Principles of treatment for soft tissue sarcoma

Evaluation of a targeted anti-αvβ3 integrin near-infrared fluorescent dye for fluorescence-guided resection of naturally occurring soft tissue sarcomas in dogs

PURPOSE

Complete resection is a key prognostic factor for survival in patients with soft tissue sarcoma (STS), in humas and companion animals alike. Fluorescence-guided surgery could improve resection accuracy. As dogs are frequently affected by STS, they serve as a model to test an anti-αvβ3 integrin targeting near-infrared fluorescent (NIRF) dye (AngiostampTM800) for fluorescence-guided surgery in STS to evaluate its safety and feasibility in dogs, and if it translates into a clinically relevant benefit compared to the standard of care with regards to completeness of surgery and local recurrence. Furthermore, we aimed to correlate target expression and NIRF-signal intensity.

METHODS

Twenty dogs with STS were randomly allocated to either receive Angiostamp™ (NIRF group) or physiologic saline (control group) preoperatively. The researchers were blinded for treatment, and resections were adapted based on the NIRF-signal, if needed. Margin status was histologically determined at the 1 and 3 cm margin. The tumor-to-background ratio was measured in native tissue biopsies and formalin-fixed tissue. The fluorescent area was compared to the corresponding tumor areas as confirmed by histology using the Dice coefficient. Target expression was quantified by immunohistochemistry and correlated to NIRF-signal ratios.

RESULTS

A fluorescent signal was detected in all 10 tumors of the NIRF group, with a tumor-to-background ratio of 7.4 ± 5.8 in native biopsies and 13.5 ± 10.9 in formalin-fixed tissue. In the NIRF group, resection margins were adapted in 5/10 cases, leading to complete resection and preventing R1 in four of these cases. In the NIRF and control group 9/10 and 8/10 resections were R0, with one local recurrence in each group and one sarcoma-related death in the NIRF group. The NIRF-signal correlated with the histologically confirmed tumor area (Dice coefficient 0.75 ± 0.17). Target expression was higher in tumor compared to peritumoral tissue (p < 0.0003) and showed a moderate correlation with the NIRF-signal (r = 0.6516, p < 0.0001).

CONCLUSION

Fluorescence-guided surgery using Angiostamp™ can pinpoint residual disease in the tumor bed and contributes to an improved resection accuracy in canine STS.

Keeping Pathologists in the Loop and an Adaptive F1-Score Threshold Method for Mitosis Detection in Canine Perivascular Wall Tumours

Performing a mitosis count (MC) is the diagnostic task of histologically grading canine Soft Tissue Sarcoma (cSTS). However, mitosis count is subject to inter- and intra-observer variability. Deep learning models can offer a standardisation in the process of MC used to histologically grade canine Soft Tissue Sarcomas. Subsequently, the focus of this study was mitosis detection in canine Perivascular Wall Tumours (cPWTs). Generating mitosis annotations is a long and arduous process open to inter-observer variability. Therefore, by keeping pathologists in the loop, a two-step annotation process was performed where a pre-trained Faster R-CNN model was trained on initial annotations provided by veterinary pathologists. The pathologists reviewed the output false positive mitosis candidates and determined whether these were overlooked candidates, thus updating the dataset. Faster R-CNN was then trained on this updated dataset. An optimal decision threshold was applied to maximise the F1-score predetermined using the validation set and produced our best F1-score of 0.75, which is competitive with the state of the art in the canine mitosis domain.

Relationship between magnetic resonance imaging findings and histological grade in spinal peripheral nerve sheath tumors in dogs

BACKGROUND

Peripheral nerve sheath tumors (PNSTs) are a group of neoplasms originating from Schwann cells or pluripotent cell of the neural crest. Therapeutic options and prognosis are influenced by their degree of malignancy and location.

HYPOTHESIS/OBJECTIVES

Identify magnetic resonance imaging (MRI) features predictive of PNST histologic grade.

ANIMALS

Forty-four dogs with histopathological diagnosis of spinal PNSTs and previous MRI investigation.

METHODS

A multicenter retrospective study including cases with (a) histopathologic diagnosis of PNST and (b) MRI studies available for review. Histologic slides were reviewed and graded by a board-certified pathologist according to a modified French system (FNCLCC) for grading soft tissue sarcomas. The MRI studies were reviewed by 2 board-certified radiologists blinded to the grade of the tumor and the final decision on the imaging characteristics was reached by consensus. Relationships between tumor grade and histological and MRI findings were assessed using statistical analysis.

RESULTS

Forty-four cases met inclusion criteria; 16 patients were PNSTs Grade 1 (low-grade), 19 were PNSTs Grade 2 (medium-grade), and 9 were PNSTs Grade 3 (high-grade). Large volume (P = .03) and severe peripheral contrast enhancement (P = .04) were significantly associated with high tumor grade. Degree of muscle atrophy, heterogeneous signal and tumor growth into the vertebral canal were not associated with grade.

CONCLUSIONS AND CLINICAL IMPORTANCE

Grade of malignancy was difficult to identify based on diagnostic imaging alone. However, some MRI features were predictive of high-grade PNSTs including tumor size and peripheral contrast enhancement.

Cross-species evaluation of fibroblast activation protein alpha as potential imaging target for soft tissue sarcoma: a comparative immunohistochemical study in humans, dogs, and cats

Introduction

Complete surgical tumor resection is paramount in the management of soft tissue sarcoma (STS) in humans, dogs, and cats alike. Near-infrared targeted tracers for fluorescence-guided surgery (FGS) could facilitate intraoperative visualization of the tumor and improve resection accuracy. Target identification is complicated in STS due to the rarity and heterogeneity of the disease. This study aims to validate the expression of fibroblast activation protein alpha (FAP) in selected human, canine, and feline STS subtypes to assess the value of FAP as a target for FGS and to validate companion animals as a translational model.

Methods

Formalin-fixed and paraffin-embedded tissue samples from 53 canine STSs (perivascular wall tumor (PWT), canine fibrosarcoma (cFS), and STS not further specified (NOS)), 24 feline fibrosarcomas, and 39 human STSs (myxofibrosarcoma, undifferentiated pleomorphic sarcoma, dermatofibrosarcoma protuberans, and malignant peripheral nerve sheath tumor) as well as six canine and seven feline healthy controls and 10 inflamed tissue samples were immunohistochemically stained for their FAP expression. FAP labeling in tumor, peritumoral, healthy skin, and inflamed tissue samples was quantified using a visually assessed semiquantitative expression score and digital image analysis. Target selection criteria (TASC) scoring was subsequently performed as previously described.

