腫瘤學-纖維肉瘤

SigMiddleagedFS,Dalmatian中年，母犬，History-theownersnoticedamassonthethoraxandimmedia ypresentedtotheRDVM.Physicalexam-massonthethorax(alwaysmeasure體檢－胸部有腫塊ProblemList問題列SCmassonthethorax胸部DDs鑒Diagnostic 計Fineneedleaspirate- PlanWheredothesetumorsmetastasizeLungsThoracicradiographs-noevidenceofWhatisthemainproblemwiththeseWhichtests erformLocalaggressivenesssoweshouldperformaCT!所以我們要做Inmanycases,despitenoevidenceofproblemsradiographs,whatweseeisthe“tipoftheSushi-BasedontheCT-thesurgerywasperformed,andcleanmarginswereobtained. ngfine,BAR.Theonlyabnormalityisthemassonthelateralthorax.DiagnosedattheRDVMwithaspindle a( ThoracicradiographswerewithinnormalAsthereisnoevidenceofmetastasis,wedecidedtoperformaCTpriortosurgery.由于無明顯轉移，我們決定在手術前進行CTShowClearly–inthiscase-surgeryisnotanoptionandwouldhavebeenamistake.Thedogisasymptomaticandcancontinuelivinguntilthetumoraffectshisqualityoflife.生活質量IncidenceandRisk影響和風險因 asaresolitaryintheolder dcat大 ashavebeenassociatedwithradiation,trauma,foreignbodies,andparasites Pathology病理Developfrommesenchymaltissues從間質Donotincludetumorsofhematopoieticororigin不包括造血和淋巴系 的腫Oftenconsideredcollectivelyduetotheirsimilarityinclinicalbehaviorandsimilarityinhistologicfeatures.通ImportantCommon重要的共同特Tendtoappearpseudoencapsulatedsofttofirmtumorsbuthavedefinedhistologicmarginsorinfiltratethroughandalongfacialmargins-locallyinvasive趨于出現假包囊的由軟及硬的腫瘤，但是在組織學上沒有Localrecurrenceafterconservativesurgicalexcisionis局部復發(fā)在保守手術切除后常Tendtometastasizethroughhematogenousroutesinupto20%of高達20％病例會通過造血途徑RegionalLNmetsareunusualexceptsynovial)局部淋Histopathologicgradeispredictiveofmetastasis組織Resectedtumormarginspredictlocalrecurrence被切除腫瘤的邊緣預示PoorresponsetochemotherapyandradiationtherapyforbulkydiseaseDiagnosticTechniquesand FineneedleaspirateToruleoutlipomas,seromas,inflammation,abscess可排除脂肪 Problems-Poorcellularity-don’texfoliatewellresemblancebetweenreactivetissueandandmalignagnttumors.有反 FNAfromareasofnecrosis-falsenegative壞死組織細針DiagnosticTechniquesand Biopsy活Necessaryforadefinitivediagnosis!!確切 所必Plannedwell-tobeexcisedwithsurgerylater計劃好－后期的手術RadiographsXRegionalThoracicAdditionalimaging其他影UltrasoundMRICBCandChemistryPanel血規(guī)和生Therapy療Determinedbasedonspecies,location,clinicalstage,histologicMostsuccessful大多少成WidesurgicalexcisionbasedonCT手術切除廣泛（基于Ifthemarginsaredirty-eitheradditionalsurgeryand/or如果邊緣被污染－可附加手術和/Ifthehistologyrevealsahighgradetumorchemotherapy如組織學顯示為高度分化腫瘤－化Routinefollowup日常要追蹤觀Treatment(治療（放療Plavec.VCO.15dogswithSTSweretreatedwithpalliativeradiation15只患軟組織肉瘤的犬用緩和的放療來Cobalt3treatments0,7,14days3X8GyResponses1dog( a)-PRthensurgery1只犬（脂肪13dogsSDmedianTTP-263days(60-891+days)13只犬－平均存活263天1dogPD1只犬－PDMST平均存活時間332Treatment(治療（化療Selting.JAVMA.Examinedtheeffectofadjuvantdoxorubicinon eindogswithhighgrade(grade3)STSs檢查輔助使用阿霉素對高度分化腫瘤的犬的效39dogs39只OverallmedianDFI724days總共平均無病間期－724Mediansurvival856days平均存活856Nobenefitseenindogsthatreceivedchemotherapy接受化療無明Manypeople