1
|
Anderson K, Pellin M, Snyder E, Clarke D. Tumor Grade and Mitotic Count Are Prognostic for Dogs with Cutaneous Mast Cell Tumors Treated with Surgery and Adjuvant or Neoadjuvant Vinblastine Chemotherapy. Vet Sci 2024; 11:363. [PMID: 39195818 PMCID: PMC11360381 DOI: 10.3390/vetsci11080363] [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: 05/06/2024] [Revised: 07/21/2024] [Accepted: 08/06/2024] [Indexed: 08/29/2024] Open
Abstract
OBJECTIVE Canine cutaneous mast cell tumors (cMCTs) have variable rates of recurrence and metastasis. We evaluated how various prognostic factors affect survival, recurrence, and metastasis in dogs with cMCT who underwent surgery and vinblastine chemotherapy. ANIMALS 90 dogs with cMCT treated with surgery and vinblastine at a veterinary referral institution were included. METHODS Medical records were retrospectively reviewed. Prognostic factors were evaluated. RESULTS Most dogs (94%) had grade 2 or 3 cMCTs. Neoadjuvant vinblastine was used in 18 dogs, and none progressed locally before surgery. The use of neoadjuvant vinblastine was associated with a higher chance of local recurrence (p = 0.03) but not survival. Shorter survival times were found for tumors that were high-grade (p < 0.001), grade 3 (p < 0.001), or a MC of >5 (p < 0.001). Dogs with grade 2 tumors that were low-grade lived longer than those with high-grade tumors (p < 0.001). Histologic tumor-free margins and the ability to achieve local tumor control were not associated with outcome. CLINICAL RELEVANCE Both grading systems and MC were prognostic for survival in this population of dogs, supporting the need for the standard reporting of histopathologic findings. Neoadjuvant chemotherapy can be effective in downsizing cMCTs but does not influence survival. These findings are consistent with previous publications, showing the benefits of a more modern population of patients, surgical treatments, and histopathologic assessments.
Collapse
Affiliation(s)
| | - MacKenzie Pellin
- Department of Medical Sciences, Veterinary Medical Teaching Hospital, University of Wisconsin-Madison, Madison, WI 53706, USA
| | | | - Dawn Clarke
- Department of Small Animal Medicine and Surgery, University of Georgia College of Veterinary Medicine, Athens, GA 30602, USA;
| |
Collapse
|
2
|
Marconato L, Faroni E, Battisti E, Zaccone R, Stefanello D, Sabattini S. Incorporation of Biologic Variables Into the Staging for Canine Cutaneous and Subcutaneous Mast Cell Tumours: Proposal of the UBo pTNM System. Vet Comp Oncol 2024. [PMID: 39099458 DOI: 10.1111/vco.13000] [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: 01/22/2024] [Revised: 06/05/2024] [Accepted: 07/21/2024] [Indexed: 08/06/2024]
Abstract
Canine cutaneous mast cell tumours (MCTs) are currently staged based on the World Health Organization (WHO) classification, which has remained unchanged since its initial formulation. Our study aimed to assess the reliability of a novel pTNM staging system, which incorporates tumour extent (T), lymph node involvement (N), presence of distant metastases (M) and the two-tier histologic grade. We analysed medical records of dogs with one or more cutaneous/subcutaneous completely staged MCT, undergoing tumour excision with lymphadenectomy, unless distant metastases were present, in which cases, medical therapy was administered. Dogs were categorized into three stages: I (T1-2N0M0), II (T1-2N1M0) and III (distant metastases). Stages I and II were further divided based on histologic grade into 'low' and 'high'. Substage b was defined as the presence of tumour diameter of ≥3 cm and/or ulceration. Of 226 dogs, 87 (38.5%) were in Stage I (I-low, n = 75; I-high, n = 12), 107 (47.3%) in Stage II (II-low, n = 59; II-high, n = 48), and 32 (14.2%) in Stage III. The newly proposed staging system was able to significantly stratify the population for both time to progression and tumour-specific survival. Compared to Stage I-low, the risk of progression increased significantly for Stage I-high (18.3 times), Stage II-low (8.5 times), Stage II-high (41.5 times) and Stage III (110.3 times). The staging system was highly prognostic for both cutaneous and subcutaneous MCTs. Prospective validation studies are essential to compare this new system with the current WHO staging and further validate its accuracy and clinical utility.
Collapse
Affiliation(s)
- Laura Marconato
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Eugenio Faroni
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Emiliano Battisti
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Riccardo Zaccone
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Damiano Stefanello
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Lodi, Italy
| | - Silvia Sabattini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| |
Collapse
|
3
|
Stefanello D, Gariboldi EM, Boracchi P, Ferrari R, Ubiali A, De Zani D, Zani DD, Grieco V, Giudice C, Recordati C, Caniatti M, Auletta L, Chiti LE. Weishaar's classification system for nodal metastasis in sentinel lymph nodes: Clinical outcome in 94 dogs with mast cell tumor. J Vet Intern Med 2024; 38:1675-1685. [PMID: 38426589 PMCID: PMC11099738 DOI: 10.1111/jvim.16997] [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] [Received: 07/07/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The therapeutic role and prognostic relevance of lymphadenectomy in mast cell tumor (MCT) has historically been evaluated on regional rather than sentinel lymph nodes. HYPOTHESIS/OBJECTIVES To update information about the association of histological nodal (HN) classes with clinical outcome in dogs with MCT after tumor excision and extirpation of normal-sized sentinel nodes (SLN) guided by radiopharmaceutical. ANIMALS Ninety-four dogs with histologically-confirmed treatment-naïve MCT (71 cutaneous, 22 subcutaneous and 1 conjunctival MCT) were included if without: distant metastases, lymphadenomegaly, concurrent mixed cutaneous, and subcutaneous MCT. METHODS This was a monoistitutional cohort study. Tumors characteristics were retrieved and SLNs were classified according to Weishaar's system. Incidence of MCT-related events (local, nodal, distant relapse), de novo MCT or other tumors and death (MCT-related and non-MCT-related), were recorded. Incidence curves were compared among the HN classes. RESULTS Twenty-seven dogs had HN0, 19 HN1, 37 HN2, and 11 HN3 SLN. Thirteen (2 HN0, 4 HN2, and 7 HN3) received adjuvant chemotherapies. Kiupel high grade, increasing number of SLN and lymphocentrums were associated with higher HN classes. Five dogs died for MCT-related causes: 1 low-grade (HN0) and 1 subcutaneous (HN3) had a local relapse, 2 high-grade had distant relapse (HN3-HN0) and 1 dog developed disease progression from a de novo subcutaneous MCT. No nodal relapse was registered. Fourteen dogs developed de novo MCTs. CONCLUSION/DISCUSSION Low grade/low-risk MCT with nonpalpable and normal sized SLN have a favorable outcome independently from the HN. Result should be considered strictly related to the successful SLN detection guided pre- and intraoperative by radiopharmaceutical markers.
