Feline injection site sarcomas

Sarcoma felino posvacunal (FISS), reporte de caso en Colombia

El sarcoma felino posvacunal o sarcoma de sitio de inyección (FISS) en una neoplasia poco descrita en felinos en Colombia, se presenta posterior al uso de vacunas inactivas con adyuvante. El objetivo fue describir la presencia de un sarcoma felino posterior a la vacunación con leucemia felina virus inactivo, primer caso documentado en Colombia. Un felino, macho, mestizo, de 7 años de edad, esterilizado, vacunado con leucemia felina inactiva desde hace 3 años, desarrolla un nódulo de 5 cm de diámetro en la región dorsal, firme y no doloroso. En dermis profunda y músculo estriado, se evidencia proliferación neoplásica de células fusiformes, de crecimiento principalmente expansivo y en menor medida invasivo, que se organiza y forma haces cortos y fascículos largos que se entrecruzan, con focos densos y laxos y en focos se dispone en un patrón de espina de pescado. Las células presentan morfología fusiforme, ligeramente ovoide, irregular, algunas redondeadas, con citoplasma eosinófilo tenue e intenso en otros focos más densos. Se evidencia pleomorfismo celular y anisocitosis moderadas. Los núcleos presentan morfología redonda, ovoide e irregular. Se evidencia la presencia de uno o más nucléolos en algunas de sus células, cromatina principalmente granular fina, pleomorfismo nuclear y anisocariosis moderada. Se contabilizaron 4 mitosis en 10 campos con el objetivo de alto poder en 2,37 mm2, no se observa aparente invasión linfovascular, se evidencia compromiso de bordes laterales. Adicionalmente, discretos focos de necrosis multifocal < 50%, infiltrado inflamatorio mixto polimorfonuclear, neutrófilos moderados multifocales e infiltrado mononuclear linfocítico multifocal.

Treatment of feline injection-site sarcoma with surgery and iridium-192 brachytherapy: retrospective evaluation of 22 cats

OBJECTIVES

The aim of this retrospective descriptive study was to determine the effectiveness of using iridium implants in addition to surgery in cats with feline injection-site sarcomas (FISSs) in terms of time to progression and disease-specific survival and to identify prognostic factors for patient outcome.

METHODS

Medical records of cats presented at our institution with FISS were reviewed. Inclusion criteria included histologic diagnosis of a tumor type associated with post-injection neoplastic development, tumor located at a site associated with vaccination, no other therapies prior to the administration of brachytherapy with the exception of surgery and adequate follow-up data.

RESULTS

Twenty-two cats with FISS were treated with surgery and brachytherapy delivered by postoperative iridium-192 interstitial implants. Radiation doses ranged from 4000 to 6000 cGy (median dose 5079.55 cGy), with most doses delivered over 7 days. The median number of surgeries prior to brachytherapy was one (range 1-4). The complications associated with postoperative brachytherapy were typically mild, although four cats developed more severe complications. The median time to progression for all cats was 619 days and disease-specific survival time for all cats was 1242 days. The 1 and 2 year tumor-free rates in these cats were 63.6% and 40.9%, respectively. The local failure rate was 54.5% and the distant failure rate was 13.6% due to lung metastasis. There was a significant difference in time to progression of cats that had a single surgery performed prior to brachytherapy and those that had multiple surgeries (undefined vs 310 days; P = 0.01). There were no other statistically significant identified prognostic factors.

CONCLUSIONS AND RELEVANCE

These data suggest that the addition of brachytherapy postoperatively in cats with FISS was well tolerated and is comparable to other forms of adjuvant therapy.

Prevention of Feline Injection-Site Sarcomas: Is There a Scientific Foundation for Vaccine Recommendations at This Time?

Recently published guidelines have made specific vaccine recommendations purported to potentially reduce the incidence of feline injection-site sarcomas (FISS). These recommendations have largely been based on experimental models of inflammation under different vaccine formulations. In none of these studies did sarcomas occur. It is scientifically untenable to address FISS risk based on propensity of vaccines to elicit differential inflammatory responses if none of those responses led to sarcoma development. Although the recommendations may ultimately be found to be prescient and valid, it will take considerable additional research before this can happen. Until then, such guidelines must be regarded with skepticism.