Results

Eighty-five percent (85%) of human (33/39), 76% of canine (40/53), and 92% of feline (22/24) STSs showed FAP positivity in over 10% of the tumor cells. A high expression was determined in 53% canine (28/53), 67% feline (16/24), and 44% human STSs (17/39). The average FAP-labeled area of canine, feline, and human STSs was 31%, 33%, and 42%, respectively (p > 0.8990). The FAP-positive tumor area was larger in STS compared to healthy and peritumoral tissue samples (p < 0.0001). TASC scores were above 18 for all feline and human STS subtypes and canine PWTs but not for canine STS NOS and cFS.

Conclusion

This study represents the first cross-species target evaluation of FAP for STS. Our results demonstrate that FAP expression is increased in various STS subtypes compared to non-cancerous tissues across species, thereby validating dogs and cats as suitable animal models. Based on a TASC score, FAP could be considered a target for FGS.

Oclacitinib and Myxoma Virus Therapy in Dogs with High-Grade Soft Tissue Sarcoma

Human rhabdomyosarcomas are rarely cured by surgical resection alone. This is also true for high-grade soft tissue sarcomas in dogs. Dogs with spontaneous sarcoma are good models for clinical responses to new cancer therapies. Strategic combinations of immunotherapy and oncolytic virotherapy (OV) could improve treatment responses in canine and human cancer patients. To develop an appropriate combination of immunotherapy and OV for dogs with soft tissue sarcoma (STS), canine cancer cells were inoculated with myxoma viruses (MYXVs) and gene transcripts were quantified. Next, the cytokine concentrations in the canine cancer cells were altered to evaluate their effect on MYXV replication. These studies indicated that, as in murine and human cells, type I interferons (IFN) play an important role in limiting MYXV replication in canine cancer cells. To reduce type I IFN production during OV, oclacitinib (a JAK1 inhibitor) was administered twice daily to dogs for 14 days starting ~7 days prior to surgery. STS tumors were excised, and MYXV deleted for serp2 (MYXV∆SERP2) was administered at the surgical site at two time points post-operatively to treat any remaining microscopic tumor cells. Tumor regrowth in dogs treated with OV was decreased relative to historical controls. However, regrowth was not further inhibited in patients given combination therapy.

Thoracic Tumor Associated with a Unilateral Empyema in a Beef Cow: A Case Report

Tumors in cows are not frequently reported in the literature. They often represent unusual findings in live animals and are incidental at slaughter with rare positive therapeutic outcomes for farmers. A 9-year-old beef cow was referred to the hospital of ruminants of the National Veterinary School of Toulouse, France. The cow started to become sick 10 days prior, and major symptoms were anorexia, arched back, tachycardia, and tachypnea associated with significantly attenuated cardiac and pulmonary sounds upon right-sided auscultation. After specific investigations, a thoracic sarcoma associated with unilateral empyema was diagnosed. The empyema was treated, and supportive treatment was only performed for the tumor. Although the sarcoma remained, clinical improvement was significant, and the cow went back to her farm of origin. After the end of the withdrawal period, the cow recovered clinically but was culled by the owners for economic reasons. The present case report offers a continuum from the initial clinical signs motivating specific investigations to interesting laboratory findings, which were confirmed post-mortem.

Evaluating the relevance of surgical margins. Part one: The problems with current methodology

The goal of cancer surgery is to achieve a "clean" microscopic resection, with no residual tumour remaining in the wound. To achieve that goal, the surgeon typically incorporates a measured buffer of grossly normal tissue about the entire circumference of the tumour. Microscopic analysis of the resection boundaries is then performed to determine if all traces of the tumour have been completely removed. This analysis is thought to provide a surrogate indication as to the likelihood for that tumour to recur after surgery. However, it is recognised that tumour recurrence may not occur even when microscopic evidence of tumour has been identified at the resection margins, and recurrence can also occur when conventional histology has considered the tumour to have been completely removed. The explanations for this dichotomy are numerous and include technical and practical limitations of the processing methodology, and also several surgeon-related and tumour-related reasons. Ultimately, the inability to confidently determine when a tumour has been removed sufficiently to prevent recurrence can impact on the ability to provide owners with confident treatment advice. In this article, the authors describe the challenges with defining the true extent of the tumour margin from the perspective of the surgeon, the pathologist and the tumour. The authors also provide an analysis of why our current efforts to ensure that all traces of the local tumour have been successfully removed may provide an imperfect assessment of the risk of recurrence.

Detection of Necrosis in Digitised Whole-Slide Images for Better Grading of Canine Soft-Tissue Sarcomas Using Machine-Learning

The definitive diagnosis of canine soft-tissue sarcomas (STSs) is based on histological assessment of formalin-fixed tissues. Assessment of parameters, such as degree of differentiation, necrosis score and mitotic score, give rise to a final tumour grade, which is important in determining prognosis and subsequent treatment modalities. However, grading discrepancies are reported to occur in human and canine STSs, which can result in complications regarding treatment plans. The introduction of digital pathology has the potential to help improve STS grading via automated determination of the presence and extent of necrosis. The detected necrotic regions can be factored in the grading scheme or excluded before analysing the remaining tissue. Here we describe a method to detect tumour necrosis in histopathological whole-slide images (WSIs) of STSs using machine learning. Annotated areas of necrosis were extracted from WSIs and the patches containing necrotic tissue fed into a pre-trained DenseNet161 convolutional neural network (CNN) for training, testing and validation. The proposed CNN architecture reported favourable results, with an overall validation accuracy of 92.7% for necrosis detection which represents the number of correctly classified data instances over the total number of data instances. The proposed method, when vigorously validated represents a promising tool to assist pathologists in evaluating necrosis in canine STS tumours, by increasing efficiency, accuracy and reducing inter-rater variation.

Non-injection-site soft tissue sarcoma in cats: outcome following adjuvant radiotherapy

OBJECTIVES

Biological behaviour and treatment options of non-injection-site soft tissue sarcomas (nFISS) in cats are less well understood than in dogs. The aim of this retrospective study was to assess the outcomes of cats with nFISS following treatment with adjuvant radiotherapy.

METHODS

The medical records of cats with soft tissue sarcomas in locations not associated with, and histology reports not suggestive of, injection-site sarcomas were reviewed. All cats underwent adjuvant radiotherapy, either hypofractionated (32-36 Gy delivered in weekly 8-9 Gy fractions) or conventionally fractionated (48-54 Gy delivered in 16-18 3 Gy fractions) to microscopic disease.

