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Bertram CA, Donovan TA, Bartel A. Mitotic activity: A systematic literature review of the assessment methodology and prognostic value in canine tumors. Vet Pathol 2024; 61:752-764. [PMID: 38533804 DOI: 10.1177/03009858241239565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
One of the most relevant prognostic indices for tumors is cellular proliferation, which is most commonly measured by the mitotic activity in routine tumor sections. The goal of this systematic review was to analyze the methods and prognostic relevance of histologically measuring mitotic activity that have been reported for canine tumors in the literature. A total of 137 articles that correlated the mitotic activity in canine tumors with patient outcome were identified through a systematic (PubMed and Scopus) and nonsystematic (Google Scholar) literature search and eligibility screening process. Mitotic activity methods encompassed the mitotic count (MC, number of mitotic figures per tumor area) in 126 studies, presumably the MC (method not specified) in 6 studies, and the mitotic index (MI, number of mitotic figures per number of tumor cells) in 5 studies. A particularly high risk of bias was identified based on the available details of the MC methods and statistical analyses, which often did not quantify the prognostic discriminative ability of the MC and only reported P values. A significant association of the MC with survival was found in 72 of 109 (66%) studies. However, survival was evaluated by at least 3 studies in only 7 tumor types/groups, of which a prognostic relevance is apparent for mast cell tumors of the skin, cutaneous melanoma, and soft tissue tumor of the skin and subcutis. None of the studies using the MI found a prognostic relevance. This review highlights the need for more studies with standardized methods and appropriate analysis of the discriminative ability to prove the prognostic value of the MC and MI in various tumor types. Future studies are needed to evaluate the influence of the performance of individual pathologists on the appropriateness of prognostic thresholds and investigate methods to improve interobserver reproducibility.
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Flory A, Wilson-Robles H. Noninvasive Blood-Based Cancer Detection in Veterinary Medicine. Vet Clin North Am Small Anim Pract 2024; 54:541-558. [PMID: 38195361 DOI: 10.1016/j.cvsm.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
The past decade has seen incredible advances in blood-based cancer detection in people and in dogs - yet this represents only a glimpse of the benefits these tests can provide to patients. The clinical uses of this technology range from screening asymptomatic individuals for early detection to use as an aid in diagnosis when cancer is suspected, to cancer monitoring both during and after treatment. This article summarizes the benefits of early cancer detection and examines use cases and methods of blood-based cancer detection in dogs, including quantitative, qualitative, and alternative approaches.
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Affiliation(s)
- Andi Flory
- PetDx, 9310 Athena Circle, Suite 230, La Jolla, CA 92037, USA.
| | - Heather Wilson-Robles
- Volition Veterinary Diagnostics Development, LLC 1489 West Warm Springs Road Suite 110, Henderson, NV 89014, USA; Ethos Discovery, 10435 Sorrento Valley Road, San Diego, CA 92121, USA; The Oncology Service, United Veterinary Health, 6651 Backlick Road, Springfield, VA 22150, USA
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Brachelente C, Torrigiani F, Porcellato I, Drigo M, Brescia M, Treggiari E, Ferro S, Zappulli V, Sforna M. Tumor Immune Microenvironment and Its Clinicopathological and Prognostic Associations in Canine Splenic Hemangiosarcoma. Animals (Basel) 2024; 14:1224. [PMID: 38672372 PMCID: PMC11047608 DOI: 10.3390/ani14081224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Tumor cells can induce important cellular and molecular modifications in the tissue or host where they grow. The idea that the host and tumor interact with each other has led to the concept of a tumor microenvironment, composed of immune cells, stromal cells, blood vessels, and extracellular matrix, representing a unique environment participating and, in some cases, promoting cancer progression. The study of the tumor immune microenvironment, particularly focusing on the role of tumor-infiltrating lymphocytes (TILs), is highly relevant in oncology due to the prognostic and therapeutic significance of TILs in various tumors and their identification as targets for therapeutic intervention. Canine splenic hemangiosarcoma (HSA) is a common tumor; however, its immune microenvironment remains poorly understood. This retrospective study aimed to characterize the histological and immunohistochemical features of 56 cases of canine splenic HSA, focusing particularly on tumor-infiltrating lymphocytes (TILs). We assessed the correlations between the lymphocytic response, the macroscopic and histological characteristics of the tumor, and the survival data. Our study demonstrated that FoxP3 distribution was associated with tumor-related death and survival, while the CD20 count was associated with metastasis. This study provides an in-depth characterization of the tumor immune microenvironment in canine splenic HSA and describes potential prognostic factors.