Evaluation of adjuvant chemotherapy in feline injection site-associated sarcoma

ABSTRACT Feline Injection Site-Associated Sarcoma (FISS) is a neoplasm that implies in reduction of quality of life and overall survival in feline patients. A retrospective study of 13 cases of FISS was conducted to evaluate the efficacy of surgical treatment associated to chemotherapy with doxorubicin or carboplatin. Local recurrence occurred in all patients. Patients treated with surgery and chemotherapy presented a longer overall survival and disease-free interval when compared to those that solely received surgical treatment, although no statistical significance was observed (p= 0.3360 and 0.7506, respectively). Surgery remains as the main option for FISS treatment. Further prospective studies with larger samples are warranted to investigate the benefit of chemotherapy for this neoplasm.

Vaccine-associated feline sarcoma: current perspectives

Feline injection site sarcomas (FISS; also known as vaccine-associated sarcomas) have been recognized for >20 years. Although uncommon, these tumors are iatrogenic, and vaccination against rabies and feline leukemia virus is perhaps the most common inciting cause. The exact etiopathogenesis is unknown, but it is widely accepted that inflammation induced by vaccines or other injections likely plays a critical role in tumor development. Injection site sarcomas are extremely locally invasive. Multimodal therapy, incorporating combinations of surgery, radiation therapy, and sometimes chemotherapy or immunotherapy, is recommended. However, tumor recurrences are common even with aggressive treatment, and many cats with FISS ultimately succumb to this devastating disease. While vaccination protocols play an important role in the management and control of infectious disease, veterinarians must be diligent in following established vaccination guidelines to minimize individual patient risk of FISS development. Early tumor detection and client education are also vital in the successful treatment of FISS.

Recurrent and non-recurrent feline injection-site sarcoma: computed tomographic and ultrasonographic findings

OBJECTIVES

This study describes the sonographic and computed tomographic (CT) characteristics of primary and recurrent feline injection-site sarcomas (FISSs).

METHODS

Between 2005 and 2013, 32 cats were selected for prospective and retrospective studies. Tumor shape and margins, presence of thickening of the adipose tissue, muscular and bone involvement, pre- and postcontrast attenuation, blurring of fat planes, calcification and liquefactive necrosis, intratumoral areas and skip metastasis were analyzed in CT scans. Echogenicity, echotexture, tumor margins and peritumoral tissue characteristics were analyzed by ultrasound (US).

RESULTS

Irregular shape (62.5%) with digitiform projections (100.0%), mixed (peripheral and intratumoral) contrast enhancement (67.7%), blurring of fat planes (68.8%) and signs of liquefactive intratumoral necrosis (68.8%) were the prevailing CT findings. Ultrasonography revealed irregular tumor margins, peripheral hyperechoic capsule-like rim, heterogeneous echotexture, and hyperechoic tissue contiguous with the formations and thickening of adjacent subcutaneous tissues in all cases. Mixed echogenicity with areas suggestive of tumor liquefactive necrosis was documented in 83.3% of cases. Skip metastases were highly correlated with tumor recurrence (P = 0.001). The incidence of muscular involvement tended to be higher (P = 0.003) in tumors presenting with thickening of adjacent adipose tissue.

CONCLUSIONS AND RELEVANCE

CT and US features common to FISS lesions were highlighted in this study. The imaging modalities employed allowed assessment of peritumoral inflammation, particularly adipose tissue inflammation. Imaging data may contribute to FISS diagnosis, therapeutic planning and patient follow-up.

Onco-epidemiology of domestic animals and targeted therapeutic attempts: perspectives on human oncology

The spontaneous tumor biology has been investigated with the support of animalists using animals as a preclinical model allowing translation of results in clinical practice. This review provides an insight into the field of comparative oncology. Evidence shows that companion animal health care is impressively growing in terms of development of new therapies and diagnostic tools, nutrition and disease prevention. However, even if most animal tumors might be a reliable model to study human carcinomas, many open questions, related to the opportunities to select and recruit new models in oncology, along with their legal and ethical implications, remain unanswered.