Collapse
Affiliation(s)
- Damiano Stefanello
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Elisa M. Gariboldi
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Patrizia Boracchi
- Dipartimento di Scienze Biomediche e ClinicheUniversità degli Studi di MilanoMilanoItaly
| | - Roberta Ferrari
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Alessandra Ubiali
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Donatella De Zani
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Davide D. Zani
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Valeria Grieco
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Chiara Giudice
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Camilla Recordati
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Mario Caniatti
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Luigi Auletta
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
| | - Lavinia E. Chiti
- Dipartimento di Medicina Veterinaria e Scienze AnimaliUniversità degli Studi di MilanoLodiItaly
- Clinic for Small Animals Surgery—Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| |
Collapse
|
4
|
Sabattini S, Brocanelli A, Zaccone R, Faroni E, Renzi A, Ciammaichella L, Bettini G, Marconato L. The 2-tier grading system identifies canine cutaneous and/or subcutaneous mast cell tumors with aggressive biological behavior regardless of growth model. Vet Pathol 2024:3009858241240443. [PMID: 38577816 DOI: 10.1177/03009858241240443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Histologic grading of canine cutaneous mast cell tumors (cMCTs) has prognostic and therapeutic implications, yet validation for subcutaneous MCTs (scMCTs) is lacking. For scMCTs with or without dermal invasion, determining their biological behavior remains poorly standardized and sometimes sparks controversy. This prospective study aimed to assess the prognostic utility of the 2-tier histologic grading system in MCTs with different growth models (GMs) and explore the prognostic impact of the GM itself. We assessed 6 histologic GM categories: solely cMCT (C-SC0), cMCT with superficial (C-SC1) or deep subcutaneous (C-SC2) involvement, solely scMCT (SC-C0), and scMCT with deep (SC-C1) or superficial (SC-C2) infiltration of the dermis. Ninety-one MCTs from 76 dogs undergoing excision and regional/sentinel lymphadenectomy were examined. GM classification identified 11 (12%) C-SC0 tumors, 12 (13%) C-SC1, 15 (16%) C-SC2, 21 (23%) SC-C0, 15 (16%) SC-C1, and 17 (19%) SC-C2. Mitotic count, 2-tier grade, nodal involvement, surgical margins, and outcome were stratified according to GM. scMCTs lacking dermal invasion, historically associated with a benign clinical course, had a poor prognosis in 10% of cases. cMCTs exhibiting deep subcutaneous involvement included the largest percentage of high-grade tumors (33%), had the highest occurrence of overt nodal metastases (33%), and had the lowest 1-year survival rate (86%). Histologic grade was confirmed as a relevant prognostic factor, surpassing nodal involvement and histologic margin status. The 2-tier histologic grading enabled the identification of all MCTs with aggressive biological behavior, regardless of their cutaneous or subcutaneous location.
Collapse
|
5
|
Annoni M, Borgonovo S, Aralla M. Sentinel lymph node mapping in canine mast cell tumours using a preoperative radiographic indirect lymphography: Technique description and results in 138 cases. Vet Comp Oncol 2023; 21:469-481. [PMID: 37191042 DOI: 10.1111/vco.12906] [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] [Received: 10/05/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
Several sentinel lymph node (SLN) mapping techniques, to detect nodal metastasis in canine tumours have been investigated in the last 10 years in veterinary oncology. The purpose of this prospective study was to describe a reliable, quick, and inexpensive technique for SLN mapping in canine patients affected by cutaneous and subcutaneous mast cell tumours (MCT). Eighty dogs were enrolled in this study for a total of 138 cytologically diagnosed MCTs. Sentinel lymph node mapping was performed by injecting iomeprole peritumorally followed by serial radiographs at 1, 3, 6 and 9-min post injection. A total of 168 SLNs were detected, 90% at first radiograph, 1 min after the peritumoral iomeprole injection, while in the rest of the cases SLN was identified at 3 min. Sentinel lymph nodes detected by the preoperative radiographic indirect lymphography with iomeprole (PRILI) differed from regional lymph nodes in 57% of cases. The PRILI technique detected simultaneously multiple SLNs in the 26% of cases and multiple lymph centers in the 31% of MCTs. To allow the surgical identification of the SLNs, a peritumoral injection of methylene blue was performed at the time of surgery. This study reports a widely available technique for SLN mapping using digital radiographs in combination with a water-soluble medium, representing a cost-effective alternative to other SLN mapping procedures. Based on our results, this technique can be effective for SLNs mapping in dogs with MCTs but further comparative studies are needed to assess its reliability and efficacy in different tumours.