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Affiliation(s)
- Chiara Brachelente
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (C.B.); (M.B.); (M.S.)
| | - Filippo Torrigiani
- Department of Comparative Biomedicine and Food Science, University of Padua, AGRIPOLIS, Viale dell’Università 16, 35020 Legnaro, Italy; (F.T.); (S.F.); (V.Z.)
| | - Ilaria Porcellato
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (C.B.); (M.B.); (M.S.)
| | - Michele Drigo
- Department of Animal Medicine, Production and Health, University of Padua, AGRIPOLIS, Viale dell’Università 16, 35020 Legnaro, Italy;
| | - Martina Brescia
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (C.B.); (M.B.); (M.S.)
| | - Elisabetta Treggiari
- Clinica Veterinaria Croce Blu, via San Giovanni Bosco 27/C, 15121 Alessandria, Italy;
| | - Silvia Ferro
- Department of Comparative Biomedicine and Food Science, University of Padua, AGRIPOLIS, Viale dell’Università 16, 35020 Legnaro, Italy; (F.T.); (S.F.); (V.Z.)
| | - Valentina Zappulli
- Department of Comparative Biomedicine and Food Science, University of Padua, AGRIPOLIS, Viale dell’Università 16, 35020 Legnaro, Italy; (F.T.); (S.F.); (V.Z.)
| | - Monica Sforna
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy; (C.B.); (M.B.); (M.S.)
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Ferrari R, Marconato L, Boracchi P, Stefanello D, Godizzi F, Murgia D, Schievenin V, Amati M, Faroni E, Roccabianca P. Splenic stromal sarcomas in dogs: Outcome and clinicopathological prognostic factors in 32 cases. Vet Comp Oncol 2024; 22:12-21. [PMID: 37918913 DOI: 10.1111/vco.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 10/06/2023] [Accepted: 10/19/2023] [Indexed: 11/04/2023]
Abstract
Due to the low frequency and the changes in diagnostic techniques and terminology during the last few years, only little clinical information is available on splenic stromal sarcoma (SSS). This multi-institutional study aimed at gathering clinical cases of SSS in dogs and investigates their clinical behaviour, as well as analyse possible clinicopathological prognostic factors, including the use of adjuvant therapy. Dogs with a histologically confirmed SSS that underwent splenectomy were retrospectively included. To be included in the study, either FFPE tissue blocks or multiple tissue sections had to be available for histopathologic and immunohistochemical revision. Clinical and pathological variables, along with adjuvant therapy data, were collected. Cumulative incidence of metastatic disease was analysed through univariate and bivariate analyses. The impact of adjuvant chemotherapy on metastasis incidence and survival was assessed, considering an estimated propensity score. A total of 32 dogs were included. Among them, 22 developed metastases with an incidence of 37.5%, 59.38%, and 65.94% at 6, 12, and 24 months, respectively. Univariate analysis identified mitotic count, total scoring, and necrosis as prognostic factors. In bivariate analysis, mitotic count remained prognostic. The administration of adjuvant chemotherapy did not have an impact on metastasis incidence or survival time. The study found that dogs with SSSs are at high risk of metastasis, although a small subgroup may experience longer survival after splenectomy. Mitotic count was the only variable having a reliable prognostic impact. Adjuvant chemotherapy did not appear to decrease the incidence of metastasis or prolong survival in these dogs.
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Affiliation(s)
- Roberta Ferrari
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Laura Marconato
- Dipartimento di Scienze Mediche Veterinarie, Alma Mater Studiorum, Università di Bologna, Ozzano dell'Emilia, Italy
| | - Patrizia Boracchi
- Dipartimento di Scienze Cliniche e di Comunità, Laboratorio di Statistica Medica, Biometria ed Epidemiologia "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Damiano Stefanello
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Francesco Godizzi
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | | | | | - Maria Amati
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
| | - Eugenio Faroni
- Dipartimento di Scienze Mediche Veterinarie, Alma Mater Studiorum, Università di Bologna, Ozzano dell'Emilia, Italy
| | - Paola Roccabianca
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, Lodi, Italy
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Hildebrandt I, Culp WTN, Griffin MA. A Systematic Review of Canine Cystectomy: Indications, Techniques, and Outcomes. Animals (Basel) 2023; 13:2896. [PMID: 37760296 PMCID: PMC10525623 DOI: 10.3390/ani13182896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/30/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
This review provides a summary of the literature encompassing partial and total cystectomy procedures in dogs and subsequent conclusions that can be drawn. Surgical excision as a component of treatment for lower urinary tract neoplasia in dogs may enhance survival time and result in acceptable quality of life, though risk for surgical complications is substantial, particularly following total cystectomy procedures. However, for dogs with urothelial carcinoma, cystectomy is generally not considered curative and disease progression is common. Appropriate case selection and thorough preoperative discussion with owners regarding potential risks and benefits of cystectomy are imperative for successful outcomes.