Musculoskeletal neoplasia: an important differential for lumps or lameness in the cat

PRACTICAL RELEVANCE

Musculoskeletal neoplasia is an uncommon but Important differential diagnosis for cats presenting with lameness, pain or swellings associated with bones and/or soft tissues. The most common tumours of soft tissue origin are the sarcomas (in particular feline injection site sarcomas [FISSs]); the most common bone tumour of the cat is osteosarcoma (OSA).

CLINICAL CHALLENGES

FISSs present a clinical challenge in terms of their local invasiveness, difficulty in obtaining complete surgical excision and high risk of local recurrence. Axial and extraskeletal OSAs pose similar challenges, whereas appendicular OSA is usually easy to remove via limb amputation and can, therefore, carry a good prognosis in many cases.

PATIENT GROUP

Cats of any age, gender or breed may be affected, although bone tumours predominantly affect middle- to old-aged cats.

GLOBAL IMPORTANCE

Vaccination of cats is of global importance in preventing feline diseases; hence, any possible significant consequences of vaccination such as neoplasia, even of a low incidence, are of huge concern to cat owners and veterinarians alike.

EVIDENCE BASE

This review is based on current literature relating to pathogenesis, pathology, presentation, diagnosis, staging, treatment and prognosis. It aims to summarise feline musculoskeletal neoplasia for clinicians in general practice.

Phase II clinical evaluation of lomustine chemotherapy for feline vaccine-associated sarcoma

Treatment of feline vaccine-associated sarcoma (VAS) is challenging, in part due to the high likelihood of tumour recurrence despite aggressive local therapy. Lomustine is potentially an attractive agent to add to the current treatment armamentarium. In this de-escalating phase I/II prospective trial, 28 cats with measurable VAS were treated at target dosages of 38-60 mg m(-2) every 3 weeks until disease progression. The overall response rate was 25%, with a median progression-free survival and median duration of response of 60.5 and 82.5 days, respectively. Haematologic toxicity, specifically cumulative neutropenia, was significant, and dose reductions and treatment delays were common. Although these data support further investigation of lomustine for the treatment of VAS, safe, multidosing protocols must first be determined.

Long-term fertility control in female cats with GonaCon™, a GnRH immunocontraceptive

The uncontrolled reproduction of free-roaming feral cats contributes to overpopulation and associated concerns regarding their welfare and impact on public health and the environment. Nonsurgical fertility control that could be administered to feral cats in the field would be a powerful tool for cat population control. The objective was to test the efficacy and duration of activity of a single-dose GnRH immunocontraceptive vaccine (GonaCon™) on the fertility of adult female laboratory cats. Vaccinated cats (n = 15) received a single injection of vaccine containing a GnRH-KLH conjugate (200 μg) emulsified in a mycobacterial and oil adjuvant on study Day 0. Sham-treated cats (n = 5) received a single injection containing all vaccine components except the GnRH-KLH conjugate. A breeding trial started on study Day 120. Vaccinated cats had a longer time to conception (median 39.7 mo) compared to sham-treated cats (4.4 mo; P < 0.001). A total of 93% of vaccinated cats remained infertile for the first year following vaccination, whereas 73, 53, and 40% were infertile for 2, 3, and 4 y, respectively. At study termination (5 y after a single GnRH vaccine was administered), four cats (27%) remained infertile. The GnRH antibody titers declined more rapidly in short-term responding cats with < 2 y of infertility (n = 4), compared to long-term responding cats that experienced fertility control for >2 y (n = 11) (P < 0.05). Non-painful but persistent late-onset granulomatous injection site masses appeared 2 y after initial vaccination in five cats. We concluded that GnRH immunocontraception is an ideal candidate for further development for feral cat control.