Collapse
Affiliation(s)
- Maurizio Annoni
- Department of Soft Tissue and Oncologic Surgery, AniCura Clinica Veterinaria Tibaldi, Milan, Italy
| | - Simone Borgonovo
- Department of Diagnostic Imaging, AniCura Clinica Veterinaria Tibaldi, Milan, Italy
| | - Marina Aralla
- Department of Oncology, Pronto Soccorso Veterinario Laudense, Lodi, Milan, Italy
| |
Collapse
|
6
|
Treggiari E, Valenti P, Porcellato I, Maresca G, Romanelli G. Retrospective analysis of outcome and prognostic factors of subcutaneous mast cell tumours in dogs undergoing surgery with or without adjuvant treatment. Vet Comp Oncol 2023; 21:437-446. [PMID: 37121954 DOI: 10.1111/vco.12902] [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] [Received: 10/23/2022] [Revised: 04/02/2023] [Accepted: 04/18/2023] [Indexed: 05/02/2023]
Abstract
Subcutaneous mast cell tumours (SC MCTs) can display a different biological behaviour in dogs when compared to their cutaneous counterpart. There is a paucity of information with regards to the outcome of dogs with SC MCTs treated with surgery and/or receiving adjuvant chemotherapy. The aim of this study was to retrospectively review the outcome of dogs with surgically excised SC MCTs undergoing adjuvant treatment or not. A secondary aim was to assess prognostic factors in the same group. Fifty-two cases were included. Recurrence rate was 15% and 63% of evaluated lymph nodes were consistent with early or overt metastasis. Median survival time (range 83-1357 days) and median time to progression (range 14-1357 days) were not reached. Factors predictive of shorter overall survival time included increasing age (HR 1.29, 95% CI 1.06-1.55, p = .0092), presence of clinical signs at presentation (HR 10.44, 95% CI 2.69-40.52, p = .0007), mitotic count >4 (HR 8.69, 95% CI 2.55-29.55, p = 0.0005), presence of multinucleation (HR 4.21, 95% CI 1.35-13.18, p = .0135), use of neoadjuvant and adjuvant chemotherapy (HR 7.16, 95% CI 1.26-40.73, p = .0266). The same factors, together with increasing tumour dimensions, were predictive for shorter progression-free survival (PFS), including increasing age (p = .0012), presence of clinical signs at presentation (p = .0045), increasing tumour dimensions (p = .0004), MC > 4 (p = .0004), presence of multinucleation (p = .0282), use of neoadjuvant and adjuvant chemotherapy (p = .0485). No variables remained significant for overall survival using multivariate analysis. There was a longer survival in cases where chemotherapy was not required (HR 0.14, 95% CI 0.03-0.68, p = .0148), and this variable remained significant for PFS on multivariate analysis (HR 0.13, 95% CI 0.02-0.76, p = .02). In conclusion, our study suggests that dogs with SC MCTs, in the absence of negative prognostic factors, may have a prolonged survival when treated with surgery alone. Further studies are needed to clarify the role of adjuvant treatment for biologically aggressive SC MCTs in dogs.
Collapse
Affiliation(s)
- E Treggiari
- Oncology Service, Centro Specialistico Veterinario, Milan, Italy
| | - P Valenti
- Oncology Service, Clinica Veterinaria Malpensa AniCura, Samarate, Italy
- Oncology Service, Ospedale Veterinario I Portoni Rossi AniCura, Zola Predosa, Italy
| | - I Porcellato
- Pathology Service, University of Perugia, School of Veterinary Medicine, Perugia, Italy
| | - G Maresca
- Oncology Service, Centro Specialistico Veterinario, Milan, Italy
| | - G Romanelli
- Oncology Service, Centro Specialistico Veterinario, Milan, Italy
| |
Collapse
|
7
|
Buzzi G, Gambini M, Recordati C, Grieco V, Stefanello D, Ferrari R, Zamboni C, Manfredi M, Giudice C. Cytological Quantification of Nodal Mast Cells in Dogs Affected by Non-Neoplastic Condition and Mast Cell Tumor Using Different Sample Preparation Techniques: An Explorative Study. Animals (Basel) 2023; 13:2634. [PMID: 37627425 PMCID: PMC10451199 DOI: 10.3390/ani13162634] [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: 07/10/2023] [Revised: 08/03/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Cytological evaluation of lymph nodes (LN) in canine cutaneous mast cell tumors (MCT) has a key role in MCT staging. However, cytological discrimination between metastatic and reactive LNs is debated and diagnostic criteria inconsistent. The aim of this study was to retrospectively quantify nodal mast cells (MCs) in non-oncological (NOD) and MCT-bearing dogs (MCTBD), using different sample preparation techniques, to evaluate the significance of the MCT number. Cytological specimens from NOD-LNs (10 fine-needle aspirates-FNAs) and MCTBD-LNs (10 FNAs, 10 scrapings, 10 touch imprints) were evaluated. MCTBD-LNs were grouped in: non-metastatic, possibly-metastatic, and metastatic based on current literature criteria. MCs were counted in 4, 8, and 20 high-power-fields, and over 500, 1000, and 2000 total cells. MCs were significantly more numerous in MCTBD-LNs than in NOD-LNs and in "metastatic" samples than in "non-metastatic". There was no significant difference between "metastatic" and "possibly metastatic" samples. Sample preparation techniques did not influence these results. A negative correlation between MCs number and sample cellularity was observed. Results were confirmed regardless of the counting method applied. MCs counting per se cannot distinguish possibly metastatic and metastatic cytological samples. Sample preparation technique and the counting method applied seem to have no influence on cytological quantification of nodal MCs in MCTBDs.
Collapse
Affiliation(s)
- Giulia Buzzi
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, 26900 Lodi, Italy; (G.B.); (M.G.); (C.R.); (V.G.); (D.S.); (R.F.); (C.Z.); (M.M.)
- AniCura Istituto Veterinario di Novara, Granozzo con Monticello, 28060 Novara, Italy
| | - Matteo Gambini
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, 26900 Lodi, Italy; (G.B.); (M.G.); (C.R.); (V.G.); (D.S.); (R.F.); (C.Z.); (M.M.)