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Affiliation(s)
- Isabella Hildebrandt
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce St., Philadelphia, PA 19104, USA
| | - William T. N. Culp
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, One Garrod Avenue, Davis, CA 95616, USA
| | - Maureen A. Griffin
- Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce St., Philadelphia, PA 19104, USA
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De Nardi AB, de Oliveira Massoco Salles Gomes C, Fonseca-Alves CE, de Paiva FN, Linhares LCM, Carra GJU, dos Santos Horta R, Ruiz Sueiro FA, Jark PC, Nishiya AT, de Carvalho Vasconcellos CH, Ubukata R, Batschinski K, Sobral RA, Fernandes SC, Biondi LR, De Francisco Strefezzi R, Matera JM, Rangel MMM, dos Anjos DS, Brunner CHM, Laufer-Amorim R, Cadrobbi KG, Cirillo JV, Martins MC, de Paula Reis Filho N, Silva Lessa DF, Portela R, Scarpa Carneiro C, Ricci Lucas SR, Fukumasu H, Feliciano MAR, Gomes Quitzan J, Dagli MLZ. Diagnosis, Prognosis, and Treatment of Canine Hemangiosarcoma: A Review Based on a Consensus Organized by the Brazilian Association of Veterinary Oncology, ABROVET. Cancers (Basel) 2023; 15:cancers15072025. [PMID: 37046686 PMCID: PMC10093745 DOI: 10.3390/cancers15072025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
Hemangiosarcoma is a mesenchymal neoplasm originating in the endothelial cells of blood vessels; they can be classified as non-visceral and visceral types. Non-visceral hemangiosarcomas can affect the skin, subcutaneous tissues, and muscle tissues; visceral hemangiosarcomas can affect the spleen, liver, heart, lungs, kidneys, oral cavity, bones, bladder, uterus, tongue, and retroperitoneum. Among domestic species, dogs are most affected by cutaneous HSA. Cutaneous HSA represents approximately 14% of all HSA diagnosed in this species and less than 5% of dermal tumors, according to North American studies. However, Brazilian epidemiological data demonstrate a higher prevalence, which may represent 27 to 80% of all canine HSAs and 13.9% of all skin neoplasms diagnosed in this species. Cutaneous HSA most commonly affects middle-aged to elderly dogs (between 8 and 15 years old), with no gender predisposition for either the actinic or non-actinic forms. The higher prevalence of cutaneous HSA in some canine breeds is related to lower protection from solar radiation, as low skin pigmentation and hair coverage lead to greater sun exposure. Actinic changes, such as solar dermatosis, are frequent in these patients, confirming the influence of solar radiation on the development of this neoplasm. There are multiple clinical manifestations of hemangiosarcoma in canines. The diagnostic approach and staging classification of cutaneous HSAs are similar between the different subtypes. The definitive diagnosis is obtained through histopathological analysis of incisional or excisional biopsies. Cytology can be used as a presurgical screening test; however, it has little diagnostic utility in cases of HSA because there is a high risk of blood contamination and sample hemodilution. Surgery is generally the treatment of choice for dogs with localized non-visceral HSA without evidence of metastatic disease. Recently, electrochemotherapy (ECT) has emerged as an alternative therapy for the local ablative treatment of different neoplastic types; the use of radiotherapy for the treatment of dogs with cutaneous HSA is uncommon. There is greater consensus in the literature regarding the indications for adjuvant chemotherapy in subcutaneous and muscular HSA; doxorubicin is the most frequently used antineoplastic agent for subcutaneous and muscular subtypes and can be administered alone or in combination with other drugs. Other therapies include antiangiogenic therapy, photodynamic therapy, the association of chemotherapy with the metronomic dose, targeted therapies, and natural products. The benefits of these therapies are presented and discussed. In general, the prognosis of splenic and cardiac HSA is unfavorable. As a challenging neoplasm, studies of new protocols and treatment modalities are necessary to control this aggressive disease.
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Flory A, McLennan L, Peet B, Kroll M, Stuart D, Brown D, Stuebner K, Phillips B, Coomber BL, Woods JP, Miller M, Tripp CD, Wolf‐Ringwall A, Kruglyak KM, McCleary‐Wheeler AL, Phelps‐Dunn A, Wong LK, Warren CD, Brandstetter G, Rosentel MC, DiMarzio LR, O'Kell AL, Cohen TA, Grosu DS, Chibuk J, Tsui DWY, Chorny I, Rafalko JM. Cancer detection in clinical practice and using blood-based liquid biopsy: A retrospective audit of over 350 dogs. J Vet Intern Med 2023; 37:258-267. [PMID: 36661398 PMCID: PMC9889684 DOI: 10.1111/jvim.16616] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/14/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Guidelines-driven screening protocols for early cancer detection in dogs are lacking, and cancer often is detected at advanced stages. HYPOTHESIS/OBJECTIVES To examine how cancer typically is detected in dogs and whether the addition of a next-generation sequencing-based "liquid biopsy" test to a wellness visit has the potential to enhance cancer detection. ANIMALS Client-owned dogs with definitive cancer diagnoses enrolled in a clinical validation study for a novel blood-based multicancer early detection test. METHODS Retrospective medical record review was performed to establish the history and presenting complaint that ultimately led to a definitive cancer diagnosis. Blood samples were subjected to DNA extraction, library preparation, and next-generation sequencing. Sequencing data were analyzed using an internally developed bioinformatics pipeline to detect genomic alterations associated with the presence of cancer. RESULTS In an unselected cohort of 359 cancer-diagnosed dogs, 4% of cases were detected during a wellness visit, 8% were detected incidentally, and 88% were detected after the owner reported clinical signs suggestive of cancer. Liquid biopsy detected disease in 54.7% (95% confidence interval [CI], 49.5%-59.8%) of patients, including 32% of dogs with early-stage cancer, 48% of preclinical dogs, and 84% of dogs with advanced-stage disease. CONCLUSIONS/CLINICAL IMPORTANCE Most cases of cancer were diagnosed after the onset of clinical signs; only 4% of dogs had cancer detected using the current standard of care (i.e., wellness visit). Liquid biopsy has the potential to increase detection of cancer when added to a dog's wellness visit.
