腫瘤學(xué)-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(jì)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(zhuǎn)移，我們決定在手術(shù)前進(jìn)行CTShowClearly–inthiscase-surgeryisnotanoptionandwouldhavebeenamistake.Thedogisasymptomaticandcancontinuelivinguntilthetumoraffectshisqualityoflife.生活質(zhì)量IncidenceandRisk影響和風(fēng)險(xiǎn)因 asaresolitaryintheolder dcat大 ashavebeenassociatedwithradiation,trauma,foreignbodies,andparasites Pathology病理Developfrommesenchymaltissues從間質(zhì)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(xiàn)假包囊的由軟及硬的腫瘤，但是在組織學(xué)上沒有Localrecurrenceafterconservativesurgicalexcisionis局部復(fù)發(fā)在保守手術(shù)切除后常Tendtometastasizethroughhematogenousroutesinupto20%of高達(dá)20％病例會(huì)通過造血途徑RegionalLNmetsareunusualexceptsynovial)局部淋Histopathologicgradeispredictiveofmetastasis組織Resectedtumormarginspredictlocalrecurrence被切除腫瘤的邊緣預(yù)示PoorresponsetochemotherapyandradiationtherapyforbulkydiseaseDiagnosticTechniquesand FineneedleaspirateToruleoutlipomas,seromas,inflammation,abscess可排除脂肪 Problems-Poorcellularity-don’texfoliatewellresemblancebetweenreactivetissueandandmalignagnttumors.有反 FNAfromareasofnecrosis-falsenegative壞死組織細(xì)針DiagnosticTechniquesand Biopsy活Necessaryforadefinitivediagnosis!!確切 所必Plannedwell-tobeexcisedwithsurgerylater計(jì)劃好－后期的手術(shù)RadiographsXRegionalThoracicAdditionalimaging其他影UltrasoundMRICBCandChemistryPanel血規(guī)和生Therapy療Determinedbasedonspecies,location,clinicalstage,histologicMostsuccessful大多少成WidesurgicalexcisionbasedonCT手術(shù)切除廣泛（基于Ifthemarginsaredirty-eitheradditionalsurgeryand/or如果邊緣被污染－可附加手術(shù)和/Ifthehistologyrevealsahighgradetumorchemotherapy如組織學(xué)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(shí)間332Treatment(治療（化療Selting.JAVMA.Examinedtheeffectofadjuvantdoxorubicinon eindogswithhighgrade(grade3)STSs檢查輔助使用阿霉素對(duì)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(yù)Prognosticindicators預(yù)后Histologicgradepredicativeofmetastasisandprognosis組織學(xué)Kuntzet13%ofgradeIdevelopedmetastasis,7%ofgradeIIand41%gradeIIIOverallmediansurvivalwithsurgeryalone1416days平均存活時(shí)間－1416Fordogswith>19mitoticfigures/10HPF-236daysvs1444fordogswith<10SizeSiteFavorablesuperficialextremities良好Unfavorabledeep,trunkinvasive,nearspinalcord軀干 的，脊髓附SurgicalmarginsPresentingComplaint現(xiàn)病Theownersnoticedamassbetweenhisshoulderblades主人發(fā)現(xiàn)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(gè)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(jì)Fineneedleaspirate細(xì)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(jié)果－胸部Results結(jié)Thoracicrads-Around,approxima y4-5cmindiametersofttissuemassispresentdorsaltothemidthoracicvertebra.Thecardiovascularstructuresareunremarkable,asisthepulmonaryparenchyma.Results結(jié)Incisionalbiopsyofthemass- a腫Continuation-Diagnostic進(jìn)一步 計(jì)Preanesthetictests麻醉前檢CBCChemistryPanelCTscanCT掃PlanCTScan計(jì)劃－CT掃CTScanCT掃Contrastenhancingleftdorsalthoracicsofttissuemasscompatiblewith a.Probableinvolvementofthelefttrapeziusmusclebellyandpossibleinvolvementoftheproximalaspectoftheleftscapula.Thenoncontrastenhancingportionwouldbeconsistentwithregionsofnecrosisorpoorvascularsupply. 影響左側(cè)斜方肌，也可能影響的左肩胛，這部分對(duì)比TherapeuticPlan治療計(jì)(PreOpradiationtherapy手術(shù)前放Surgery手Chemotherapy化DoxorubicinYuriwastreatedwithradiationtherapyFollowedbysurgeryand隨后進(jìn)行手術(shù)和化Ayearlaterthereisnoevidenceofmetastasisorlocalrecurrence一年后無明顯轉(zhuǎn)移或局部復(fù)Statisticallylinkedtovaccination-FeLV,rabiesAlso-maybelongactingpenicillinandmethyl-prednisolone統(tǒng)計(jì)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(fù)注射接種狂Usually2-10monthsaftervaccination通常免疫后維持2-10個(gè)1/10,000vaccinesgiven1/10,000免Pathology-Madewelletal as44只有纖維肉Grade1=25GradeII=48GradeIII271級(jí)25％，2級(jí)級(jí)Mitoticindex,differentiation,necrosis有 期，分化，壞MultinucleatedgiantcellsingradeIIandIIIonly只有2期和3期出多核巨細(xì)Mosthaveperitumorallymphocyticinflammation大多數(shù)有腫瘤樣巴細(xì)胞炎HighproportionofTcellsT細(xì)胞比例Increasedvasculardensityat 動(dòng)脈管壁增Highcellularproliferation細(xì)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(dǎo)的炎癥區(qū)Fibroblasticormyofibroblastic纖維細(xì)胞或MalignantRoleofadjuvants輔助藥物的NotlinkedtoFeLV,Clinical2-10monthsaftervaccination(48免疫后2－104cmdiameteratdiagnosis--rapid時(shí)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(xì)的免疫記Standardizeandseparatevaccine標(biāo)準(zhǔn)化并分點(diǎn)注Exciseorbiopsyvaccine-sitereactionsthatpersist>3mo.,>2cmdiameter,orincreaseinsize1mo.after免疫后反應(yīng)持續(xù)超過個(gè)月后2厘米或接種后生長者，實(shí)施切除或?qū)γ庖邊^(qū)進(jìn)行活檢Martanoetal-Surgeryaloneversussurgeryanddoxorubi