- I-Vet S.r.l. Diagnostica Veterinaria, 25020 Flero, Italy
| | - Camilla Recordati
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, 26900 Lodi, Italy; (G.B.); (M.G.); (C.R.); (V.G.); (D.S.); (R.F.); (C.Z.); (M.M.)
| | - Valeria Grieco
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, 26900 Lodi, Italy; (G.B.); (M.G.); (C.R.); (V.G.); (D.S.); (R.F.); (C.Z.); (M.M.)
| | - Damiano Stefanello
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, 26900 Lodi, Italy; (G.B.); (M.G.); (C.R.); (V.G.); (D.S.); (R.F.); (C.Z.); (M.M.)
| | - Roberta Ferrari
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, 26900 Lodi, Italy; (G.B.); (M.G.); (C.R.); (V.G.); (D.S.); (R.F.); (C.Z.); (M.M.)
| | - Clarissa Zamboni
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, 26900 Lodi, Italy; (G.B.); (M.G.); (C.R.); (V.G.); (D.S.); (R.F.); (C.Z.); (M.M.)
| | - Martina Manfredi
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, 26900 Lodi, Italy; (G.B.); (M.G.); (C.R.); (V.G.); (D.S.); (R.F.); (C.Z.); (M.M.)
| | - Chiara Giudice
- Dipartimento di Medicina Veterinaria e Scienze Animali, Università degli Studi di Milano, 26900 Lodi, Italy; (G.B.); (M.G.); (C.R.); (V.G.); (D.S.); (R.F.); (C.Z.); (M.M.)
| |
Collapse
|
8
|
Marconato L, Stefanello D, Solari Basano F, Faroni E, Dacasto M, Giantin M, Bettini G, Aresu L, Bonfanti U, Bertazzolo W, Annoni M, Lecchi C, Sabattini S. Subcutaneous mast cell tumours: A prospective multi-institutional clinicopathological and prognostic study of 43 dogs. Vet Rec 2023; 193:e2991. [PMID: 37224084 DOI: 10.1002/vetr.2991] [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] [Received: 10/28/2022] [Revised: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Canine subcutaneous mast cell tumours (ScMCTs) reportedly have a good prognosis. However, biomarkers that can be used to predict outcome are currently limited. METHODS A multicentre prospective study was conducted to identify new prognostic markers. Dogs with a first occurrence of ScMCT were enrolled upon primary tumour removal and regional lymphadenectomy. In the absence of metastasis, dogs were monitored, while dogs with overtly metastatic lymph nodes (histological node 3, HN3) received adjuvant vinblastine. RESULTS Forty-three dogs were enrolled: 15 (34.9%) had at least one HN3 lymph node and received vinblastine, and 28 (65.1%) were monitored. Three tumours harboured exon 8 and 9 c-kit mutations. Eight (18.6%) dogs experienced tumour progression, and five (11.6%) died of MCT-related causes. The 1- and 2-year survival rates were 90% and 77%, respectively. Variables significantly associated with an increased risk of progression included high cytograde, a mitotic count (MC) greater than 4/10 high-power fields (hpf) and Ki67-index greater than 23. An MC greater than 4/10 hpf was also associated with an increased risk of tumour-related death. LIMITATIONS Regional rather than sentinel lymphadenectomy was performed in these dogs. Dogs were enrolled in oncology referral centres, constituting a different population compared to previous studies. CONCLUSIONS ScMCTs have a good prognosis. However, the metastatic rate at admission was higher in this study than previously reported, and a subset of tumours were associated with a fatal outcome despite multimodal treatment. Proliferative activity and cytograding may predict more aggressive behaviour in ScMCTs.
Collapse
Affiliation(s)
- Laura Marconato
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Ozzano dell'Emilia, Italy
| | - Damiano Stefanello
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Lodi, Italy
| | | | - Eugenio Faroni
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Ozzano dell'Emilia, Italy
| | - Mauro Dacasto
- Department of Comparative Biomedicine and Food Science, University of Padua, Legnaro, Italy
| | - Mery Giantin
- Department of Comparative Biomedicine and Food Science, University of Padua, Legnaro, Italy
| | - Giuliano Bettini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Ozzano dell'Emilia, Italy
| | - Luca Aresu
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | | | | | | | - Cristina Lecchi
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Lodi, Italy
| | - Silvia Sabattini
- Department of Veterinary Medical Sciences, Alma Mater Studiorum University of Bologna, Ozzano dell'Emilia, Italy
| |
Collapse
|
9
|
Cino M, Gariboldi EM, Stefanello D, Spindler KP, Ferraris EI, Morello EM, Bertola L, Maniscalco L, Martano M. Ki67 Index in Patnaik Grade 2/Kiupel Low-Grade Canine Cutaneous Mast Cell Tumors with Early Lymph Node Metastasis: A Descriptive Study. Vet Sci 2023; 10:436. [PMID: 37505841 PMCID: PMC10384441 DOI: 10.3390/vetsci10070436] [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: 06/17/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/29/2023] Open
Abstract
Several studies evaluating Ki67 in canine cutaneous mast cell tumors (cMCTs) have reported its prognostic value when tumors of all histological grades are included. This study aims to evaluate whether the Ki67 index has a predictive value in a homogeneous cohort of G2/LG cMCTs with HN2 lymph nodes (LNs) and to describe the clinical outcome. The second goal was to explore the correlation between the Ki67 index and MC. The medical databases of three institutions were retrospectively searched for dogs undergoing surgical treatment for cMCT and LN extirpation, with a histological diagnosis of G2/LG with HN2 LNs. Information about histological margins, MC, Ki67 index, local recurrence, nodal relapse, distant metastasis, de novo cMCT occurrence and date and cause of death were included. A total of 39 cases were identified. None of these developed local and nodal relapse or metastatic distant disease. Median MC was 1 (0-2). Median Ki67 index was 3.5 (0.7-14.3). Ki67 and MC were not significantly correlated. At the end of the study, 32 (82%) dogs were alive, 7 (18%) dogs were dead from unrelated causes and 4 (10.2%) dogs were lost to follow-up. The median ST was not reached, and the mean was 893 days (104-2241 days). Considering the strict inclusion criteria, dogs affected by G2/LG with HN2 LNs treated with surgery alone may have a good oncologic outcome; the Ki67 index does not have prognostic impact.