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Affiliation(s)
| | | | | | | | - Deirdre Stuart
- Department of Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Devon Brown
- Bridge Animal Referral CenterEdmondsWashingtonUSA
| | - Kathy Stuebner
- Clinical Investigation CenterUniversity of MinnesotaSaint PaulMinnesotaUSA
| | - Brenda Phillips
- Veterinary Specialty Hospital of San DiegoSan DiegoCaliforniaUSA
| | - Brenda L. Coomber
- Department of Biomedical Sciences, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - J. Paul Woods
- Institute for Comparative Cancer Investigation at the Mona Campbell Centre for Animal Cancer, Ontario Veterinary College, University of GuelphGuelphOntarioCanada
| | - Mairin Miller
- Veterinary Specialty Hospital of North CountySan MarcosCaliforniaUSA
| | | | - Amber Wolf‐Ringwall
- Department of Veterinary Clinical SciencesUniversity of Minnesota, College of Veterinary MedicineSaint PaulMinnesotaUSA
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Sabattini S, Rigillo A, Foiani G, Marconato L, Vascellari M, Greco A, Agnoli C, Annoni M, Melchiotti E, Campigli M, Benali SL, Bettini G. Clinicopathologic features and biologic behavior of canine splenic nodules with stromal, histiocytic and lymphoid components. Front Vet Sci 2022; 9:962685. [PMID: 36032303 PMCID: PMC9411940 DOI: 10.3389/fvets.2022.962685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
The term fibrohistiocytic nodule has been discouraged in favor of specific pathologic entities, including complex nodular hyperplasia, splenic stromal sarcoma and histiocytic sarcoma. Nevertheless, the diagnosis of splenic lesions with mixed stromal, histiocytic and lymphoid components still remains a challenge due to lack of straightforward histologic criteria. Misestimation of the biologic behavior of these lesions may lead to detrimental consequences on the clinical management of patients. In this study, we retrospectively evaluated the clinicopathologic features and outcome of canine splenic nodular lesions with mixed components, to identify prognostic factors and histologic criteria of malignancy. Thirty-seven cases were included. Immunohistochemistry did not allow for further subclassification. Nine (24.3%) dogs died from disease-related causes after a median of 234 days (range, 48–1,247). One-, 2- and 3-year disease-specific survival rates were 80, 60, and 43%, respectively. When considering nodules with stromal cell atypia and at least one of mitotic count ≥9, presence of karyomegaly/multinucleated cells and lymphoid component <40%, half of these dogs died of disease-related causes with a median disease-specific survival time of 548 days (95% CI, 0-1216). In the remaining dogs, no disease-related death was reported (P < 0.001). Canine splenic nodular lesions with mixed stromal, histiocytic and lymphoid components and histologic criteria of malignancy may behave aggressively, leading to distant metastasis and death. In the absence of further criteria aiding their classification, and to better characterize their biologic behavior, we encourage the distinction of these complex splenic tumors from conventional sarcomas and histiocytic sarcomas.
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Affiliation(s)
- Silvia Sabattini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Ozzano dell'Emilia, Bologna, Italy
- *Correspondence: Silvia Sabattini
| | - Antonella Rigillo
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Greta Foiani
- Istituto Zooprofilattico Sperimentale delle Venezie, Padua, Italy
| | - Laura Marconato
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Marta Vascellari
- Istituto Zooprofilattico Sperimentale delle Venezie, Padua, Italy
| | - Alessandra Greco
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | - Chiara Agnoli
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Ozzano dell'Emilia, Bologna, Italy
| | | | - Erica Melchiotti
- Istituto Zooprofilattico Sperimentale delle Venezie, Padua, Italy
| | - Michela Campigli
- Oncology Division, San Marco Veterinary Clinic and Laboratory, Padua, Italy
| | | | - Giuliano Bettini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Ozzano dell'Emilia, Bologna, Italy
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Matz BM, Hlusko KC, Linden DS, Tillson DM, Hofmeister E. Ex vivo comparison of different thoracoabdominal stapler sizes for typhlectomy in canine cadavers. Vet Surg 2022; 51:682-687. [PMID: 35191557 DOI: 10.1111/vsu.13793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the influence of staple size on leakage pressure of typhlectomy sites in canine cadavers. STUDY DESIGN Randomized, experimental cadaveric study. ANIMALS Twenty-four fresh canine cadavers. METHODS Ileocecocolic segments were exteriorized following right paracostal laparotomy after euthanasia. Cecal base length and wall thickness were measured. Each cecum was randomly assigned to 1 of 3 groups (TA 30 V3 2.5 mm, TA 60 3.5 mm, and TA 60 4.8 mm). The cecal base was stapled and the cecum was removed. A 10 cm segment including the stapled cecal excision site was tested for initial leak pressure. RESULTS The mean ± standard deviation body weights across the groups were 18.7 ± 6.1 kg, 16.2 ± 7.5 kg, and 14.2 ± 5.5 kg for the TA 30 V3 2.5 mm, TA 60 3.5 mm, and TA 60 4.8 mm groups, respectively (P = .48). There were no differences for mean cecal base length or wall thickness. Mean initial leak pressure (ILP) across groups was 182 ± 111 mmHg (TA 30 V3 2.5 mm), 112 ± 57 mmHg (TA 60 3.5 mm), and 77 ± 60 mmHg (TA 60 4.8 mm) (P = .78). CONCLUSION Each stapler size that was evaluated resulted in a mean ILP in excess of typical intraluminal pressures under normal circumstances. There were no differences among groups. CLINICAL SIGNIFICANCE The results of this cadaveric study support the use of any of the stapler sizes evaluated in similarly sized dogs. A prospective study is needed to be able to correlate stapler size and clinical outcome.
