腫瘤學(xué)-泌尿系統(tǒng)

TumorsoftheUrinary泌尿FabienneMueller,Dr.med.vet. ResidentMedicalOncology SectionofDiagnosticImagingandRadio-Oncology腫瘤放射與影 蘇黎士大學(xué)，獸醫(yī)Signalment特FS,collieFs和牧羊犬的雜12years 12Presenting 臨床表Stranguria(barelyableto痛性尿淋瀝（幾乎不能排尿Discolored Forafewweeks,theownerhasnoticedstranguriaanddiscoloredurine.幾周以來，主人發(fā)現(xiàn) 有痛性尿淋瀝和尿液顏色異Susanwasfirstslightlybetterafterantibiotictherapy,nowtheclinicalsignsareworseagain.起初，在抗生素治療后情況有所好轉(zhuǎn)，但現(xiàn)在臨床癥 Sheiseatinganddrinkingnormally,no其飲食情況正常，無咳嗽 /拉稀/沉郁等現(xiàn)象PhysicalExam體檢（異常Stranguriamultipletimesduringtheexam,afewdropsofdiscoloredurinewerereleasedwitheachepisode.Problem Stranguria痛性尿淋瀝（淋癥DiscoloredurineDiagnostic 血細(xì)胞計(jì)ChemistrypanelUrinalysisThoracicradiographs胸部xAbdominalultrasound腹部BResults-血液/尿液分析結(jié)CBC: Chemistrypanel: Urinalysis:尿液分析：SpecificGravity :10184+blood 20-50WBC/hpf50-100RBC/hpfnoorganismsAbdominaldiffusemassthroughoutthetrigoneandallvisibleareasoftheurethra 的可視區(qū)域PlanCatheterization(diagnosticandtherapeutic)診->TransitionalcellcarcinomaTreatmentOptions ->notpossibleduetoChemotherapyMitoxantrone鹽 Piroxicam dischargedwithaurinarycatheter. 蒽醌 進(jìn)行治療，并用導(dǎo)尿管進(jìn)行導(dǎo)流After2treatmentswithmitoxantronepluspiroxicamtherewasnochangeinthesizeofthetumor. 蒽醌和吡氧噻嗪進(jìn)行兩次治療以后，腫瘤大小mendation:cystostomy建議 切開，安裝導(dǎo)尿SusancontinuedtreatmentwithRecheckradiographsafter6months:Susanpresented4weekslaterforpainontheleftfront XlyticlesionproximalThoracicradiographs: enlargingpulmonarynodulesconsistentwithpulmonarymetastasisXSusanwaseuthanizedthenext Thenecropsyrevealedtransitionalcellcarcinomain lefthumerussublumbarlymph NecropsyBladder 2ofcancersindogsMostcommonurinarytracttumorin最常見的犬泌腫瘤97malignantindogs97%Transitionalcellcarcinoma(TCC)>>squamouscellcarcinoma,adenocarcinoma,pri 行性細(xì)胞癌多見于鱗狀細(xì)胞癌、和早期腫瘤。Benigntumors:fibromas,leiomyomas,良性腫瘤：纖維瘤、平滑肌瘤 狀瘤TransitionalCellCarcinomaAverageage:10 平 f>m 母犬多于公犬 Breeds:發(fā)病品種有Scottishterriers Shetlandsheepdogs喜樂蒂牧羊AiredaleterriersCollies科利牧羊Wirehairfox 白毛狐Westhighlandwhiteterriers西高地白RiskFactorsHerbicide/pesticide除草劑殺蟲 肥胖 接觸環(huán)磷酰胺也有可能致RiskFactor–致病因素-除草

Glickmanetal.JAVMA. G…， 獸 雜志，HerbicideexposureandtheriskofTCCoftheurinarybladderinScottishTerriers接觸除草劑和蘇格蘭犬 移行細(xì)胞癌有CaseControl 病例對照研究表83ScottishTerrierswithTCCand83ScottishTerrierswithotherhealthrelatedconditions在83例患有移形細(xì)胞癌的蘇格蘭更和83只健康狀況下的蘇格蘭Ownerscompletedaquestionnaireaboutexposuretolawnorgardenchemicals對家中草坪或花園是否用過除草劑或其它化學(xué)藥品展開問Conclusion:結(jié)Exposuretolawnsorgardenstreatedwithherbicides=>increasedriskforTCCinScottishTerriers使用除草劑的家庭使得蘇格蘭更患移形細(xì)胞癌的幾率增RiskFactor–致病因素-殺蟲

Raghavanetal-JAVMA. R…等 獸 雜志TopicalfleaandtickpesticidesandtheriskofTCCoftheurinarybladderinScottishTerriers殺蚤和蜱的殺蟲劑與蘇格蘭犬 移行細(xì)胞癌有CaseControlStudy病例對照研87ScottishTerrierswithTCCand83ScottishTerrierswithotherhealthrelatedconditions87例患移形細(xì)胞癌的蘇格蘭更和83只健康條件下的蘇格蘭更病例Ownerscompletedaquestionnaireaboutthehistoryofexposuretofleaandtickpesticides研究者完成了一份關(guān)于治療蚤和蜱的殺蟲劑接觸史 問Conclusion:結(jié)TopicalspotonfleaandtickproductsdidNOTincreasetheriskofTCCinScottishTerriers外用殺蟲劑不增加蘇格蘭更患移形細(xì)胞癌RiskFactor–致病因素-飲