RESULTS

In total, 18 cats were included in the study, 17 with extremity nFISS and one with facial nFISS. Nine received radiotherapy after a single surgery and nine after multiple surgeries for recurrent nFISS. Eight cats were treated with a hypofractionated protocol and 10 with a conventionally fractionated protocol. The median follow-up time was 540 days (range 51-3317 days). The tumour recurred in eight (44.4%) cats following adjuvant radiotherapy; it recurred in three (37.5%) cats following a hypofractionated protocol and in five (50%) cats following a conventionally fractionated protocol. The overall median progression-free interval (PFI) for 17/18 cats was 2748 days, while the median PFI for the 7/8 cats with recurrence was 164 days. The recurrence for one cat was reported, but the date was unknown and it was therefore censored from these data. When stratifying based on the protocol, the median PFI for hypofractionated and conventionally fractionated protocols was 164 days and 2748 days, respectively. Statistically, there was no significant difference between the two protocols (P = 0.636).

CONCLUSIONS AND RELEVANCE

Adjuvant radiotherapy resulted in good long-term tumour control in 12/18 cats with nFISS. Further studies in larger populations are required to assess the significance of radiation dose and fractionation on tumour control and the effect of multiple surgeries prior to initiation of radiotherapy on outcome.

Immunohistochemical Expression of Platelet-Derived Growth Factor Receptor β (PDGFR-β) in Canine Cutaneous Peripheral Nerve Sheath Tumors: A Preliminary Study

Simple Summary

The peripheral nerve sheath tumors are relatively common neoplasms, belong to the soft tissue sarcomas group, and are poorly investigated in veterinary medicine; the diagnosis is complex, and therapeutic options are limited. The platelet-derived growth factor receptors, namely the β subunit, are an important class of tyrosine kinase receptors that can be activated by genetic alterations and contribute to the process of carcinogenesis, so the inhibition of this receptor is an important therapeutic target. Using the immunohistochemical technique, this study aims to evaluate the expression of this receptor in 19 samples, 10 malignant and 9 benign tumors. The results showed that the majority of benign tumors, about 67% of cases, expressed the receptor in less than 25% of neoplastic cells and, in 80% cases of malignant tumors, the receptor was expressed in more than 25% of neoplastic cells. It was also found that, in the larger tumors, the expression of this receptor was significantly higher. With these findings it seems reasonable to speculate that the drugs able to inhibit this receptor, such as toceranib, may be considered in the therapeutic approach of these tumors.

Abstract

As in humans, the prevalence of tumors in companion animals is increasing dramatically and there is a strong need for research on new pharmacological agents particularly for the treatment of those tumors that are resistant to conventional chemotherapy agents such as soft tissue sarcomas (STS). Because malignant (MPNST) and benign peripheral nerve sheath tumors (BPNST) are relatively common STS in dogs, the aim of this retrospective study was to evaluate the immunohistochemical (IHC) expression of PDGFR-β, contributing to its characterization as a potential target for their treatment. A total of 19 samples were included, 9 histologically classified as benign and the other 10 as malignant. The results showed diffuse immunoexpression in the cytoplasm of neoplastic cells. Six (66.7%) BPNST expressed the receptor in less than 25% of neoplastic cells and only three (33.3%) exhibited labelling in more than 25% of neoplastic cells. In contrast, all MPNST expressed PDGFR-β, and in 8 (80%) of these samples, the receptor was expressed in more than 25% of neoplastic cells, and only 2 (20%) cases expressed the receptor in less than 25% of neoplastic cells. PDGFR-β expression was significantly higher in MPNST and larger tumors, suggesting that drugs able to inhibit the activity of this tyrosine kinase receptor, such as toceranib, may be considered in the approach of unresectable tumors and/or in the context of adjuvant or neoadjuvant therapies.

Deep learning for necrosis detection using canine perivascular wall tumour whole slide images

Necrosis seen in histopathology Whole Slide Images is a major criterion that contributes towards scoring tumour grade which then determines treatment options. However conventional manual assessment suffers from inter-operator reproducibility impacting grading precision. To address this, automatic necrosis detection using AI may be used to assess necrosis for final scoring that contributes towards the final clinical grade. Using deep learning AI, we describe a novel approach for automating necrosis detection in Whole Slide Images, tested on a canine Soft Tissue Sarcoma (cSTS) data set consisting of canine Perivascular Wall Tumours (cPWTs). A patch-based deep learning approach was developed where different variations of training a DenseNet-161 Convolutional Neural Network architecture were investigated as well as a stacking ensemble. An optimised DenseNet-161 with post-processing produced a hold-out test F1-score of 0.708 demonstrating state-of-the-art performance. This represents a novel first-time automated necrosis detection method in the cSTS domain as well specifically in detecting necrosis in cPWTs demonstrating a significant step forward in reproducible and reliable necrosis assessment for improving the precision of tumour grading.

Outcome with Surgical Treatment of Canine Soft Tissue Sarcoma in the Region of the Ischiatic Tuberosity: A Veterinary Society of Surgical Oncology Retrospective Study

OBJECTIVE

To determine the outcome of dogs with soft tissue sarcoma (STS) within the region of the ischiatic tuberosity (ITSTS) treated surgically.

STUDY DESIGN

Multi-institutional retrospective study ANIMALS: Fifty-two client-owned dogs with histologically confirmed STS in the region of the IT treated with surgical resection between March 1st, 2009, and March 1st, 2021, and a minimum follow-up time of six months.

METHODS

Data collected included signalment, preoperative diagnostics, surgical intent/method, complications, histopathology, margins, outcome, and cause of death. Statistical analyses were performed to determine significant factors in treatment and prognosis of ITSTS.

RESULTS

Fifty-two dogs with histopathologically-confirmed ITSTS included resulting in 24 grade I, 20 grade II, and seven grade III tumors. Overall survival time and disease progression were negatively associated with tumor grade while recurrence was positively associated with grade and incomplete margins. Overall survival time and progression-free survival time was not reached for tumors graded as I or II and was 255 and 268 days respectively for grade III. Median time to recurrence was not reached for tumors excised with complete margins and 398 days for incomplete margins. There was a 25% reported surgical complication rate.

CONCLUSION

Ischiatic tuberosity soft tissue sarcoma was not found to be a unique clinical entity in dogs. Treatment recommendations and prognosis were similar to STS in other locations. The outcome was influenced by histologic grade and margins.

CLINICAL SIGNIFICANCE

Ischiatic tuberosity soft tissue sarcoma of dogs does not behave more aggressively than those in other locations. Surgical complications were common but not life-threatening. Overall prognosis, including survival and disease recurrence, appears to depend on histological grade and surgical margins. This article is protected by copyright. All rights reserved.