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Affiliation(s)
- Brad M Matz
- Department of Clinical Sciences, Auburn University, Auburn, Alabama, USA
| | - Katelyn C Hlusko
- Department of Clinical Sciences, Auburn University, Auburn, Alabama, USA
| | - Daniel S Linden
- First Coast Veterinary Specialists, Jacksonville, Florida, USA
| | - D Michael Tillson
- Department of Clinical Sciences, Auburn University, Auburn, Alabama, USA
| | - Erik Hofmeister
- Department of Clinical Sciences, Auburn University, Auburn, Alabama, USA
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10
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Spröhnle-Barrera CH, McGhie J, Allavena RE, Owen HC, Palmieri C, Barnes TS. Epidemiology and Survival of Dogs Diagnosed with Splenic Lymphoid Hyperplasia, Complex Hyperplasia, Stromal Sarcoma and Histiocytic Sarcoma. Animals (Basel) 2022; 12:960. [PMID: 35454207 PMCID: PMC9028997 DOI: 10.3390/ani12080960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 12/12/2022] Open
Abstract
Canine splenic fibrohistiocytic nodules traditionally encompassed benign lymphoid hyperplasia, complex hyperplasia, and malignant fibrous histiocytoma. The latter has been recently re-classified into histiocytic sarcoma and stromal sarcoma. Reliable indicators of post-splenectomy survival and demographic factors predisposing to the four types of nodules are not completely understood. This study aims to estimate frequency, survival times, and identify risk factors of splenectomized dogs diagnosed with lymphoid hyperplasia, complex hyperplasia, histiocytic sarcoma, and stromal sarcoma using medical records containing histopathological diagnosis from the VetCompass Australia database (1989−2018), which collects demographic, and clinical information from veterinary clinics. Out of 693 dogs, 315 were diagnosed with fibrohistiocytic nodules, mostly lymphoid hyperplasia (169/693, 24.4%), followed by stromal sarcoma (59/693, 8.5%), complex hyperplasia (55/693, 7.9%), and histiocytic sarcoma (32/693, 4.6%). Dogs aged 8−10 years were more likely to be diagnosed with histiocytic or stromal sarcoma than lymphoid hyperplasia. Dogs diagnosed with lymphoid hyperplasia had a longer survival time than those with other diagnoses (median > 2 years). Dogs diagnosed with histiocytic sarcoma had longer survival times (median 349 days) than stromal sarcoma (median 166 days). Results suggest that knowledge of the type of splenic fibrohistiocytic nodule, patients’ age, and sex can be used to increase prognostic accuracy.
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Affiliation(s)
| | - Jayne McGhie
- School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
| | - Rachel E Allavena
- School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
| | - Helen C Owen
- School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
| | - Chiara Palmieri
- School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
| | - Tamsin S Barnes
- School of Veterinary Science, University of Queensland, Gatton, QLD 4343, Australia
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11
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Lomas DC, Garrett K, Taylor D, Havlicek M, Jenkins PL. Primary mediastinal spindle cell sarcoma in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Daniel C. Lomas
- Surgery Department Small Animal Specialist Hospital Central Coast New South Wales Australia
| | - Katrina Garrett
- Radiology Department Small Animal Specialist Hospital Central Coast New South Wales Australia
| | | | - Martin Havlicek
- Surgery Department Small Animal Specialist Hospital Sydney New South Wales Australia
| | - Paul L. Jenkins
- Surgery Department Small Animal Specialist Hospital Central Coast New South Wales Australia
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12
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Avallone G, Pellegrino V, Muscatello LV, Roccabianca P, Castellani G, Sala C, Tecilla M, Valenti P, Sarli G. Canine smooth muscle tumors: A clinicopathological study. Vet Pathol 2021; 59:244-255. [PMID: 34955045 DOI: 10.1177/03009858211066862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Canine smooth muscle tumors (SMTs) commonly develop in the alimentary and female genital tracts and less frequently in soft tissue. The definition of histological criteria of malignancy is less detailed for SMTs in dogs than in humans. This study evaluated the clinicopathologic features of canine SMTs and compared the veterinary and human medical criteria of malignancy. A total of 105 canine SMTs were evaluated histologically and classified according to both veterinary and human criteria. The Ki67 labeling index was assessed in all SMTs. Estrogen receptor (ER) and progesterone receptor (PR) expression was evaluated for soft tissue SMTs. Follow-up data were available in 25 cases. SMTs were diagnosed in the female genital tract (42%), alimentary tract (22%), and soft tissue (20%). Soft tissue SMTs frequently arose in the perigenital area, pelvic cavity, and retroperitoneum. A subset of soft tissue SMTs expressed ER and/or PR, resembling the gynecologic type of soft tissue SMT in humans. SMTs were less frequently malignant when assessed with human criteria than with veterinary criteria, better reflecting their benign behavior, especially in the genital tract where human criteria tolerate a higher mitotic count for leiomyoma. Decreased differentiation was correlated with increased proliferation, necrosis, and reduced desmin expression. Mitotic count, Ki67 labeling index, and necrosis were correlated with metastases and tumor-related death. Further prognostic studies are warranted to confirm the better performance of the human criteria when assessing SMT malignancy, especially genital cases, to confirm their usefulness in ER/PR-expressing soft tissue SMTs, and to better define the most useful prognostic parameters for canine SMTs.
