still <0.1% of all head and neck tumors. Since angiosarcoma is an umbrella term for many types of tumor that vary greatly in origin and location, many symptoms may occur, from completely asymptomatic to non-specific symptoms like skin lesions, ulceration, shortness of breath and abdominal pain. Multiple-organ involvement at time of diagnosis is common and makes it difficult to ascertain origin and how to treat it.

<span class="mw-page-title-main">Mastocytoma</span> Medical condition

A mastocytoma or mast cell tumor is a type of round-cell tumor consisting of mast cells. It is found in humans and many animal species; it also can refer to an accumulation or nodule of mast cells that resembles a tumor.

<span class="mw-page-title-main">Canine transmissible venereal tumor</span> Disease in dogs and other canines

A canine transmissible venereal tumor (CTVT), also known as a transmissible venereal tumor (TVT), canine transmissible venereal sarcoma (CTVS), sticker tumor and infectious sarcoma, is a histiocytic tumor of the external genitalia of the dog and other canines, and is transmitted from animal to animal during mating. It is one of only three known transmissible cancers in mammals; the others are devil facial tumor disease, a cancer which occurs in Tasmanian devils, and contagious reticulum cell sarcoma of the Syrian hamster.

<span class="mw-page-title-main">Hamartoma</span> Tumour-like overgrowth due to a systemic genetic condition

A hamartoma is a mostly benign, local malformation of cells that resembles a neoplasm of local tissue but is usually due to an overgrowth of multiple aberrant cells, with a basis in a systemic genetic condition, rather than a growth descended from a single mutated cell (monoclonality), as would typically define a benign neoplasm/tumor. Despite this, many hamartomas are found to have clonal chromosomal aberrations that are acquired through somatic mutations, and on this basis the term hamartoma is sometimes considered synonymous with neoplasm. Hamartomas are by definition benign, slow-growing or self-limiting, though the underlying condition may still predispose the individual towards malignancies.

<span class="mw-page-title-main">Dog health</span> Health of dogs

The health of dogs is a well studied area in veterinary medicine.

<span class="mw-page-title-main">Lymphoma in animals</span> Type of cancer in animals

Lymphoma (lymphosarcoma) in animals is a type of cancer defined by a proliferation of malignant lymphocytes within solid organs such as the lymph nodes, bone marrow, liver and spleen. The disease also may occur in the eye, skin, and gastrointestinal tract.

<span class="mw-page-title-main">Mammary tumor</span>

A mammary tumor is a neoplasm originating in the mammary gland. It is a common finding in older female dogs and cats that are not spayed, but they are found in other animals as well. The mammary glands in dogs and cats are associated with their nipples and extend from the underside of the chest to the groin on both sides of the midline. There are many differences between mammary tumors in animals and breast cancer in humans, including tumor type, malignancy, and treatment options. The prevalence in dogs is about three times that of women. In dogs, mammary tumors are the second most common tumor over all and the most common tumor in female dogs with a reported incidence of 3.4%. Multiple studies have documented that spaying female dogs when young greatly decreases their risk of developing mammary neoplasia when aged. Compared with female dogs left intact, those spayed before puberty have 0.5% of the risk, those spayed after one estrous cycle have 8.0% of the risk, and dogs spayed after two estrous cycles have 26.0% of the risk of developing mammary neoplasia later in life. Overall, unspayed female dogs have a seven times greater risk of developing mammary neoplasia than do those that are spayed. While the benefit of spaying decreases with each estrous cycle, some benefit has been demonstrated in female dogs even up to 9 years of age. There is a much lower risk in male dogs and a risk in cats about half that of dogs.

<span class="mw-page-title-main">Anal sac adenocarcinoma</span> Malignant tumor found in dogs

An anal sac adenocarcinoma is an uncommon and aggressive malignant tumor found in dogs that arises from the apocrine glandular tissue of anal sac. The disease exists in cats as well, but is much less common in that species. They are the second most common cancerous cause of hypercalcaemia in dogs, following T-cell lymphoma.