Cell lines derived from feline fibrosarcoma display unstable chromosomal aneuploidy and additionally centrosome number aberrations

The purpose of the study was to evaluate clonality and presence of numerical chromosomal and centrosomal aberrations in 5 established feline fibrosarcoma cell lines and in a fetal dermal fibroblast cell line as a control. The clonality of all cell lines was examined using limited-dilution cloning. The number of chromosomes was counted in metaphase spreads. The immunocytochemical analysis of centrosome numbers was performed by indirect immunofluorescence using a monoclonal antibody that targets γ-tubulin, a well-characterized component of centrosomes. Monoclonal cell populations could be established from all cell lines. In all feline fibrosarcoma cell lines, the number of chromosomes deviated abnormally from the normal feline chromosome number of 2n = 38, ranging from 19 to 155 chromosomes per cell. Centrosome hyperamplification was observed in all 5 feline fibrosarcoma cell lines with a proportion of cells (5.7 to 15.2%) having more than 2 centrosomes. In the control cell line, only 0.6% of the cells had more than 2 centrosomes. In conclusion, the examinations revealed that centrosome hyperamplification occurs in feline fibrosarcoma cell lines. The feline fibrosarcoma cell lines possessed 10 to 25 times as many cells with centrosome hyperamplification as the control cell line. These observations suggest an association of numerical centrosome aberrations with karyotype instability by increasing the frequency of chromosome missegregation. The results of this study may be helpful for further characterization of feline fibrosarcomas and may contribute to the knowledge of cytogenetic factors that may be important for the pathogenesis of feline fibrosarcomas.

Contraceptive vaccines for the humane control of community cat populations

Free-roaming unowned stray and feral cats exist throughout the world, creating concerns regarding their welfare as well as their impact on the environment and on public health. Millions of healthy cats are culled each year in an attempt to control their numbers. Surgical sterilization followed by return to the environment is an effective non-lethal population control method but is limited in scope because of expense and logistical impediments. Immunocontraception has the potential to be a more practical and cost-effective method of control. This is a review of current research in immunocontraception in domestic cats. Functional characteristics of an ideal immunocontraceptive for community cats would include a wide margin of safety for target animals and the environment, rapid onset and long duration of activity following a single treatment in males and females of all ages, and sex hormone inhibition. In addition, product characteristics should include stability and ease of use under field conditions, efficient manufacturing process, and low cost to the user. Two reproductive antigens, zona pellucida and GnRH, have been identified as possible targets for fertility control in cats. Zona pellucida, which is used successfully in multiple wildlife species, has achieved little success in cats. In contrast, immunization against GnRH has resulted in long-term contraception in both male and female cats following a single dose. GnRH is an ideal contraceptive target because it regulates pituitary and gonadal hormone responses in both males and females, thus suppressing nuisance behaviors associated with sex hormones in addition to preventing pregnancy. The responsiveness of cats to fertility control via GnRH suppression should encourage researchers and cat control stakeholders to continue efforts to optimize vaccines that induce multiyear contraception following a single dose in a high proportion of treated cats.

Origins of injection-site sarcomas in cats: the possible role of chronic inflammation-a review

The etiology of feline injection-site sarcomas remains obscure. Sarcomas and other tumors are known to be associated with viral infections in humans and other animals, including cats. However, the available evidence suggests that this is not the case with feline injection-site sarcomas. These tumors have more in common with sarcomas noted in experimental studies with laboratory animals where foreign materials such as glass, plastics, and metal are the causal agent. Tumors arising with these agents are associated with chronic inflammation at the injection or implantation sites. Similar tumors have been observed, albeit infrequently, at microchip implantation sites, and these also are associated with chronic inflammation. It is suggested that injection-site sarcomas in cats may arise at the administration site as a result of chronic inflammation, possibly provoked by adjuvant materials, with subsequent DNA damage, cellular transformation, and clonal expansion. However, more fundamental research is required to elucidate the mechanisms involved.

Orbital extraskeletal osteosarcoma following enucleation in a cat: a case report

OBJECTIVE

We present a unique case of a feline orbital extraskeletal osteosarcoma that developed 5 years post-enucleation.