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Affiliation(s)
- Giancarlo Avallone
- Department of Veterinary Medical Sciences (DIMEVET), University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Valeria Pellegrino
- Department of Veterinary Medical Sciences (DIMEVET), University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Luisa Vera Muscatello
- Department of Veterinary Medical Sciences (DIMEVET), University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Paola Roccabianca
- Department of Veterinary Medicine (DIMEVET), University of Milano, Lodi (LO), Italy
| | - Gastone Castellani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Claudia Sala
- Department of Physics and Astronomy, University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Marco Tecilla
- Department of Veterinary Medicine (DIMEVET), University of Milano, Lodi (LO), Italy
| | | | - Giuseppe Sarli
- Department of Veterinary Medical Sciences (DIMEVET), University of Bologna, Ozzano dell'Emilia (BO), Italy
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13
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Wittenberns BM, Thamm DH, Palmer EP, Regan DP. Canine Non-Angiogenic, Non-Myogenic Splenic Stromal Sarcoma: a Retrospective Clinicopathological Analysis and Investigation of Podoplanin as a Marker of Tumour Histogenesis. J Comp Pathol 2021; 188:1-12. [PMID: 34686271 DOI: 10.1016/j.jcpa.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/30/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
Splenic stromal sarcomas are rarely reported tumours that were previously grouped as non-angiomatous, non-lymphomatous mesenchymal neoplasms of the canine spleen. Highly variable survival times have been reported probably due to their heterogeneous nature. The purpose of this study was to assess the outcome and prognostic factors in dogs with splenic stromal sarcoma after treatment by splenectomy. Clinical data were collected retrospectively and histopathology was reviewed for 47 patients. Histological classification, based on morphology in haematoxylin and eosin-stained sections, in conjunction with immunolabelling of macrophage scavenger receptor-A (CD204), desmin, factor VIII-related antigen and smooth muscle actin ,yielded diagnoses of undifferentiated stromal sarcoma (n = 22), complex nodular hyperplasia (CNH, n = 9), sarcoma arising from benign complex nodular hyperplasia (n = 3), histiocytic sarcoma (n = 3), haemangiosarcoma (n = 1) and leiomyosarcoma (n = 1). Four samples were excluded from analysis due to extensive necrosis. An anti-podoplanin (PDPN) antibody was validated on canine tissue and used to assess expression of this protein as a potential indicator of the tissue of origin of the neoplasms (28/42 tumours were positive). There was a statistically significant difference in survival time between patients with stromal sarcoma (sarcoma from benign CNH and undifferentiated stromal sarcoma) and CNH (178 d versus 637 d, respectively; P = 0.027). Dogs with stromal sarcomas and high mitotic count (≥9 per 10 high-power fields) had a significantly shorter survival time (67 d versus 439 d; P = 0.01). Clinical diagnosis of splenic tumours should include evaluation for the presence of benign nodular hyperplasia morphology and immunohistochemistry to exclude more aggressive malignancies where adjuvant therapy is recommended. As in humans, PDPN may be an effective marker for stromal sarcomas of the canine spleen and immunopositivity suggests a fibroblastic reticular or follicular dendritic cell origin.