Raghavanetal.JAVMA.2005R…等 獸 雜志EvaluationoftheeffectofdietaryvegetableconsumptionreducingriskofTCCoftheurinarybladderinScottish評估多食蔬菜是否能減少蘇格蘭更 移形細(xì)胞癌的機(jī)CaseControl 病例對照研92ScottishTerrierswithTCCand83ScottishTerrierswithotherhealthrelated92例患有移形細(xì)胞癌和83例健康的蘇格蘭更進(jìn)行病例對照研Ownerscompletedaquestionnaireregardingthedog’s研究者完成了關(guān)于狗的飲食 問Conclusion:結(jié)ConsumptionofcertainvegetablesmaypreventorslowdevelopmentofTCCinScottish蘇格 食蔬菜可 或減緩移形細(xì)胞癌病情的發(fā)展Localization

Mostcommon:trigoneregionof經(jīng)常發(fā)生 三角區(qū)56%ofdogs:bladderandurethral56%的狗同時(shí)存在 Maledogs:29%prostatic 的問Biologic

16%lymphnode,14%distantmetastasesatthetimeof進(jìn) 時(shí)發(fā)現(xiàn)16%位于 ，14% 時(shí)已轉(zhuǎn)50%metastasesattimeof->sublumbarnodes,lumbarvertebrae,lesscommon:liver,mesentericandsternal時(shí)50%的腫瘤已經(jīng)轉(zhuǎn)移到腰下淋 Causeofdeath-60%localeffectsofprimary60%是由 HistoryandPhysicalClinical hematuria,pollakiuria,lesscommon:lameness,cough,abdominal

PhysicalExam:rectalexam!normalin30%of30%thickening/extensionoflymphnode也 增厚或擴(kuò)張，

Blood 血液檢查azotemia hematuria,pyuria, ->neoplasticcellsarepresentin30%ofthe30%Bladdertumorantigenurinedipsticktest-Glycoproteinantigencomplexassociatedwithbladdercancerinhumanpatients糖蛋白抗原 有復(fù)雜的關(guān)Henryetal.AJVR.2003-229falsepositivesduetohematuria,proteinuria,在229 中，由于出現(xiàn)血尿、蛋白尿和糖尿而呈現(xiàn)假陽性（等 獸醫(yī)放射雜志.2003RadiographyUltrasonographyBiopsyFineneedleaspirate微針抽吸Traumaticcatheterization導(dǎo)

鏡檢查 Preventpossible

Preferredmethodoftreatmentforalltumorslocatedattheapexandbenigntumors對 頂部的腫瘤及良性腫瘤，手術(shù)是首選治療方Upto75-80%ofthebladdercanbe多達(dá)75-80% 可被切 技Completeorpartialcystectomy(ureterocolonicanastomosis->CO2laser 二氧化碳激光消融Transurethralplacementofmetallic安置金屬支Permanentindwellingurethralcathetersorcystostomy長期內(nèi)置導(dǎo)尿管 人造導(dǎo)尿治療-放射線療

postoperativeradiationtherapyhasbeenusedUretersorbladderinradiation estenoticand =>urinaryincontinenceandsecondaryinjury Localtumorcontrol

Knapp,JVIM.Piroxicam(0.3mg/kgq24hrs(+(0.3mg/kg24)可配合膠體34 Responserate 有效率SideeffectsGItoxicity Mediansurvival7 治療-化Henry,ClinCancerRes.Mitoxantrone(5mg/m2q21daysx+ (0.3

蒽醌(5mg/m2，每隔21天，連用4次)配合炎痛喜康(每天每公斤體重0.3mg)55dogsResponserate Sideeffects:GItoxicity(18%),azotemiaMedianSurvival350days平均存活期：350

Boriaetal-VCO.Carboplatin(300mg/m2q21days)+Piroxicam(0.3卡波鉑(300mg/m2每隔21天)，配合炎痛喜康(每天每公斤體重0.331 31條GItoxicity(23dogs),hematologicaltoxicity(11dogs)出現(xiàn)胃腸毒MedianSurvival:161 平均存活期：161FrequenttoxicityandlimitedsurvivaldonotsupporttheuseofthisprotocolagainstTCC Immunotherapy IntralesionalCalmette-Guerin modulationoftheimmunesystemPhotodynamicTherapy Antibiotics- 治 炎的抗生FelineUrinaryBladder貓 腫 少Oldercats多見 Onestudy:一 27cases-15carcinomas,5benignmesenchymal5malignantmesenchymaltumors,2Sameprinciplesoftreatmentasdogs治療原則和狗相 逐項(xiàng)檢Removethetumorsurgicallyifpossible如果可能手術(shù)切除腫Responsetochemostillnotclear化療效果仍不清(Rememberno（似乎沒有使用cisplatin的記錄Urethral Majority:malignantepithelialtumorslessfrequent:smoothmuscletumorsImportantDD:granulomatous重要的鑒 ：肉芽 Oftennot ResponsetochemotherapyseemssimilartoTCCoftheurinarybladder化療效果 移形細(xì)胞癌相Renal Primaryrenal monindogs狗 性腎臟腫瘤不常Majority: >halfareepithelial Reportof54tumors:35renaltubularcellcarcinoma(RCC),5TCC,3renaltransitionalcellpapilloma,anaplasticcarcinoma,anaplastica,fibroma,hemangioa,l