Local tumour response to neoadjuvant therapy with 2-aminoethyl dihydrogen phosphate in dogs with soft tissue sarcoma

BACKGROUND

In cases of soft tissue sarcoma (STS), neoadjuvant therapy is indicated to downstage the tumour prior to surgery to achieve enhanced local tumour control. The antineoplastic phospholipid compound 2-aminoethyl dihydrogen phosphate (2-AEH2F) is an alkyl phosphate ester capable of inhibiting cell proliferation and inducing cell death by modifying the asymmetry of phospholipids in the cytoplasmic membrane OBJECTIVES: This clinical study was designed to investigate local antitumoural effects of neoadjuvant therapy with 2-AEH2F in dogs with naturally occurring STS MATERIAL AND METHODS: Dogs (n = 11) received four consecutive weekly intravenous injections of 2-AEH2F (70 mg/kg) prior to tumour resection. Tomographic (CT) and thermal (TE) images were used to investigate changes in tumour size and local temperature in response to treatment RESULTS: Comparative analysis of CT images (n = 9/11) failed to reveal complete or partial remission according to selected assessment criteria (RECIST, WHO and volumetric). Comparative analysis of TE images (n = 10/11) revealed significantly (p = 0.01416) lower temperatures in tumoural areas relative to surrounding tissues over the course of treatment CONCLUSIONS: 2-AEH2F had no cytoreductive effects when used at doses and intervals described in this study. However, significant drop in skin temperatures recorded in tumoural areas suggest induction of physiological changes.

Marginal excision of cutaneous mast cell tumors in dogs was not associated with a higher rate of complications or prolonged wound healing than marginal excision of soft tissue sarcomas

OBJECTIVE

To compare wound healing following planned marginal excision of cutaneous mast cell tumors (MCTs) with that of soft tissue sarcomas (STSs) and to identify risk factors for wound healing complications and delay in healing.

ANIMALS

126 dogs that underwent intentional marginal excision of cutaneous MCTs (n = 77) or subcutaneous STSs (49).

PROCEDURES

Medical records of included dogs were reviewed and signalment, tumor size, tumor location, skin closure type, time to healing, reported complications, histopathological grade, and surgical margins were recorded. These variables and outcomes (complication rate and time to complete healing) were compared between dogs in the MCT and STS groups. Potential risk factors for complications and delayed healing were analyzed.

RESULTS

No significant difference between the groups was found in any of the variables. Wound healing complication rates were 29% (22/77) for the MCT group and 31% (15/49) for the STS group. The mean ± SD time to complete healing was 16.5 ± 7.5 days for the MCT group and 17.7 ± 9.3 days for the STS group. These outcomes did not differ significantly between groups. For both groups, the use of subdermal plexus flap reconstruction was associated with the development of complications and increased time to complete healing.

CLINICAL RELEVANCE

Marginal excision of cutaneous MCTs was not associated with a higher rate of complication or prolonged wound healing, compared with marginal excision of STSs. The use of flap reconstruction in skin closure may delay healing and planned adjuvant therapy. Owners should be counseled regarding these risks and where appropriate and feasible, surgery without reconstruction should be considered.

Intersurgeon agreement in determining 3 cm surgical margins of subcutaneous tumors in dogs

OBJECTIVE

To evaluate intersurgeon agreement in performing a 3 cm wide surgical excision for subcutaneous malignancies in dogs.

STUDY DESIGN

Prospective, blinded, randomized, clinical study.

ANIMALS

Client-owned dogs with subcutaneous tumors undergoing curative-intent, wide surgical excision between April 2019 to March 2020.

METHODS

Four surgeons, instructed to perform a 3 cm wide excision, each sequentially indicated their proposed skin incision locations around subcutaneous tumors, without knowledge of the other surgeons' proposed incisions. A tripod-mounted camera and laser positioning system were used to photograph each surgeon's proposed margin length. A random-effects model was used to estimate the standard deviation of margin lengths that would be expected from a random sample of surgeons.

RESULTS

Each of the four surgeons provided 33 independent radial measurements from 11 tumors (six soft tissue sarcomas and five mast cell tumors), for a total of 132 radial measurements. No individual surgeon consistently proposed longer or shorter margin incision locations. The prediction interval for a future margin measurement was 6 mm, implying that the 95% confidence interval of an individual surgeon's margin length would be within ±6 mm of the mean margin length from a random sample of surgeons.

CONCLUSION

Ninety-five percent of surgeons would be expected to deliver a surgical dose between 2.4-3.6 cm, for a theoretically uniform surgical dose of 3 cm wide margins.

CLINICAL SIGNIFICANCE

Surgical doses are likely to vary at clinically relevant levels among surgeons, complicating design and interpretation of studies attempting to identify an ideal surgical dose.

International Guidelines for Veterinary Tumor Pathology: A Call to Action

Standardization of tumor assessment lays the foundation for validation of grading systems, permits reproducibility of oncologic studies among investigators, and increases confidence in the significance of study results. Currently, there is minimal methodological standardization for assessing tumors in veterinary medicine, with few attempts to validate published protocols and grading schemes. The current article attempts to address these shortcomings by providing standard guidelines for tumor assessment parameters and protocols for evaluating specific tumor types. More detailed information is available in the Supplemental Files, the intention of which is 2-fold: publication as part of this commentary, but more importantly, these will be available as "living documents" on a website (www.vetcancerprotocols.org), which will be updated as new information is presented in the peer-reviewed literature. Our hope is that veterinary pathologists will agree that this initiative is needed, and will contribute to and utilize this information for routine diagnostic work and oncologic studies. Journal editors and reviewers can utilize checklists to ensure publications include sufficient detail and standardized methods of tumor assessment. To maintain the relevance of the guidelines and protocols, it is critical that the information is periodically updated and revised as new studies are published and validated with the intent of providing a repository of this information. Our hope is that this initiative (a continuation of efforts published in this journal in 2011) will facilitate collaboration and reproducibility between pathologists and institutions, increase case numbers, and strengthen clinical research findings, thus ensuring continued progress in veterinary oncologic pathology and improving patient care.

Novel use of a combination of extracellular matrices for wound healing following resection of a large inferior eyelid mass in a miniature Hereford

CASE DESCRIPTION

A 9-month-old miniature Hereford heifer was evaluated for a mass on the right inferior eyelid that had progressed in size over 3 months.

CLINICAL FINDINGS

Physical examination revealed a firm, ulcerated, pedunculated mass on the right inferior eyelid that extended from the medial quarter to beyond the lateral canthus of the eye. The base of the mass measured 7.4 × 6.7 cm, and the dorsal margin of the base of the mass was approximately 3 mm ventral to the inferior eyelid margin. Histologic evaluation of incisional biopsy specimens from the mass was consistent with fibrosarcoma.

TREATMENT AND OUTCOME

The mass was surgically resected with care taken to preserve the eyelid margin. The resulting 10 × 8.5-cm surgical wound was treated with adjunct CO₂ laser therapy and closed by primary closure at its medial and central aspects and placement of a 4.6 × 2.6-cm lyophilized equine amnion multilayer graft and 2 sheets of 4-ply porcine small intestinal submucosa at its lateral aspect. The grafts were kept moist by alternating topical antimicrobial and artificial tear ointments for 3 weeks. The wound healed without complications, resulting in a functional and aesthetically pleasing outcome despite the development of moderate ectropion at the lateral aspect of the inferior eyelid.