Collapse
Affiliation(s)
- Marzia Cino
- Department of Veterinary Medical Sciences, University of Parma, Strada del Taglio 10, 43126 Parma, Italy
| | - Elisa Maria Gariboldi
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Via dell' Università 1, 26900 Lodi, Italy
| | - Damiano Stefanello
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Via dell' Università 1, 26900 Lodi, Italy
| | - Kevin Pascal Spindler
- Department of Veterinary Medical Sciences, University of Parma, Strada del Taglio 10, 43126 Parma, Italy
| | - Erica Ilaria Ferraris
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy
| | - Emanuela Maria Morello
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy
| | - Luca Bertola
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Via dell' Università 1, 26900 Lodi, Italy
| | - Lorella Maniscalco
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy
| | - Marina Martano
- Department of Veterinary Medical Sciences, University of Parma, Strada del Taglio 10, 43126 Parma, Italy
| |
Collapse
|
10
|
Burge R, Woolard KD, Willcox JL, Rebhun RB, Burton JH, Al-Nadaf S, Skorupski KA. High-Grade, Stage 2 Mast Cell Tumors: Outcome in Dogs With Local and Systemic Therapy. J Am Anim Hosp Assoc 2023; 59:167-176. [PMID: 37432790 DOI: 10.5326/jaaha-ms-7319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 07/13/2023]
Abstract
Canine mast cell tumors (MCTs) have highly variable clinical behavior, and predicting outcomes in individual dogs remains challenging. Many studies combine dogs with varying tumor grades, clinical stage, or treatments, confounding those results. The purpose of this retrospective study was to determine outcome and prognostic factors in a specific subset of dogs with high-grade, stage 2, cutaneous MCTs treated with adequate local control via surgery with or without radiation therapy and adjuvant cytotoxic chemotherapy. Seventeen dogs met the inclusion criteria, and the median survival time was 259 days. Development of local recurrence, tumor location, and presence of ulceration were all associated with shorter survival times. Tumor size, mitotic count, chemotherapy protocol, lymph node classification, and radiation therapy were not significantly associated with outcome. In this study, a specific population of dogs characterized by high-grade MCTs with local lymph node metastasis who received aggressive local and systemic therapy had a median survival of about 8.5 mo. Dogs with ulcerated tumors, recurrent tumors, or tumors located on the head had a worse outcome despite aggressive therapy. These results may serve as a basis of comparison for future research exploring alternative treatment combinations in this specific population of dogs.
Collapse
Affiliation(s)
- Rhonda Burge
- From the Department of Veterinary Clinical Sciences (R.B.), College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Kevin D Woolard
- Department of Pathology, Microbiology, and Immunology (K.D.W.), School of Veterinary Medicine, University of California, Davis, California
| | - Jennifer L Willcox
- Department of Surgical and Radiological Sciences (J.L.W., R.B.R., S.A.-N., K.A.S.), School of Veterinary Medicine, University of California, Davis, California
| | - Robert B Rebhun
- Department of Surgical and Radiological Sciences (J.L.W., R.B.R., S.A.-N., K.A.S.), School of Veterinary Medicine, University of California, Davis, California
| | - Jenna H Burton
- Clinical Sciences Department, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado (J.H.B.)
| | - Sami Al-Nadaf
- Department of Surgical and Radiological Sciences (J.L.W., R.B.R., S.A.-N., K.A.S.), School of Veterinary Medicine, University of California, Davis, California
| | - Katherine A Skorupski
- Department of Surgical and Radiological Sciences (J.L.W., R.B.R., S.A.-N., K.A.S.), School of Veterinary Medicine, University of California, Davis, California
| |
Collapse
|
11
|
Gariboldi EM, Ubiali A, Chiti LE, Ferrari R, De Zani D, Zani DD, Grieco V, Giudice C, Recordati C, Stefanello D, Auletta L. Evaluation of Surgical Aid of Methylene Blue in Addition to Intraoperative Gamma Probe for Sentinel Lymph Node Extirpation in 116 Canine Mast Cell Tumors (2017-2022). Animals (Basel) 2023; 13:1854. [PMID: 37889797 PMCID: PMC10251889 DOI: 10.3390/ani13111854] [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: 02/22/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 10/29/2023] Open
Abstract
Methylene Blue (MB) is combined with radiopharmaceutical for intraoperative sentinel lymph node (SLN) mapping, but its role during SLN extirpation has not been investigated yet in veterinary medicine. The aim of this study was to assess whether MB increased surgical detection of SLN beyond the use of intraoperative gamma-probe (IGP) alone in clinically node-negative dogs with mast cell tumors (MCTs) following the detection of sentinel lymphocentrums (SLCs) via preoperative planar lymphoscintigraphy. Dogs enrolled underwent MCT excision and SLC exploration guided by both MB and IGP. Data recorded for each SLN were staining (blue/non-blue), radioactivity (hot/non-hot), and histopathological status (HN0-1 vs. HN2-3). A total of 103 dogs bearing 80 cutaneous, 35 subcutaneous, and 1 mucocutaneous MCTs were included; 140 SLCs were explored, for a total of 196 SLNs removed. Associating MB with IGP raised the SLNs detection rate from 90% to 95%. A total of 44% of SLNs were metastatic: 86% were blue/hot, 7% were only blue, 5% were only hot, and 2% were non-blue/non-hot. All HN3 SLNs were hot. Combining MB with IGP can increase the rate of SLN detection in dogs with MCTs; nonetheless, all lymph nodes identified during dissection should be removed, as they might be unstained but metastatic.