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Affiliation(s)
- Brittany M Wittenberns
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA; Flint Animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Douglas H Thamm
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA; Flint Animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Eric P Palmer
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA; Flint Animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Daniel P Regan
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA; Flint Animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
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14
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Del Alcazar CM, Mahoney JA, Dittrich K, Stefanovski D, Church ME. Outcome, prognostic factors and histological characterization of canine gastrointestinal sarcomas. Vet Comp Oncol 2021; 19:578-586. [PMID: 33774909 DOI: 10.1111/vco.12696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/31/2022]
Abstract
Canine gastrointestinal sarcomas, a group of tumours that includes leiomyosarcomas (LMSAs), gastrointestinal stromal tumours (GISTs) and other rarer sarcomas, comprise about 10-30% of all gastrointestinal tumours. This study aims to characterize the histologic characteristics and clinical behaviour in order to identify prognostic factors predictive of outcome. A single institution database search for surgically treated gastrointestinal sarcomas yielded 47 cases with adequate tissue remaining for histologic analysis and 42 cases available for analysis of clinical outcome. Tumours were then prospectively evaluated for mitotic count, necrosis, haemorrhage and inflammation, as well as categorized via immunohistochemical (IHC) staining for smooth muscle actin, c-KIT and DOG-1. IHC analysis defined 32 tumours as GISTs, 14 as LMSAs and one as a sarcoma not otherwise specified. For both GISTs and LMSAs, the overall median survival time (MST) is 1024 days (range 31-1456), which did not differ statistically between tumour types (p = .92). The overall metastatic rate of GISTs in this study was 32.1% (n = 9) which was not significantly different to that of LMSAs at 15.3% (n = 2, p = .45). In multivariate analysis, mitotic count under 9 in GIST patients and complete surgical excision in all tumour types correlated with improved MST. For patients with GISTs, the intensity of c-KIT staining also correlated positively with survival, with an MST of 250 days in cases with weak staining and an MST of 1418 days in cases with moderate or strong c-KIT staining (p = .005).
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Affiliation(s)
- Chelsea M Del Alcazar
- University of Pennsylvania School of Veterinary Medicine Philadelphia, Philadelphia, Pennsylvania, USA.,Friendship Hospital for Animals, Washington, District of Columbia, USA
| | - Jennifer A Mahoney
- University of Pennsylvania School of Veterinary Medicine Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine Dittrich
- University of Pennsylvania School of Veterinary Medicine Philadelphia, Philadelphia, Pennsylvania, USA.,Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Darko Stefanovski
- University of Pennsylvania School of Veterinary Medicine Philadelphia, Philadelphia, Pennsylvania, USA
| | - Molly E Church
- University of Pennsylvania School of Veterinary Medicine Philadelphia, Philadelphia, Pennsylvania, USA
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15
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Avallone G, Rasotto R, Chambers JK, Miller AD, Behling-Kelly E, Monti P, Berlato D, Valenti P, Roccabianca P. Review of Histological Grading Systems in Veterinary Medicine. Vet Pathol 2021; 58:809-828. [PMID: 33769136 DOI: 10.1177/0300985821999831] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tumor grading is a method to quantify the putative clinical aggressiveness of a neoplasm based on specific histological features. A good grading system should be simple, easy to use, reproducible, and accurately segregate tumors into those with low versus high risk. The aim of this review is to summarize the histological and, when available, cytological grading systems applied in veterinary pathology, providing information regarding their prognostic impact, reproducibility, usefulness, and shortcomings. Most of the grading schemes used in veterinary medicine are developed for common tumor entities. Grading systems exist for soft tissue sarcoma, osteosarcoma, multilobular tumor of bone, mast cell tumor, lymphoma, mammary carcinoma, pulmonary carcinoma, urothelial carcinoma, renal cell carcinoma, prostatic carcinoma, and central nervous system tumors. The prognostic relevance of many grading schemes has been demonstrated, but for some tumor types the usefulness of grading remains controversial. Furthermore, validation studies are available only for a minority of the grading systems. Contrasting data on the prognostic power of some grading systems, lack of detailed instructions in the materials and methods in some studies, and lack of data on reproducibility and validation studies are discussed for the relevant grading systems. Awareness of the limitations of grading is necessary for pathologists and oncologists to use these systems appropriately and to drive initiatives for their improvement.
