practical oncology round cell tumors
DESCRIPTION
Practical Oncology Round Cell Tumors. Wendy Blount, DVM. Round Cell Tumors. Lymphoma Mast Cell Tumor Plasma Cell Tumor Extramedullary Plasmacytoma Multiple myeloma Histiocytic Disease Transmissible Venereal Tumor. Diagnosis. Generally diagnosed with cytology, as they exfoliate well - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/1.jpg)
Practical OncologyRound Cell Tumors
Wendy Blount, DVM
![Page 2: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/2.jpg)
Round Cell Tumors
• Lymphoma• Mast Cell Tumor• Plasma Cell Tumor
• Extramedullary Plasmacytoma• Multiple myeloma
• Histiocytic Disease• Transmissible Venereal Tumor
![Page 3: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/3.jpg)
Diagnosis
• Generally diagnosed with cytology, as they exfoliate well
• May need histopathology if anaplastic
• Immunohistochemistry if markedly anaplastic• Gives information about
prognosis
![Page 4: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/4.jpg)
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
![Page 5: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/5.jpg)
Plasmacytoma
![Page 6: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/6.jpg)
Plasmacytoma
![Page 7: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/7.jpg)
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
![Page 8: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/8.jpg)
Multiple MyelomaClinical Signs• Lethargy, anorexia weight loss• Lameness + pathologic fracture• PU-PD• Hyperesthesia• Hyperviscosity Syndrome• Immunosuppression – cytopenias & inhibition of
humoral immunity• anemia more common than leukopenia or
thrombocytopenia• Hypercalcemia• Azotemia - hypercalcemia, renal infiltration,
hyperviscosity
![Page 9: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/9.jpg)
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
![Page 10: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/10.jpg)
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
![Page 11: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/11.jpg)
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
![Page 12: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/12.jpg)
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)
![Page 13: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/13.jpg)
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
![Page 14: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/14.jpg)
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
![Page 15: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/15.jpg)
Multiple Myeloma
x
x
![Page 16: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/16.jpg)
Multiple MyelomaPrognosis• Short term prognosis is good
• median survival 540 days (2.5 years) 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
![Page 17: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/17.jpg)
Histiocytic Disease
• Histiocytoma• Cutaneous histiocytosis• Systemic histiocytosis• Localized histiocytic sarcoma• Malignant histiocytosis
• aka disseminated histiocytic sarcoma
![Page 18: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/18.jpg)
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
![Page 19: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/19.jpg)
Histiocytoma
![Page 20: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/20.jpg)
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
![Page 21: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/21.jpg)
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
![Page 22: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/22.jpg)
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
![Page 23: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/23.jpg)
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
![Page 24: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/24.jpg)
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
![Page 25: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/25.jpg)
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
![Page 26: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/26.jpg)
TVT
![Page 27: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/27.jpg)
TVT
![Page 28: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/28.jpg)
TVT
![Page 29: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/29.jpg)
TVT
![Page 30: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/30.jpg)
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
![Page 31: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/31.jpg)
Cytology• Rottweiler, sick with enlarged lymph nodes,
spleen and liver – LN cytology• Dx – large cell lymphoma
![Page 32: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/32.jpg)
Cytology
• Button like alopecic skin mass
![Page 33: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/33.jpg)
Cytology
• Button like alopecic skin mass• Dx - Plasmacytoma
![Page 34: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/34.jpg)
Cytology• Button like alopecic tumor• Dx – mast cell tumor
![Page 35: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/35.jpg)
xx
![Page 36: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/36.jpg)
Cytology• Golden Retriever, sick with enlarged lymph
nodes, spleen and liver• Dx – malignant histiocytosis
![Page 37: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/37.jpg)
Cytology• Recurring button like alopecic masses• Dx – cutaneous histiocytosis
![Page 38: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/38.jpg)
Cytology• alopecic tumor protruding from the naris,
bleeds when bumped• Dx – TVT
![Page 39: Practical Oncology Round Cell Tumors](https://reader035.vdocument.in/reader035/viewer/2022081512/56816449550346895dd610de/html5/thumbnails/39.jpg)
Cytology
• Infiltrative plaque-like skin masses• Dx – Multiple Myeloma