Collapse
Affiliation(s)
- Elisa Maria Gariboldi
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Alessandra Ubiali
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Lavinia Elena Chiti
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
- Clinic for Small Animals Surgery, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| | - Roberta Ferrari
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Donatella De Zani
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Davide Danilo Zani
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Valeria Grieco
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Chiara Giudice
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Camilla Recordati
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Damiano Stefanello
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Luigi Auletta
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| |
Collapse
|
12
|
Alvarez-Sanchez A, Townsend KL, Newsom L, Milovancev M, Gorman E, Russell DS. Comparison of indirect computed tomographic lymphography and near-infrared fluorescence sentinel lymph node mapping for integumentary canine mast cell tumors. Vet Surg 2023; 52:416-427. [PMID: 36574349 DOI: 10.1111/vsu.13929] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 11/18/2022] [Accepted: 12/03/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare the independent and combined use of indirect computed tomographic lymphography (ICTL) and near-infrared fluorescence (NIRF) for sentinel lymph node (SLN) mapping in dogs with integumentary mast cell tumors (MCT) and report the metastatic LN rate. STUDY DESIGN Prospective clinical study. ANIMALS Twenty client-owned dogs. METHODS Dogs underwent preoperative ICTL, then intraoperative NIRF SLN mapping and excision of the anatomic lymph node (ALN) and/or SLN, and primary MCT. Technique agreement was complete if the same SLN was detected, and partial if the same SLN was detected along with additional SLN. No agreement occurred if the techniques detected different or no SLN. MCT were graded using two- and three-tier schemes, and LN were graded from HN0-3; HN2-3 were considered metastatic. RESULTS Complete, partial, and no agreement between ICTL and NIRF was seen in 8/20 (40%), 8/20 (40%), and 4/20 (20%) dogs, respectively. Detection of ICTL-SLN and NIRF-SLN failed in 1/20 (5%) and 4/20 (20%), respectively. Tumors were grade II/low-grade in 19/20 (95%) and grade III/high-grade in 1/20 (5%) dogs. Nineteen out of 20 (95%) dogs had HN2-3 LN. CONCLUSIONS Technique agreement of at least one SLN was seen in 16/20 (80%) dogs. Although most MCT were classified as intermediate to low grade, LN metastases were commonly detected. CLINICAL SIGNIFICANCE Combining ICTL and NIRF for MCT SLN mapping yields high SLN detection rates. Lymph node metastasis may be more common than previously reported for intermediate to low grade MCT.
Collapse
Affiliation(s)
- Alejandro Alvarez-Sanchez
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Katy L Townsend
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Lauren Newsom
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Milan Milovancev
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
- Summit Veterinary Referral Center, Tacoma, Washington, USA
| | - Elena Gorman
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| | - Duncan S Russell
- Department of Biomedical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, Oregon, USA
| |
Collapse
|
13
|
Chalfon C, Finotello R, Sabattini S, Gramer I, Morris JS, Aralla M, Morello EM, Ferraris E, Ramos S, Polton G, Schiavo L, Dobson J, Cola V, Marconato L. Patterns of nodal metastases, biological behaviour and prognosis of canine mast cell tumours of the pinna: A multi-institutional retrospective study. Vet Comp Oncol 2023; 21:332-338. [PMID: 36907653 DOI: 10.1111/vco.12893] [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: 01/05/2023] [Revised: 02/21/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
Canine cutaneous mast cell tumours (cMCTs) of the pinna have been associated with an aggressive biological behaviour, although data remain scarce. The knowledge acquired over the past years on histologic gradings, and the value of lymph node (LN) staging, may help in better characterizing this anatomical presentation. The first aim was to describe the frequency, location, and histologic appearance of LN metastases in cMCT of the pinna. A second aim was to evaluate prognosis. Medical records of dogs with cMCT of the pinna, that underwent tumour and sentinel (SLN) or regional LN (RLN) excision, were reviewed. The influence of potential prognostic variables on time to progression (TTP) and tumour-specific survival (TSS) was investigated. Thirty-nine dogs were included: 19 (48.7%) had Kiupel high-grade (K-HG) and 20 (51.3%) had low-grade (K-LG) MCTs. Eighteen (46.1%) dogs underwent SLN mapping: the superficial cervical LN was at least one of SLN in 17 (94.4%) cases. Twenty-two (56.4%) dogs had LN metastases; the superficial cervical LN was always involved. On multivariable analysis, only K-HG was associated with increased risk of progression (p = .043) and tumour-related death (p = .021). Median TTP and TSS were 270 and 370 days in K-HG, respectively; these were not reached in dogs with K-LG tumours (p < .01). cMCTs of the pinna are often K-HG and are also associated with a higher frequency of LN metastasis; however, we confirmed the independent prognostic value of histologic grading. A multimodal treatment may lead to favourable long-term outcome. Moreover, the superficial cervical LN is most often the SLN.
Collapse
Affiliation(s)
- Carmit Chalfon
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Riccardo Finotello
- Department of Small Animal Clinical Science, School of Veterinary Science, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - Silvia Sabattini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Irina Gramer
- Department of Clinical Science and Services, Royal Veterinary College, London, UK
| | - Joanna Siriol Morris
- Department of Small Animal Clinical Sciences, School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Marina Aralla
- Pronto Soccorso Veterinario Laudenese, Oncology Service, Lodi, Italy
| | | | - Erica Ferraris
- Department of Veterinary Sciences, University of Turin, Grugliasco, Italy
| | - Sofia Ramos
- North Downs Specialist Referrals, Bletchingley, UK
| | - Gerry Polton
- North Downs Specialist Referrals, Bletchingley, UK
| | - Luca Schiavo
- Department of Veterinary Medicine, Cambridge Veterinary School, University of Cambridge, Cambridge, UK
| | - Jane Dobson
- Department of Veterinary Medicine, Cambridge Veterinary School, University of Cambridge, Cambridge, UK
| | - Veronica Cola
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| | - Laura Marconato
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia, Italy
| |
Collapse
|
14
|
Arz R, Chiti LE, Krudewig C, Grieco V, Meier V, Fejös C, Stefanello D, Nolff MC. Lymph node metastasis in feline cutaneous low-grade mast cell tumours. J Feline Med Surg 2023; 25:1098612X221138468. [PMID: 36638145 PMCID: PMC10812050 DOI: 10.1177/1098612x221138468] [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: 01/14/2023]
Abstract
OBJECTIVES This retrospective study aimed to determine the incidence of nodal metastatic disease in cats affected by low-grade cutaneous mast cell tumours (MCTs) in our study population. METHODS The clinical records of two centres were retrospectively searched for cats with cutaneous MCTs that had undergone lymphadenectomy of enlarged and non-enlarged lymph nodes. All primary tumours were histologically reviewed by two experienced pathologists and graded as high- or low-grade based on the grading system for feline cutaneous MCT. We graded the lymph nodes based on the grading scheme used for canine MCTs and considered HN2 and HN3 nodes to be metastatic. The number of patients with nodal metastasis was calculated. RESULTS We identified 17 cats with cutaneous MCT resection and concurrent lymphadenectomy. All 21 MCTs were graded as low grade and 30 nodes were removed, with 12 being considered early or overtly metastatic (HN2 or HN3, respectively). Based on nodal status, 10/17 (59%) cats were affected by nodal metastasis in our population. CONCLUSIONS AND RELEVANCE In contrast to previous reports, high percentage of cats with cutaneous MCTs in which lymphadenectomy was performed were presented with metastatic lymph nodes. The clinical relevance of this finding and a potential benefit of lymphadenectomy must be determined in future studies.