HISTORY

In 2002, an ophthalmologist enucleated the left eye of a 2-year-old neutered male DSH and submitted it to the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW). COPLOW diagnosed the left eye with feline diffuse iris melanoma. In June 2007, the cat presented to another veterinarian for moderate swelling of the enucleation site. Palpation suggested a firm mass along the lateral orbital rim and an exploratory orbitotomy revealed a cyst with a mass adhered to it and the ventrolateral orbital rim. The cyst and mass were excised by the veterinarian and submitted to COPLOW. COPLOW diagnosed the tissue as an orbital conjunctival inclusion cyst and an acquired orbital osteosarcoma.

CONCLUSIONS

Following the enucleation, retained conjunctival epithelium became embedded in the connective tissue of the orbit and caused a cyst to develop. The cyst wall consisted of a myofibroblastic collagen-rich matrix and acted as a nidus of chronic irritation and tumor growth. This orbital osteosarcoma resembles feline vaccine-associated sarcomas (VAS), feline post-traumatic ocular sarcomas, and microchip-associated sarcomas in terms of it histopathology and its hypothesized pathogenesis related to exposure to antigenic material such as implanted epithelium, lens protein, vaccine components, and microchips as foreign bodies.

Analysis of prognostic factors associated with injection-site sarcomas in cats: 57 cases (2001-2007)

OBJECTIVE

To identify prognostic factors in cats with injection-site sarcomas (ISSs).

DESIGN

Retrospective case series.

ANIMALS

57 cats with ISSs.

PROCEDURES

Medical records of cats were reviewed with regard to sex, age, anatomic site of tumor, tumor size, histologic grade, excision of a primary tumor versus excision of a recurrent ISS, use of excision alone versus excision plus adjuvant therapy, local tumor recurrence, and development of distant metastasis to predict overall survival time (ie, time from tumor excision to death).

RESULTS

In univariate analyses, local recurrence and development of distant metastasis were significantly associated with survival time in cats. On multivariate analysis, development of distant metastasis remained a significant prognostic factor. Histologic grade was associated with distant metastasis, with cats having grade 3 tumors being significantly more likely to develop metastasis than cats with grade 1 and 2 tumors. Factors associated with local recurrence of ISSs were not identified.

CONCLUSIONS AND CLINICAL RELEVANCE

The development of distant metastasis, which may occur later during the course of the disease, was identified as a prognostic factor for overall survival time in cats with ISSs. In addition, cats with histologic grade 3 ISSs should be considered for further interventional studies with chemotherapy to prevent the high rate of distant metastasis.

A phase I trial of hyperthermia-induced interleukin-12 gene therapy in spontaneously arising feline soft tissue sarcomas

Interleukin-12 (IL-12), a proinflammatory cytokine, shows anticancer properties. Systemically administered IL-12 causes dose-dependent toxicity. To achieve localized intratumoral gene expression, an adenoviral gene therapy vector with IL-12 controlled by a heat-inducible promoter (heat shock promoter 70B) was developed and tested in a phase I clinical trial in cats with spontaneously arising soft tissue sarcoma. A feasibility study was done in 16 cats with soft tissue sarcoma using murine IL-12 and/or enhanced green fluorescent protein adenoviral vectors under cytomegalovirus or heat shock promoter 70 control. Subsequently, we conducted a phase I clinical trial using an adenoviral feline IL-12 construct in 13 cats with soft tissue sarcoma. The soft tissue sarcomas were irradiated (48 Gy/16 fractions) followed by intratumoral injection of adenovirus. Twenty-four hours postinjection, tumors were heated (41 degrees C, 60 min). Tumor expression of feline IL-12 and IFN-gamma was determined. Cats were monitored for systemic toxicity. For the murine IL-12 construct, an association was noted between viral dose and murine IL-12 levels within tumor, whereas serum levels were minimal. Mild toxicity was noted at 10(11) plaque-forming units (pfu). With the feline IL-12 construct, high levels of feline IL-12 mRNA were detected in tumor biopsies with low or absent IFN-gamma mRNA following gene therapy. Hematologic and hepatic toxicities were noted at the highest viral doses and were associated with detection of IFN-gamma mRNA in tumor. It is possible to localize gene expression and limit systemic toxicity of IL-12 using the hyperthermia-induced gene therapy approach. The maximum tolerated dose of the feline IL-12 adenoviral vector was 10(10) pfu/tumor as dose-limiting toxicities were noted at the 4 x 10(10) pfu dose.