mendchemotherapy許多人仍建議化Prognosis預Prognosticindicators預后Histologicgradepredicativeofmetastasisandprognosis組織學Kuntzet13%ofgradeIdevelopedmetastasis,7%ofgradeIIand41%gradeIIIOverallmediansurvivalwithsurgeryalone1416days平均存活時間－1416Fordogswith>19mitoticfigures/10HPF-236daysvs1444fordogswith<10SizeSiteFavorablesuperficialextremities良好Unfavorabledeep,trunkinvasive,nearspinalcord軀干 的，脊髓附SurgicalmarginsPresentingComplaint現病Theownersnoticedamassbetweenhisshoulderblades主人發(fā)現兩肩間有一Signalment特征MCDSH9yearsold9History病Ownerfirstnoticedthemass2weeksago,itwasalmondsizedandhasbeengrowingHeisanindoorcat是只家養(yǎng)PhysicalExam(體檢（異常2.5*2.5cmmassattheinterscapularregion肩胛間有2.5*2.5厘米一個腫塊ThemassinSCandattachedtounderlyingtissue肩胛間腫塊附在下層組織ProblemList問題列SC,wellcicumscribed,attachedmassintheinterscapulararea2.5cmdiameter)SCPreliminaryDiagnostic初 計Fineneedleaspirate細針穿刺抽NondiagnosticAdditionaltestsweshould我們要追加其他測Additionaldiagnostic其 試Thoracicradiographs胸部XIncisionalbiopsyofthe腫塊的切開活Results-Thoracic結果－胸部Results結Thoracicrads-Around,approxima y4-5cmindiametersofttissuemassispresentdorsaltothemidthoracicvertebra.Thecardiovascularstructuresareunremarkable,asisthepulmonaryparenchyma.Results結Incisionalbiopsyofthemass- a腫Continuation-Diagnostic進一步 計Preanesthetictests麻醉前檢CBCChemistryPanelCTscanCT掃PlanCTScan計劃－CT掃CTScanCT掃Contrastenhancingleftdorsalthoracicsofttissuemasscompatiblewith a.Probableinvolvementofthelefttrapeziusmusclebellyandpossibleinvolvementoftheproximalaspectoftheleftscapula.Thenoncontrastenhancingportionwouldbeconsistentwithregionsofnecrosisorpoorvascularsupply. 影響左側斜方肌，也可能影響的左肩胛，這部分對比TherapeuticPlan治療計(PreOpradiationtherapy手術前放Surgery手Chemotherapy化DoxorubicinYuriwastreatedwithradiationtherapyFollowedbysurgeryand隨后進行手術和化Ayearlaterthereisnoevidenceofmetastasisorlocalrecurrence一年后無明顯轉移或局部復Statisticallylinkedtovaccination-FeLV,rabiesAlso-maybelongactingpenicillinandmethyl-prednisolone統(tǒng)計顯示，與免疫接種有Killedvaccineproducts;Subcutaneous滅 ，皮下注YoungeragegroupthanIncreasedRwithincreased#of增加狂 劑量，追加免IncreasedRwithrepeatvaccinationatsame相同部位，反復注射接種狂Usually2-10monthsaftervaccination通常免疫后維持2-10個1/10,000vaccinesgiven1/10,000免Pathology-Madewelletal as44只有纖維肉Grade1=25GradeII=48GradeIII271級25％，2級級Mitoticindex,differentiation,necrosis有 期，分化，壞MultinucleatedgiantcellsingradeIIandIIIonly只有2期和3期出多核巨細Mosthaveperitumorallymphocyticinflammation大多數有腫瘤樣巴細胞炎HighproportionofTcellsT細胞比例Increasedvasculardensityat 動脈管壁增Highcellularproliferation細胞增值Centrallylocatedmicroormacroabscesses位于中間有小或大的膿Grosspathology大體病理Histopathology組織Beforeradiotherapy放療 Afterradiotherapy放療PathogenesisAtsiteofinflammationinducedby在注 誘導的炎癥區(qū)Fibroblasticormyofibroblastic纖維細胞或MalignantRoleofadjuvants輔助藥物的NotlinkedtoFeLV,Clinical2-10monthsaftervaccination(48免疫后2－104cmdiameteratdiagnosis--rapid時直徑4locallyinvasive;infiltrativegrowth局 ，滲透性生長模regrowthafterinadequatesurgery10-25metastasize--lungandothersitesPreventionandDonotover不要過量免Usesingledose用單次劑量瓶Keepdetailedvaccine保持詳細的免疫記Standardizeandseparatevaccine標準化并分點注Exciseorbiopsyvaccine-sitereactionsthatpersist>3mo.,>2cmdiameter,orincreaseinsize1mo.after免疫后反應持續(xù)超過個月后2厘米或接種后生長者，實施切除或對免疫區(qū)進行活檢Martanoetal-Surgeryaloneversussurgeryanddoxorubi