Collapse
Affiliation(s)
- Raphael Arz
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Lavinia E Chiti
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Christiane Krudewig
- Institute of Veterinary Pathology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Valeria Grieco
- Department of Veterinary Medicine and Animal Science, University of Milan, Lodi, Italy
| | - Valeria Meier
- Division of Radiation Oncology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Csilla Fejös
- Division of Radiation Oncology, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
| | - Damiano Stefanello
- Department of Veterinary Medicine and Animal Science, University of Milan, Lodi, Italy
| | - Mirja C Nolff
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse Faculty, University of Zurich, Switzerland
| |
Collapse
|
15
|
Chiti LE, Gariboldi EM, Stefanello D, De Zani D, Grieco V, Nolff MC. Sentinel Lymph Node Mapping and Biopsy in Cats with Solid Malignancies: An Explorative Study. Animals (Basel) 2022; 12:3116. [PMID: 36428344 PMCID: PMC9686746 DOI: 10.3390/ani12223116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022] Open
Abstract
There is increasing evidence on the utility of sentinel lymph node (SLN) biopsy (SLNB) for the staging of dogs with various malignancies; however, comparable information is missing in cats. This multi-institutional study aims at reporting the feasibility and detection rate of SLNB guided by lymphoscintigraphy and the blue dye or near-infrared fluorescent lymphography (NIRF-L) in cats with solid tumors. In total, 12 cats presented with 14 solid malignancies that underwent curative-intent surgical excision of the primary tumor and SLNB were retrospectively enrolled. The mapping technique used, location and number of SLN, correspondence with the regional lymph node (RLN), and histological status of the SLN were retrieved. The detection rate and complications of SLNB were also recorded. NIRF-L was performed in 64.3% of tumors and lymphoscintigraphy in 35.7%. The detection rate was 100% for both techniques. The SLN did not correspond (fully or partially) to the RLN in 71.4% of cases, with multiple SLN being excised in 9/14 tumors. No complications related to SLNB were recorded. At histopathology, metastases were identified in 41.7% of cats, all with mast cell tumors (MCT). SLNB guided by NIRF-L or lymphoscintigraphy is feasible and safe in cats with solid tumors and should be suggested for correct tumor staging in cats, especially with MCT.
Collapse
Affiliation(s)
- Lavinia Elena Chiti
- Clinic for Smal Animals Surgery, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| | - Elisa Maria Gariboldi
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Damiano Stefanello
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Donatella De Zani
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Valeria Grieco
- Department of Veterinary Medicine and Animal Sciences, Università degli Studi di Milano, 26900 Lodi, Italy
| | - Mirja Christine Nolff
- Clinic for Smal Animals Surgery, Vetsuisse Faculty, University of Zurich, CH-8057 Zurich, Switzerland
| |
Collapse
|
16
|
Brown GK, Finlay JR, Straw RC, Ziea JY, Leung B, O'Connell K, Thomson MJ, Campbell JE, Jones PD, Reddell P. Treatment of multiple synchronous canine mast cell tumours using intratumoural tigilanol tiglate. Front Vet Sci 2022; 9:1003165. [PMID: 36387404 PMCID: PMC9643212 DOI: 10.3389/fvets.2022.1003165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/30/2022] [Indexed: 02/16/2024] Open
Abstract
Mast cell tumours (MCTs) are common canine skin neoplasia. While they generally occur as single tumours, multiple synchronous MCTs (msMCTs) of de novo/non-metastatic origin are reported in a proportion of the patient population. Where there is no evidence of metastasis or lymphatic spread, MCTs are effectively controlled by surgery and other local therapies. However, treatment of de novo msMCTs can be more challenging, especially when they occur in surgically difficult locations. Here, we report the use of tigilanol tiglate, a novel small molecule registered as a veterinary pharmaceutical for the local treatment of non-metastatic MCTs, in the treatment of patients with msMCTs presenting at three Australian specialist referral centres. We also present a meta-analysis of the literature to provide a better understanding of the prevalence of canine msMCTs. Notably, nine patients with a total of 32 MCTs were treated during the study. A complete response was recorded in 26 (81%) of the individual MCTs on Day 28 after a single tigilanol tiglate injection. Of the 6 initially non-responsive MCTs, one achieved a complete response after a further tigilanol tiglate treatment. A complete response was reported at 6 months in all 22 of the tumours that were evaluable and that had recorded a complete response at Day 84. For the literature meta-analysis, 22 studies were found with prevalence estimates of msMCTs ranging from 3 to 40%; when combined, these studies yielded 3,745 patients with a prevalence of 13% (95% CI 10; 16). Overall, the results demonstrate the utility of intratumoural tigilanol tiglate as an option for the treatment of multiple MCTs where multiple surgical resections would have been required.