Feline injection site-associated sarcoma: Is it a reason to critically evaluate our vaccination policies?

Feline injection site-associated sarcoma (FISAS) or vaccination-associated sarcoma is a serious problem in cats because of the ethical and therapeutic consequences associated with the disease. The exact aetiology of FISAS is unclear; therefore, instituting preventative measures such as delaying or discontinuing vaccination schedules is questionable. This paper will give insights into the disease process, will attempt to answer the question, "what causes FISAS?", and will discuss preventative measures to decrease the chance of occurrence. Tumours are in general uncommon in the cat, however, malignant tumours, such as sarcomas, occur relatively frequently. FISAS have stimulated interest because of their reported linkage to certain types of vaccine. FISASs are reported to have an incidence of 1-10 per 10,000 cats and often appear in conjunction with a traumatic incident (such as a vaccination). The tumour displays an extreme malignant biological behaviour, both being locally aggressive and metastasising in 25-70% of the cases. Although the pathology still remains unclear, an exaggerated inflammatory/granulomatous response seems to be the predisposing factor in the transformation to FISAS. A multi-step carcinogenesis model, including genetic, iatrogenic and local factors seems to be the most plausible explanation for the occurrence of the tumour. Multi-modal therapy, based on aggressive surgical removal of the tumour in combination with radiation and/or chemotherapy, is usually recommended but randomised clinical studies have not yet been performed to prove the efficacy of any of the modalities. The question of whether FISAS can be prevented by not injecting irritant products remains unanswered. No specific brands of vaccine, manufacturers or factors associated with vaccine administration have been significantly associated with FISAS in a multi-institutional and epidemiological study. Control and evaluation measures as recommended by the US-based taskforce include determination of risk groups, extending re-vaccination intervals, the use of single component products and the use of consistent, predetermined sites for vaccination.

Somatic alterations of thep53tumor suppressor gene in vaccine-associated feline sarcoma

OBJECTIVE

To determine somatic alterations in p53 in vaccine-associated feline sarcoma (VAFS). Animals-27 domestic shorthair cats undergoing first surgical treatment for primary VAFS with no history of chemotherapy or gamma radiation.

PROCEDURES

Sequence analysis was performed on the genomic sequence of p53 (between exons 5 through 9) from tumor and blood samples obtained from the cats. Cats were monitored for 3 years and disease-free intervals and survival times calculated.

RESULTS

Eight single nucleotide polymorphisms were detected within the genomic sequence of p53, with 20 of 27 cats (74%) having heterozygosity at > or = 1 polymorphic site. Somatic loss of heterozygosity at p53 was detected in the primary tumors of 12 of these 20 (60%) cats. Such allelic deletion was significantly associated with rapid tumor recurrence and reduced overall survival. Point mutations were rare, occurring in 3 of 27 primary tumors. The finding of malignant cells in the surgical margins was significantly associated with disease recurrence, but clear margins (with no detectable malignant cells) were not predictive of positive outcome.

CONCLUSIONS AND CLINICAL RELEVANCE

p53 status is an indicator of postsurgical recurrence and overall survival in cats with VAFS. Careful follow-up is important in treating vaccine-site tumors containing allelic deletion of p53, whereas aggressive surgical treatment may be sufficient to control primary vaccination site tumors without the allelic loss.

Common malignant musculoskeletal neoplasms of dogs and cats

Malignancies of the musculoskeletal system in dogs and cats can be categorized as either primary or metastatic within the bony or soft structures that comprise the musculoskeletal system. By far, the most common tumor that affects the musculoskeletal system in dogs is osteosarcoma. The most common tumors that affect the musculoskeletal system in cats are injection site sarcomas. These tumors are locally infiltrative; whereas up to 25% metastasize, most animals die from our inability to control local disease. The aim of this article is to provide a brief review of the biologic behavior of and treatment recommendations for common tumors of the musculoskeletal system, excluding the oral and nasal cavities.