CLINICAL RELEVANCE

Results suggested that a combination of extracellular matrix scaffolds may be an alternative to extensive skin flaps for management of large dermal wounds, particularly wounds resulting from blepharoplasty where preservation of an eyelid margin is desired.

Fascial plane mapping for superficial tumor resection in dogs. Part I: Neck and trunk

OBJECTIVE

To provide qualitative fascial categories and classify the intersections of various fascial planes of the trunk of the dog to facilitate preoperative planning for superficial cancers.

STUDY DESIGN

Qualitative anatomical study.

SAMPLE POPULATION

Two male and three female mixed breed canine cadavers weighing approximately 15 to 35 kg.

METHODS

The skin and subcutaneous fat were excised. Fascial planes were incised and elevated to allow exploration of their quality and borders. Fascia was categorized as type I (discrete sheets), type II (tightly adhered to thin muscles), type III (tightly adhered to thick muscles), or type IV (associated with periosteum). Photographs of specimens were digitally modified with overlays to map tissue types.

RESULTS

Differences between cadavers were largely associated with muscle mass or sex, with only minor anatomical differences and enough subjective similarity among specimens to allow mapping. The fasciae of the neck and trunk were predominantly type I or type II, with type III fascia at the shoulder and type IV fascia at the scapular spine, 13th rib, dorsal spinous processes, and the wing of the ilium.

CONCLUSION

The superficial fasciae of the canine trunk were consistent among the dogs evaluated and can be classified as four broad fascial types. The population used was small, and individual variation should be considered when using these images in a clinical setting.

CLINICAL SIGNIFICANCE

The images and categorization of fascia and transitions between fascial layers detailed here provide a visual and written reference for surgeons to facilitate preoperative planning and excision of superficial cancers.

A retrospective comparison of carbon dioxide surgical laser and non-laser excision for removal of cutaneous and subcutaneous soft-tissue sarcomas in dogs

Aims: To compare the duration of anaesthesia, surgery, and postoperative hospitalisation, the proportion of tumours excised with complete histologic margins and immediate postoperative surgical site complications in dogs undergoing removal of cutaneous or subcutaneous soft tissue sarcomas (STS) by either carbon dioxide (CO₂) laser or non-laser surgical excision methods. Methods: Medical records of dogs that underwent surgical excision of cutaneous and subcutaneous STS at the University of Missouri between December 2004 and May 2018 were evaluated. The study population consisted of client-owned dogs that underwent CO₂ laser (n = 4) or non-laser (n = 20) excision of a single STS. Data recorded included: signalment, duration of anaesthesia, surgery and postoperative hospitalisation, tumour characteristics, completeness of histologic margins, postoperative complications, adjunctive therapy, and other procedures at the time of surgery. Results: There was no evidence of a difference in mean age, body weight or tumour size between groups. Similarly there was no evidence of a difference in the duration of anaesthesia or surgery, or in the proportion of dogs whose STS were removed with complete histologic margins between dogs whose STS was removed using laser or non-laser surgical excision methods. However, the duration of postoperative hospitalisation trended towards being longer for the laser excision group (p = 0.061). Conclusions: These data provide preliminary evidence that excision of cutaneous or subcutaneous STS with CO₂ surgical laser is comparable to non-laser methods for the measured outcomes.

Significant advances in veterinary oncology - 60 years on

The first edition of the Journal of Small Animal Practice published in February 1960, contained a paper entitled "Recent Treatments of Malignant Neoplasia" by Dr Larry Owen. Now we have reached the 60th anniversary of JSAP, that article provides a baseline from which to review subsequent advances in veterinary oncology, which now includes worldwide networks that have resulted in veterinary oncology becoming the multidisciplinary speciality that it is today. There certainly have been many advances in understanding of the pathology and epidemiology of animal cancers and in methods of diagnosis and treatment. However, the subject has become so large and diverse that not all aspects can be covered in detail here. It should also be acknowledged that there are still many gaps in knowledge in this field and that, because of a lack of randomised clinical trials, the evidence base for what is often regarded as "standard of care" is weak.

The potential of the combined use of targeted type I interferon pathway inhibitors and oncolytic viruses to treat sarcomas

Replicating oncolytic viruses (OVs) are appealing, new, FDA-approved, therapeutic options for humans with head and neck cancers and melanomas. These treatments are not yet available for veterinary patients, but recent clinical trials have shown several OVs to be safe in dogs and cats. Specific viruses being used to treat sarcomas in dogs include modified canine adenovirus 2, myxoma virus, vesicular stomatitis virus and reovirus. In cats with vaccine-associated sarcomas, poxviruses have been injected postoperatively and a reduced rate of tumour recurrence was documented. To date, the response rates of canine and feline patients to OV therapy have been variable (as they are in people). Optimal methods of OV administration and dosing schedules continue to be evaluated. One way to improve outcomes of OV therapy in veterinary patients may be to use OVs in combination with other immunomodulatory therapies. This review discusses the potential utility of concurrent therapy with an OV and an inhibitor of the type I interferon pathway.

Adjuvant electrochemotherapy with bleomycin and cisplatin combination for canine soft tissue sarcomas: A study of 30 cases

Electrochemotherapy (ECT) couples the administration of anticancer drugs with the delivery of electric pulses that increase the drug uptake through the cell membranes, thus resulting in an improved efficacy. This study has evaluated the tolerability and efficacy of the combination of systemic bleomycin and local cisplatin as ECT agents for incompletely excised canine soft tissue sarcoma (STS). Thirty dogs with incompletely excised STSs were enrolled. The dogs received intravenous 20 mg/m² bleomycin, and the tumor bed and margins were infiltrated with cisplatin at the dose of 0.5 mg/cm². Then, trains of permeabilizing biphasic electric pulses were applied under sedation. More precisely, 5 min after the injection of the chemotherapy agents, sequences of eight biphasic pulses lasting 50 + 50 μsec each, were delivered in bursts of 1,300 V/cm using caliper electrodes. A second session was performed 2 wk later. The treatment was well tolerated and side effects were minimal. Twenty-six dogs had no evidence of recurrence at the time of manuscript writing; four had recurrence and one of the four recurring dogs died of lung metastases. Median estimated disease free was 857 d. Perivascular wall tumors response was compared to that of the other STSs, but the difference in outcome was not significant. ECT using combination of bleomycin and cisplatin appears to be effective in the treatment of incompletely resected STSs in dogs. This therapeutic approach could be a useful addition to the current options in consideration of its low cost, limited toxicity, and ease of administration.