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Affiliation(s)
- Giancarlo Avallone
- Department of Veterinary medical Sciences (DIMEVET), 9296University of Bologna, Ozzano dell'Emilia, Italy
| | | | - James K Chambers
- Laboratory of Veterinary Pathology, 13143The University of Tokyo, Tokyo, Japan
| | - Andrew D Miller
- Department of Biomedical Sciences, Section of Anatomic Pathology, 43317Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Erica Behling-Kelly
- Department of Population Medicine and Diagnostic Sciences, Section of Clinical Pathology, 43317Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Paola Monti
- 170851Dick White Referrals, Six Mile Bottom, Cambridgeshire, UK
| | - Davide Berlato
- 170851AniCura Animal Oncology and Imaging Center, Hünenberg, Switzerland
| | - Paola Valenti
- 534741Clinica Veterinaria Malpensa, Samarate (VA), Italy
| | - Paola Roccabianca
- Department of Veterinary Medicine (DIMEVET), 9304University of Milano, Lodi (LO), Italy
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16
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Hyde BR, Potter BM, Plenn JB, Worley DR. What Is Your Diagnosis? J Am Vet Med Assoc 2021; 257:263-266. [PMID: 32657657 DOI: 10.2460/javma.257.3.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Farah BL, Madeline Chee YM, Ching SS, Tan CS. Primary splenic leiomyosarcoma as an exceptionally rare cause of ruptured splenomegaly – A case report and review of primary splenic sarcomas. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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18
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Montinaro V, Chiti LE, Rossi N, Massari F, Romanelli G. Partial Gastrectomy at the Time of Splenectomy in Two Dogs With Splenic Neoplasia and Gastric Involvement. Top Companion Anim Med 2020; 42:100487. [PMID: 33115688 DOI: 10.1016/j.tcam.2020.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/24/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Abstract
Splenic malignancies are reported in 30%-76% of dogs presenting with splenic masses, and splenectomy is the cornerstone in their management. However, long term prognosis is guarded due to the high rates of distant metastases reported both for HSA and nonangiogenic nonlymphomatous sarcomas. Metastases from splenic tumors usually occur to regional lymph nodes, liver, omentum, and lungs. These case series aim to describe 2 cases of splenic neoplasia with gastric involvement and report the surgical technique and outcomes associated with the condition. Two mixed-breed dogs were referred for a splenic mass and underwent explorative celiotomy. In both cases, the splenic mass was firmly attached to the gastric wall, and splenectomy with concurrent partial gastrectomy was thus performed. In case 1, liver lobectomy due to a hepatic mass was also performed. In case 2, the regional nodes were also excised due to lymphoadenomegaly. Both dogs recovered uneventfully from surgery and were discharged from the hospital at 72 and 96 hours. Histopathological examination was costent with splenic undifferentiated sarcoma and hepatic adenocarcinoma in one dog. The other dog had a diagnosis of malignant fibrous histiocytoma with nodal metastases. Neoplastic invasion of the stomach was histologically confirmed in both dogs. Adjuvant chemotherapy was refused, and both dogs were euthanized due to tumor progression at 71 and 58 days, respectively. According to our results, splenectomy with concurrent gastrectomy is feasible in dogs with splenic tumours involving the gastric wall. However, long term prognosis is poor, as previously reported for metastatic splenic sarcomas.
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Affiliation(s)
- Vincenzo Montinaro
- Clinica Veterinaria Nervianese, Via Giulio Cesare Lampugnani 3, 20014 - Nerviano, MI, Italy
| | - Lavinia Elena Chiti
- Veterinary Teaching Hospital, Università degli Studi di Milano, Via dell'Università 6, 26900 - Lodi, LO, Italy.
| | - Nicola Rossi
- Clinica Veterinaria Nervianese, Via Giulio Cesare Lampugnani 3, 20014 - Nerviano, MI, Italy
| | - Federico Massari
- Clinica Veterinaria Nervianese, Via Giulio Cesare Lampugnani 3, 20014 - Nerviano, MI, Italy
| | - Giorgio Romanelli
- Clinica Veterinaria Nervianese, Via Giulio Cesare Lampugnani 3, 20014 - Nerviano, MI, Italy
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19
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Polit JA, Moore EV, Epperson E. Primary Ureteral Hemangiosarcoma in a dog. BMC Vet Res 2020; 16:386. [PMID: 33046084 PMCID: PMC7552342 DOI: 10.1186/s12917-020-02609-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary ureteral neoplasia in dogs is extremely rare. To the best of the authors' knowledge, this is the second documented case of a primary ureteral hemangiosarcoma. This case report describes the clinical and pathological findings of a primary distal ureteral hemangiosarcoma. CASE PRESENTATION A 12-year-old spayed female goldendoodle was presented with a history of polyuria and weight loss. Abdominal radiographs revealed a large cranial abdominal mass. Abdominal ultrasound and computed tomography (CT) identified a left sided distal ureteral mass with secondary hydroureter and a left lateral hepatic mass with no evidence of connection or diffuse metastasis. A left ureteronephrectomy, partial cystectomy, and left lateral liver lobectomy were performed. Histopathology was consistent with primary ureteral hemangiosarcoma and a hepatocellular carcinoma. Adjunctive therapy including chemotherapy was discussed but declined. CONCLUSION Due to its rarity, the authors of this case presentation believe that ureteral hemangiosarcoma should be included as a differential diagnosis when evaluating a ureteral mass. With the unknown, and suspected poor prognosis, routine monitoring with adjunctive therapy should be considered.
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Affiliation(s)
- Joseph A Polit
- Chesapeake Veterinary Surgical Specialist, 1209 Cromwell Bridge Rd, Towson, Maryland, 21286, USA.
| | - Elisabeth V Moore
- Chesapeake Veterinary Surgical Specialist, 1209 Cromwell Bridge Rd, Towson, Maryland, 21286, USA
| | - Ember Epperson
- Chesapeake Veterinary Surgical Specialist, 1209 Cromwell Bridge Rd, Towson, Maryland, 21286, USA.,Antech Diagnostics, 1111 Marcus Avenue, Lake success, New York, 11042, USA
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20
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Hertel B, L'Eplattenier H. Uroabdomen following rupture of a primary ureteral soft tissue sarcoma in a Labrador retriever. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Beatrice Hertel
- Surgery ServiceSouthfields Veterinary SpecialistsBasildonEssexUK
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