<span class="mw-page-title-main">Histiocytoma (dog)</span> Benign tumor in dogs

A histiocytoma in the dog is a benign tumor. It is an abnormal growth in the skin of histiocytes (histiocytosis), a cell that is part of the immune system. A similar disease in humans, Hashimoto-Pritzker disease, is also a Langerhans cell histiocytosis. Dog breeds that may be more at risk for this tumor include Bulldogs, American Pit Bull Terriers, American Staffordshire Terriers, Scottish Terriers, Greyhounds, Boxers, and Boston Terriers. They also rarely occur in goats and cattle.

<span class="mw-page-title-main">Veterinary surgery</span> Surgery performed on non-human animals

Veterinary surgery is surgery performed on non-human animals by veterinarians, whereby the procedures fall into three broad categories: orthopaedics, soft tissue surgery, and neurosurgery. Advanced surgical procedures such as joint replacement, fracture repair, stabilization of cranial cruciate ligament deficiency, oncologic (cancer) surgery, herniated disc treatment, complicated gastrointestinal or urogenital procedures, kidney transplant, skin grafts, complicated wound management, and minimally invasive procedures are performed by veterinary surgeons. Most general practice veterinarians perform routine surgeries such as neuters and minor mass excisions; some also perform additional procedures.

<span class="mw-page-title-main">Blunt splenic trauma</span>

Blunt splenic trauma occurs when a significant impact to the spleen from some outside source damages or ruptures the spleen. Treatment varies depending on severity, but often consists of embolism or splenectomy.

<span class="mw-page-title-main">Veterinary oncology</span>

Veterinary oncology is a subspecialty of veterinary medicine that deals with cancer diagnosis and treatment in animals. Cancer is a major cause of death in pet animals. In one study, 45% of the dogs that reached 10 years of age or older died of cancer.

Soft tissue sarcoma refers to a broad group of tumors that originate from connective tissues. They tend to have similar histologic appearance and biological behavior, and can be either benign or malignant. Soft tissue sarcomas can arise in any part of the pet's body but skin and subcutaneous tumors are the most commonly observed. Soft-tissue sarcomas comprise approximately 15% of all skin and subcutaneous tumors in dogs and approximately 7% of all skin and subcutaneous tumors in cats. The variety of different tumors that fall under the category of soft tissue sarcomas includes fibrosarcoma, hemangiopericytoma, liposarcoma, rhabdomyosarcoma, leiomyosarcoma, malignant fibrous histiocytoma, malignant nerve sheath tumors, myxosarcoma, myxofibrosarcoma, mesenchymoma, and spindle cell tumor.

<span class="mw-page-title-main">Cancer in dogs</span>

Cancer is the leading cause of death in dogs. It is estimated that 1 in 3 domestic dogs will develop cancer, which is the same incidence of cancer among humans. Dogs can develop a variety of cancers and most are very similar to those found in humans. Dogs can develop carcinomas of epithelial cells and organs, sarcomas of connective tissues and bones, and lymphomas or leukemias of the circulatory system. Selective breeding of dogs has led certain pure-bred breeds to be at high-risk for specific kinds of cancer.

<span class="mw-page-title-main">Vegetarian and vegan dog diet</span> Adequate meat-free or animal-free nutrition

As in the human practice of veganism, vegan dog foods are those formulated with the exclusion of ingredients that contain or were processed with any part of an animal, or any animal byproduct. Vegan dog food may incorporate the use of fruits, vegetables, cereals, legumes including soya, nuts, vegetable oils, as well as any other non-animal based foods.

<span class="mw-page-title-main">Mastocytoma in dogs</span> Cancer tumor in dogs

A mastocytoma in dogs is a neoplasm (neoplasia) originating from mast cells in the domestic dog, which occurs mainly in the skin and subcutis. Mastocytoma are not only extremely common in dogs, but also tend to be much more malignant in them than in other animal species. The average survival time for malignant tumors is only four months, whereas for benign tumors it is over two years.