Hemangiopericytoma of Gingiva in a 4-Year-Old Child: A Rare Case Report

A hemangiopericytoma is a type of soft tissue sarcoma that originates in the pericytes in the walls of capillaries which was characterized in 1942. It is commonly seen in the age group of 5th-6th decades of adults and only 5-10% of cases occur in children with extreme rare occurrence in head and neck region (16%). A rare case of hemangiopericytoma in a 4-year-old female patient is presented here and its clinical, histopathological and immunohistochemically features are discussed. Though surgical resection remains the mainstay, excisional biopsy was primarily performed to reach the final diagnosis. Even in the follow-up phase of 1 year, no recurrence or no metastatic changes were observed.

Intra-operative imaging of surgical margins of canine soft tissue sarcoma using optical coherence tomography

Optical coherence tomography (OCT) is a rapid non-invasive imaging technique that has shown high sensitivity for intra-operative surgical margin assessment in human breast cancer clinical trials. This promising technology has not been evaluated in veterinary medicine. The objective of this study was to correlate normal and abnormal histological features with OCT images for surgical margins from excised canine soft tissue sarcoma (STS) and to establish image evaluation criteria for identifying positive surgical margins. Fourteen client-owned dogs underwent surgical resection of a STS and OCT imaging of 2 to 4 areas of interest on the resected specimen were performed. Following imaging these areas were marked with surgical ink and trimmed for histopathology evaluation. Results showed that different tissue types had distinct characteristic appearances on OCT imaging. Adipose tissue exhibited a relatively low scattering and a honey-comb texture pattern. Skeletal muscle and sarcoma tissue were both dense and highly scattering. While sarcoma tissue was highly scattering, it did not have organized recognizable structure in contrast to muscle which showed clear fibre alignment patterns. In this investigation, we showed different tissue types had different and characteristic scattering and image texture appearances on OCT, which closely correlate with low-power histology images. Given the differentiation between tissue types the results support that OCT could be used to identify positive surgical margins immediately following resection of STS. Further research is needed to assess the diagnostic accuracy of this method for surgical margin assessment.

Neurofibroma of the ulnar nerve in the carpal canal in a dog: treatment by marginal neurectomy

Peripheral nerve sheath tumours arising in the plexus or peripheral nerves can be treated by limb amputation. There are few reports of these tumours affecting peripheral nerves in the distal regions of the limbs. Here we describe a case of neurofibroma affecting the palmar branch of the ulnar nerve in an Irish setter. Surgical treatment in the region of the carpus by ulnar neurectomy resulted in resolution of chronic thoracic limb lameness. At 11 months following the surgery, clinical examination and MRI did not detect any evidence of recurrence. Neurectomy may be a feasible option for management of selected cases of distally located peripheral nerve sheath tumours.

Curative-intent radical en bloc resection using a minimum of a 3 cm margin in feline injection-site sarcomas: a retrospective analysis of 131 cases

Objectives Owing to its highly infiltrative growth, feline injection-site sarcoma (FISS) carries a significant risk of local tumour recurrence. Parameters of possible prognostic significance (eg, tumour size and location, resection of de novo vs recurrent tumours, and achievement of tumour-free surgical margins) were examined with regard to their influence on recurrence rate (RR), disease-free interval (DFI) and survival time (ST). Methods This was a retrospective analysis of cats with FISSs located on the chest or abdominal wall or the interscapular region treated in a single institution using a standardised radical resection technique with 3 cm lateral margins and full-thickness body wall resection (tumours over chest/abdominal wall) or a minimum of two fascial planes (interscapular tumours). Results Median postoperative DFI and ST of 131 cats with FISSs was 21 and 24 months, respectively. Patients operated on for recurrent tumours were significantly more likely to die from tumour-related reasons compared with patients with de novo tumours ( P <0.001). RR and DFI in the different tumour locations were comparable ( P = 0.544 and P = 0.17, respectively). Local tumour recurrence occurred in 38.1% of the cats. Cats operated on for tumour recurrences had a significantly higher chance of another recurrence (RR 55.5% vs 33.3%; P = 0.005). Completeness of excision was determined by taking tumour bed biopsies. Tumour bed biopsies that did not contain tumour cells were associated with a significantly lower RR compared with those with tumour cells (30.5% vs 76.2%). Conclusions and relevance Depending on prognostic factors such as surgery for primary vs recurrent tumour, tumour-free resection margins and tumour location, the RR in FISS ranges from 33-55%, despite curative intent radical surgery. This study may help in identifying patients at risk for recurrence.

Evaluation of information presented within soft tissue sarcoma histopathology reports in the United States: 2012-2015

Despite the existence of the American College of Veterinary Pathology guidelines for tumour biopsy specimens, anecdotally the authors' have seen inconsistency of reporting of information on the pathology report for canine soft tissue sarcomas (STSs). If crucial aspects are not reported this can result in slower or impeded patient care. This retrospective study evaluated 255 STS histopathology reports submitted from across the United States. Reports were evaluated by a single observer to assess for information contained in 5 main categories: patient history and signalment, gross and microscopic description, grading, histologic margins and the comments section. Inclusion criteria for histopathology reports included a final diagnosis of STS, having a microscopic description and resulting from the initial surgical resection. The majority of the reports stated the patient signalment (91.2%) and clinical history (90.8%). However, only 64.8% of the reports had a gross description of the specimen. Histologic margin description was present in 229 reports (91.6%), however, only 149 reports (59.6%) stated an objective measurement of these margins. Histologic classification was stated in 50.0% of the reports, while grade was given on 97.2% of the reports. Variability in histopathologic reporting including histologic margin description for resected canine STS was identified. Given surgical treatment is the mainstay for STS and histopathological assessment plays an important role in determination of whether additional surgery, radiation or chemotherapy is needed. Standardization or checklists like the American College of Pathology utilize may be helpful to ensure histopathologic characteristics are reported that may guide further treatment recommendations.

Inter- and intra-rater reliability and agreement in determining subcutaneous tumour margins in dogs

The objective of this prospective study was to evaluate agreement and reliability of calliper-based measurements of locally invasive subcutaneous malignant tumours in dogs. Four raters measured the longest diameter of 12 subcutaneous tumours (7 soft tissue sarcomas and 5 mast cell tumours) from 11 client-owned dogs during 3 randomized, blinded measurement trials, both pre- and post-sedation. Inter- and intra-rater reliability was evaluated using intra-class correlation coefficient (ICC) and agreement was evaluated using Bland-Altman plots. Inter- and intra-rater reliability was good (ICC range of 0.8694-0.89520) and excellent (ICC range of 0.9720-0.9966), respectively. For agreement calculations, an a priori clinically relevant limit of agreement of 10 mm was set. Inter- and intra-rater agreement was unacceptable with inter-rater limits of agreement ranging from 15.9 to 55.6 mm and intra-rater limit of agreement ranging from 11.9 to 28.1 mm. Review of the measurement trial photographs revealed that calliper orientation changes were frequent, occurring in 9/12 (75%) and 8/12 (67%) pre- and post-sedation cases. No significant correlation was found between inter-rater measurement standard deviations and calliper orientation changes or dog body condition score. These findings suggest veterinarians may have poor agreement in determining the gross edge of tumours, which is expected to introduce bias and inconsistency in tumour staging, assessing response to therapy, and surgical margin planning. Due to the potential consequences for veterinary cancer patients, future studies are needed to validate the present findings.

Soft tissue sarcoma in the dog - part 1: a current review

Soft tissue sarcomas are derived from tissues of mesenchymal origin. Although local recurrence following surgical resection is the characteristic challenge in their management, 40% dogs with high-grade tumours may also develop metastatic disease, despite successful local control. Soft tissue sarcoma is a complex disease and there are many uncertainties regarding the biology and optimal clinical management. There are currently no diagnostic tests that can reliably predict the amount of surgical margin required for a particular tumour, so there can be a mismatch between treatment and disease. Historically, the tendency has been to always recommend wide excision margins but this is not fully supported by recent evidence. A selection bias for less aggressive soft tissue sarcomas in primary care practice can account for good outcomes that are achieved despite narrow surgical excision margins. On the other hand, inappropriately conservative treatment will adversely affect outcomes for patients with more aggressive disease. This review provides an update on the current understanding of management of canine soft tissue sarcomas.

Identification of the two KIT isoforms and their expression status in canine hemangiosarcomas

BACKGROUND

KIT is a tyrosine kinase growth factor receptor. High expression of KIT has been found in several tumors including canine hemangiosarcoma (HSA). This study investigated the correlation of KIT expression and c-kit sequence mutations in canine HSAs and benign hemangiomas (HAs).

RESULTS

Immunohistochemistry (IHC) staining confirmed KIT expression in 94.4 % (34/36) of HSAs that was significantly higher than 0 % in HAs (0/16). Sequencing the entire c-kit coding region of HSAs and normal canine cerebellums (NCCs) revealed GNSK-deletion in exon 9. As for exon 9 genotyping by TA-cloning strategy, GNSK-deletion c-kit accounted for 48.6 % (68/140) colonies amplified from12 KIT-positive HSAs, a significantly higher frequency than 14.1 % (9/64) of colonies amplified from six NCCs.

CONCLUSIONS

Due to the distinct expression pattern revealed by IHC, KIT might be used to distinguish benign or malignant vascular endothelial tumors. Moreover, the high incidence of GNSK-deletion c-kit in canine HSAs implicates KIT isoforms as possibly participating in the tumorigenesis of canine HSAs.

Evaluation of intraoperative fluorescence imaging-guided surgery in cancer-bearing dogs: a prospective proof-of-concept phase II study in 9 cases

The objective was to prospectively evaluate the application of intraoperative fluorescence imaging (IOFI) in the surgical excision of malignant masses in dogs, using a novel lipid nanoparticle contrast agent. Dogs presenting with spontaneous soft-tissue sarcoma or subcutaneous tumors were prospectively enrolled. Clinical staging and whole-body computed tomography (CT) were performed. All the dogs received an intravenous injection of dye-loaded lipid nanoparticles, LipImage 815. Wide or radical resection was realized after CT examination. Real-time IOFI was performed before skin incision and after tumor excision. In cases of radical resection, the lymph nodes (LNs) were imaged. The margin/healthy tissues fluorescence ratio or LN/healthy tissues fluorescence ratio was measured and compared with the histologic margins or LN status. Nine dogs were included. Limb amputation was performed in 3 dogs, and wide resection in 6. No adverse effect was noted. Fluorescence was observed in all 9 of the tumors. The margins were clean in 5 of 6 dogs after wide surgical resection, and the margin/healthy tissues fluorescence ratio was close to 1.0 in all these dogs. Infiltrated margins were observed in 1 case, with a margin/healthy tissues fluorescence ratio of 3.2. Metastasis was confirmed in 2 of 3 LNs, associated with LN/healthy tissues fluorescence ratios of 2.1 and 4.2, whereas nonmetastatic LN was associated with a ratio of 1.0. LipImage 815 used as a contrast agent during IOFI seemed to allow for good discrimination between tumoral and healthy tissues. Future studies are scheduled to evaluate the sensitivity and specificity of IOFI using LipImage 815 as a tracer.

Diagnostic value of neutrophil-lymphocyte and albumin-globulin ratios in canine soft tissue sarcoma

OBJECTIVE

To investigate the ability of neutrophil-to-lymphocyte ratio and albumin-to-globulin ratio to differentiate soft tissue sarcoma from benign soft tissue tumours.

METHODS

A retrospective study of pretreatment haematology and biochemistry in dogs diagnosed with soft tissue sarcoma or benign soft tissue tumours. The neutrophil-to-lymphocyte ratio and albumin-to-globulin ratio were compared between the two groups. In dogs diagnosed with soft tissue sarcoma, the relationship of neutrophil-to-lymphocyte ratio and albumin-to-globulin ratio to histological tumour grade (I to III) was assessed.

RESULTS

In the dogs with soft tissue sarcoma (n=22), the neutrophil-to-lymphocyte ratio was significantly increased and the albumin-to-globulin ratio decreased compared to those with benign soft tissue tumours (n=14). The neutrophil-to-lymphocyte ratio and albumin-to globulin ratio were not useful as predictors of tumour grade in dogs diagnosed with soft tissue sarcoma.

CLINICAL SIGNIFICANCE

Pretreatment neutrophil-to-lymphocyte ratio and albumin-to globulin ratio may aid with diagnosis and optimal treatment planning. Further investigation into their prognostic implications is warranted.

DOG1 is a sensitive and specific immunohistochemical marker for diagnosis of canine gastrointestinal stromal tumors

Gastrointestinal stromal tumors (GISTs) and leiomyosarcomas are histologically similar primary neoplasms commonly occurring in the gastrointestinal tract of dogs and humans. Immunohistochemical staining (IHC) is needed to differentiate between these 2 entities and positive reactivity for KIT (cluster of differentiation [CD]117) is regarded as the gold standard for diagnosis of canine GIST. Studies estimate 5–10% of human GISTs stain negative or only weakly positive for KIT and have identified DOG1 (discovered on gastrointestinal stromal tumors protein 1) as a highly sensitive and specific marker for human GISTs. The purpose of this study was to evaluate immunoreactivity of a commercially available DOG1 antibody for use in diagnosis of canine GISTs. Fifty-five primary mesenchymal gastrointestinal tumors with histologic features consistent with GIST or leiomyosarcoma were evaluated via IHC for KIT, DOG1, and desmin. A subset of tumors was additionally evaluated for reactivity for smooth muscle actin (SMA). Thirty-three tumors (60%) were diagnosed as GIST based on positive immunoreactivity for KIT or DOG1 regardless of reactivity for desmin or SMA. Most GISTs (32/33, 97.0%) had similar staining for both KIT and DOG1. DOG1 expression was identified in 2 tumors (1 study tumor and 1 additional tumor) negative for KIT and desmin that had histologic features consistent with KIT-negative, platelet-derived growth factor receptor-alpha (PDGFRA)-mutant human GISTs. Our results suggest that DOG1 has improved specificity and sensitivity to that of KIT for differentiating between canine GISTs and leiomyosarcomas. Inclusion of both DOG1 and KIT IHC in diagnostic panels will improve the accuracy of canine GIST diagnosis.