References

  1. ↑ "Toxnet Has Moved".
  2. ↑ Dickerson, Erin; Bryan, Brad (2015). "Beta Adrenergic Signaling: A Targetable Regulator of Angiosarcoma and Hemangiosarcoma". Veterinary Sciences. 2 (3): 270–292. doi: 10.3390/vetsci2030270 . PMC   5644640 . PMID   29061946.
  3. ↑ Ettinger, Stephen J.; Feldman, Edward C. (1995). Textbook of Veterinary Internal Medicine (4th ed.). W.B. Saunders Company. ISBN   0-7216-6795-3.
  4. 1 2 3 Morrison, Wallace B. (1998). Cancer in Dogs and Cats (1st ed.). Williams and Wilkins. ISBN   0-683-06105-4.
  5. ↑ Nelson; et al. (2005). Manual of Small Animal Internal Medicine. St. Louis, Missouri: Elsevier Mosby.
  6. ↑ Personal communication; Modiano, Sackmann
  7. ↑ Ng, C. Y.; Mills, J. N. (January 1985). "Clinical and haematological features of haemangiosarcoma in dogs". Australian Veterinary Journal. 62 (1): 1–4. doi:10.1111/j.1751-0813.1985.tb06029.x. ISSN   0005-0423. PMID   4039924.
  8. ↑ Yamamoto, Shinya; Hoshi, Katsuichiro; Hirakawa, Atsushi; Chimura, Syuuichi; Kobayashi, Masayuki; Machida, Noboru (2013). "Epidemiological, Clinical and Pathological Features of Primary Cardiac Hemangiosarcoma in Dogs: A Review of 51 Cases". Journal of Veterinary Medical Science. advpub (11): 13–0064. doi:10.1292/jvms.13-0064. PMC   3942993 . PMID   23811814.
  9. ↑ Martins, B. D. C.; Torres, B. B. J.; Rodriguez, A. a. M.; Gamba, C. O.; Cassali, G. D.; Lavalle, G. E.; Martins, G. D. C.; Melo, E. G. (April 2013). "Clinical and pathological aspects of multicentric hemangiosarcoma in a Pinscher dog". Arquivo Brasileiro de Medicina Veterinária e Zootecnia. 65 (2): 322–328. doi: 10.1590/S0102-09352013000200003 . ISSN   0102-0935.
  10. ↑ Johannes, Chad M.; Henry, Carolyn J.; Turnquist, Susan E.; Hamilton, Terrance A.; Smith, Annette N.; Chun, Ruthanne; Tyler, Jeff W. (2007-12-15). "Hemangiosarcoma in cats: 53 cases (1992–2002)". Journal of the American Veterinary Medical Association. 231 (12): 1851–1856. doi: 10.2460/javma.231.12.1851 . PMID   18081524.
  11. ↑ Smith, Annette N. (2003-05-01). "Hemangiosarcoma in dogs and cats". Veterinary Clinics: Small Animal Practice. 33 (3): 533–552. doi:10.1016/S0195-5616(03)00002-0. ISSN   0195-5616. PMID   12852235.
  12. ↑ Tecilla, Marco; Gambini, Matteo; Forlani, Annalisa; Caniatti, Mario; Ghisleni, Gabriele; Roccabianca, Paola (2019-11-07). "Evaluation of cytological diagnostic accuracy for canine splenic neoplasms: An investigation in 78 cases using STARD guidelines". PLOS ONE. 14 (11): e0224945. Bibcode:2019PLoSO..1424945T. doi: 10.1371/journal.pone.0224945 . ISSN   1932-6203. PMC   6837434 . PMID   31697755.
  13. ↑ Sharma, Diya (August 2012). "Hemangiosarcoma in a geriatric Labrador retriever". The Canadian Veterinary Journal. 53 (8): 889–892. ISSN   0008-5286. PMC   3398530 . PMID   23372199.
  14. ↑ Carloni, Andrea; Terragni, Rossella; Morselli-Labate, Antonio Maria; Paninarova, Michaela; Graham, John; Valenti, Paola; Alberti, Monica; Albarello, Giulia; Millanta, Francesca; Vignoli, Massimo (2019). "Prevalence, distribution, and clinical characteristics of hemangiosarcoma-associated skeletal muscle metastases in 61 dogs: A whole body computed tomographic study". Journal of Veterinary Internal Medicine. 33 (2): 812–819. doi:10.1111/jvim.15456. ISSN   1939-1676. PMC   6430957 . PMID   30793807.