Malignant peripheral nerve sheath tumor of the third eyelid in a 3-year-old Rhodesian Ridgeback

A 3-year-old Rhodesian Ridgeback was presented with conjunctivitis, enlargement of the third eyelid and a dorsotemporal deviation of the right eye. A mass within the third eyelid was detected and excised. The histopathologic examination showed a malignant peripheral nerve sheath tumor, which most likely is a neurofibrosarcoma based on immunohistochemistry.

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.

Flape cutâneo em padrão axial auricular caudal para correção de defeito extenso após extirpação de fibrossarcoma facial em felino

Um felino que apresentava massa de grandes dimensões, localizada no lábio superior direito, foi submetido à cirurgia para exérese do aumento de volume mantendo-se margem de tecido sadio. O defeito facial foi reconstituído com um flape cutâneo em padrão axial auricular caudal. A ferida apresentou cicatrização em primeira intenção em sua maior extensão, com adequados resultados cosmético e funcional. A avaliação histopatológica revelou se tratar de fibrossarcoma, o qual não apresentou recidivas locais pelo período mínimo de 21 meses de pós-operatório.

Photodynamic hyperthermal chemotherapy with indocyanine green: a novel cancer therapy for 16 cases of malignant soft tissue sarcoma

Sixteen cases of malignant soft tissue sarcoma (STS; 10 canines and six felines) were treated with a novel triple therapy that combined photodynamic therapy, hyperthermia using indocyanine green with a broadband light source, and local chemotherapy after surgical tumor resection. This triple therapy was called photodynamic hyperthermal chemotherapy (PHCT). In all cases, the surgical margin was insufficient. In one feline case, PHCT was performed without surgical resection. PHCT was performed over an interval of 1 to 2 weeks and was repeated three to 21 times. No severe side effects, including severe skin burns, necrosis, or skin suture rupture, were observed in any of the animals. No disease recurrence was observed in seven out of 10 (70.0%) dogs and three out of six (50.0%) cats over the follow-up periods ranging from 238 to 1901 days. These results suggest that PHCT decreases the risk of STS recurrence. PHCT should therefore be considered an adjuvant therapy for treating companion animals with STS in veterinary medicine.

Effects of intratumoral administration of a hyaluronan-cisplatin nanoconjugate to five dogs with soft tissue sarcomas

OBJECTIVE

To determine the effects of intratumoral injection of a hyaluronan-cisplatin nanoconjugate on local and systemic platinum concentrations and systemic toxicosis.

ANIMALS

5 dogs with spontaneous soft tissue sarcomas (STSs).

PROCEDURES

For each dog, approximately 1.5 mL of hyaluronan nanocarrier conjugated with 20 mg of cisplatin was injected into an external STS. Blood samples were collected immediately before (0 hours) and at 0.5, 1, 2, 3, 4, 24, and 96 hours after hyaluronan-cisplatin injection for pharmacokinetic analyses. Urine samples were obtained at 0 and at 96 hours after hyaluronan-cisplatin injection for urinalysis. Each treated STS and its sentinel lymph nodes were surgically removed 96 hours after the hyaluronan-cisplatin injection. Inductively coupled plasma mass spectrometry was used to measure platinum concentrations in blood samples, tumors, and lymph nodes.

RESULTS

No tissue reactions were detected 96 hours after hyaluronan-cisplatin injection. Mean ± SD area under the curve, peak concentration, and terminal half-life for unbound (plasma) and total (serum) platinum were 774.6 ± 221.1 ng•h/mL and 3,562.1 ± 2,031.1 ng•h/mL, 56.5 ± 20.9 ng/mL and 81.6 ± 40.4 ng/mL, and 33.6 ± 16.1 hours and 51.2 ± 29.1 hours, respectively. Platinum concentrations ranged from 3,325 to 8,229 ng/g in STSs and 130 to 6,066 ng/g in STS-associated lymph nodes.

CONCLUSIONS AND CLINICAL RELEVANCE

Intratumoral injection of the hyaluronan-cisplatin nanoconjugate was well tolerated in treated dogs. Following intratumoral hyaluronan-cisplatin injection, platinum concentration was 1,000-fold and 100-fold greater within treated tumors and tumor-draining lymphatics, respectively, compared with that in plasma.

Radical excision with five-centimeter margins for treatment of feline injection-site sarcomas: 91 cases (1998-2002)

OBJECTIVE

To evaluate outcomes of radical excision of feline injection-site sarcomas (ISS) via assessment of local recurrence and metastasis rates, survival times, and complications associated with surgery.

DESIGN

Retrospective case series.

ANIMALS

91 cats with ISS.

PROCEDURES

Medical records of cats that had radical excision of ISS without adjunctive treatment were reviewed. Information extracted included sex, type of surgical procedure, histologic tumor grade, tumor diameter, time from tumor detection to definitive surgery, complications associated with surgery, whether tumors recurred locally or metastasized, and survival times. Diagnosis of ISS was histologically confirmed, and additional follow-up was performed.

RESULTS

Overall median survival time was 901 days. Thirteen of 91 (14%) cats had local tumor recurrence; 18 (20%) cats had evidence of metastasis after surgery. Median survival time of cats with and without recurrence was 499 and 1,461 days, respectively. Median survival time of cats with and without metastasis was 388 and 1,528 days, respectively. Tumor recurrence and metastasis were significantly associated with survival time, whereas other examined variables were not. Major complications occurred in 10 cats, including 7 with incisional dehiscence.

CONCLUSIONS AND CLINICAL RELEVANCE

Radical excision of ISS resulted in a metastasis rate similar to rates reported previously; the local recurrence rate appeared to be substantially less than rates reported after less aggressive surgeries, with or without adjuvant treatment. Major complication rates were similar to rates reported previously after aggressive surgical resection of ISS. Radical excision may be a valuable means of attaining an improved outcome in the treatment of feline ISS.

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.