  15. ↑ Lee, Mokhyeon; Park, Jiyoung; Choi, Hojung; Lee, Haebeom; Jeong, Seong Mok (November 2018). "Presurgical assessment of splenic tumors in dogs: a retrospective study of 57 cases (2012–2017)". Journal of Veterinary Science. 19 (6): 827–834. doi:10.4142/jvs.2018.19.6.827. ISSN   1229-845X. PMC   6265589 . PMID   30173499.
  16. ↑ "Characterization of canine hemangiosarcoma by 18F-Fluorodeoxyglucose Positron Emission Tomography" (PDF). Japanese Journal of Veterinary Research. 2020-08-22.
  17. 1 2 Borgatti, Antonella; Winter, Amber L.; Stuebner, Kathleen; Scott, Ruth; Ober, Christopher P.; Anderson, Kari L.; Feeney, Daniel A.; Vallera, Daniel A.; Koopmeiners, Joseph S.; Modiano, Jaime F.; Froelich, Jerry (2017-02-21). "Evaluation of 18-F-fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) as a staging and monitoring tool for dogs with stage-2 splenic hemangiosarcoma – A pilot study". PLOS ONE. 12 (2): e0172651. Bibcode:2017PLoSO..1272651B. doi: 10.1371/journal.pone.0172651 . ISSN   1932-6203. PMC   5319762 . PMID   28222142.
  18. ↑ Spriet, Mathieu; Willcox, Jennifer L.; Culp, William T. N. (2019). "Role of Positron Emission Tomography in Imaging of Non-neurologic Disorders of the Head, Neck, and Teeth in Veterinary Medicine". Frontiers in Veterinary Science. 6: 180. doi: 10.3389/fvets.2019.00180 . ISSN   2297-1769. PMC   6579945 . PMID   31245395.
  19. ↑ Farricelli, Adrienne. "The Silent Killer: Hemangiosarcomas or a Ruptured, Bleeding Spleen in Dogs". PetHelpful. Retrieved 23 March 2019.
  20. ↑ "Compound Derived From a Mushroom Lengthens Survival Time in Dogs With Cancer, Penn Vet Study Finds". University of Pennsylvania. 10 September 2012.
  21. ↑ Gedney, Allison; Salah, Pascale; Mahoney, Jennifer A.; Krick, Erika; Martins, Reenie; Scavello, Heather; Lenz, Jennifer A.; Atherton, Matthew J. (2022). "Evaluation of the anti-tumour activity of Coriolus versicolor polysaccharopeptide (I'm-Yunity) alone or in combination with doxorubicin for canine splenic hemangiosarcoma". Veterinary and Comparative Oncology. 20 (3): 688–696. doi:10.1111/vco.12823. PMID   35442554. S2CID   248263381.
  22. ↑ Ludcroy & al. (2020). "Evaluation of an autologous cancer vaccine for the treatment of metastatic canine hemangiosarcoma: a preliminary study". BMC Veterinary Research. 16 (1): 447. doi: 10.1186/s12917-020-02675-y . PMC   7672887 . PMID   33208160.
  23. ↑ "Immunotherapy treatment". Riney Canine Health Center. Cornell University College of Veterinary. Retrieved 1 June 2023.
  24. ↑ Ward, H.; Fox, L. E.; Calderwood-Mays, M. B.; Hammer, A. S.; Couto, C. G. (September 1994). "Cutaneous hemangiosarcoma in 25 dogs: a retrospective study". Journal of Veterinary Internal Medicine. 8 (5): 345–348. doi:10.1111/j.1939-1676.1994.tb03248.x. ISSN   0891-6640. PMID   7837111.


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