Collapse
Affiliation(s)
| | | | - Rodney C. Straw
- Brisbane Veterinary Specialist Centre, The Australian Animal Cancer Foundation, Albany Creek, QLD, Australia
| | - Joy Y. Ziea
- Brisbane Veterinary Specialist Centre, The Australian Animal Cancer Foundation, Albany Creek, QLD, Australia
| | - Becky Leung
- Brisbane Veterinary Specialist Centre, The Australian Animal Cancer Foundation, Albany Creek, QLD, Australia
| | | | | | | | | | - Paul Reddell
- QBiotics Group Limited, Yungaburra, QLD, Australia
| |
Collapse
|
17
|
De Bonis A, Collivignarelli F, Paolini A, Falerno I, Rinaldi V, Tamburro R, Bianchi A, Terragni R, Gianfelici J, Frescura P, Dolce G, Pagni E, Bucci R, Vignoli M. Sentinel Lymph Node Mapping with Indirect Lymphangiography for Canine Mast Cell Tumour. Vet Sci 2022; 9:vetsci9090484. [PMID: 36136700 PMCID: PMC9503988 DOI: 10.3390/vetsci9090484] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/21/2022] [Accepted: 09/05/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Mast cell tumour (MCT) is a common cutaneous and subcutaneous neoplasia in dogs. Recent studies describe that sentinel lymph node (SLN) assessment is more specific to stage MCT, while regional lymph node (RLN) evaluation is not as specific. SNL is the first site of drainage of a tumour and the first metastatic site in several tumours. The study aims to evaluate the SLN drainage mapping of MCT with indirect lymphography in dogs. The second objective of the study is to compare the SLN to the RLN. Survey radiographs followed by an indirect lymphography were obtained for SLN mapping. Twenty-six dogs with 29 MCTs were included. SLNs were detectable in 26 MCTs and radiographic indirect lymphangiography with Lipiodol was able to detect at least one SLN in 90% of MCTs in dogs. In conclusion, radiographic indirect lymphangiography with Lipiodol is a feasible technique to map SLNs and its draining system in MCTs. The lymph drainage pattern of the MCTs may be different for each MCT and more than one SLN can be involved. Abstract Mast cell tumour (MCT) is a common cutaneous and subcutaneous neoplasia in dogs. It can metastasise to lymph nodes (LNs), and this adversely affects the prognosis and treatment. The study aims to evaluate the SLN mapping of MCTs with radiographic indirect lymphography. Dogs that underwent clinical staging were prospectively enrolled. Lipiodol was injected around the MCT or the surgical scar. After 24 h, LNs that picked up contrast were radiographically assessed. Twenty-six dogs with 29 MCTs were included. MCTs were confirmed histologically, while SLNs were evaluated either by cytology and/or histology. SLNs were detectable in 23 dogs with 26 MCTs. Lymphatic vessels were visible in 19 MCTs. In nine MCTs, at least two SLNs picked up contrast. In particular, seven MCTs involved two SLNs, and two MCTs involved three different SLNs. In nine MCTs, at least a SLN was metastatic. This study indicates that the lymph drainage pattern of the MCTs may be different for each MCT, and more than one SLN can be involved. Indirect lymphangiography with Lipiodol allowed the detection of the SLN in 90% of MCTs. This provided clinically relevant information to remove the LN and stage the patient.
Collapse
Affiliation(s)
- Andrea De Bonis
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
- Correspondence: (A.D.B.); (A.P.)
| | | | - Andrea Paolini
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
- Correspondence: (A.D.B.); (A.P.)
| | - Ilaria Falerno
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Valentina Rinaldi
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Roberto Tamburro
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Amanda Bianchi
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | | | | | | | - Giulia Dolce
- Policlinico Veterinario Roma Sud, 00173 Roma, Italy
| | | | - Roberta Bucci
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| |
Collapse
|
18
|
Rinaldi V, Crisi PE, Vignoli M, Pierini A, Terragni R, Cabibbo E, Boari A, Finotello R. The Role of Fine Needle Aspiration of Liver and Spleen in the Staging of Low-Grade Canine Cutaneous Mast Cell Tumor. Vet Sci 2022; 9:vetsci9090473. [PMID: 36136689 PMCID: PMC9506313 DOI: 10.3390/vetsci9090473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Clinical staging is a fundamental step in the clinical assessment of canine cutaneous mast cell tumor (cMCT), and it is recommended to evaluate the tumor draining lymph node (eTDLN), perform diagnostic imaging, and fine needle aspiration (FNA) of the spleen and liver to determine the presence of metastatic disease, thereby refining the prognosis. The aim of this retrospective study was to evaluate the prevalence of splenic and hepatic involvement in newly diagnosed canine low-grade cMCT (Patnaik grade I–II, Kiupel low-grade). Medical records of dogs that underwent a clinical staging work-up and surgical excision for a low-grade cMCT between December 2019 and December 2021 were reviewed at five veterinary centers. Only dogs with a histological diagnosis of low-grade cMCT, FNA or histology of the eTDLN, FNA of the spleen and liver, and one year of follow up were included. One hundred and thirty-six dogs met the inclusion criteria. Only 1 out of 136 dogs (0.7%) had the presence of visceral metastases at diagnosis, suggesting that the prevalence of visceral metastases in low-grade cMCT is extremely low. The results of this study are consistent with previous literature and suggest that after a diagnosis of low-grade cMCT, cytology of visceral organs may not represent an essential step in the clinical staging work-up.
Collapse
Affiliation(s)
- Valentina Rinaldi
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Paolo Emidio Crisi
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
- Correspondence:
| | - Massimo Vignoli
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Alessio Pierini
- Department of Veterinary Sciences, Veterinary Teaching Hospital “Mario Modenato”, University of Pisa, 56122 Pisa, Italy
| | - Rossella Terragni
- Clinica Veterinaria Pet Care, Animalia, via Marzabotto 1/2 M-N, 40133 Bologna, Italy
| | - Emanuele Cabibbo
- Clinica Veterinaria Jenner, VetPartners, via Jenner 37, 43126 Parma, Italy
| | - Andrea Boari
- Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy
| | - Riccardo Finotello
- Department of Small Animal Clinical Science, Institute of Infection, Veterinary and Ecological Science, University of Liverpool, Chester High Road, Neston CH64 7TE, UK
| |
Collapse
|
19
|
Sentinel Lymph Node Biopsy Is Feasible in Dogs with Scars from Prior Local Excision of Solid Malignancies. Animals (Basel) 2022; 12:ani12172195. [PMID: 36077914 PMCID: PMC9454906 DOI: 10.3390/ani12172195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 12/11/2022] Open
Abstract
Simple Summary Sentinel lymph node (SLN) excision is gaining relevance in the management of various canine malignancies due to its recognized impact on staging and treatment choices. However, the technologies to perform SLN mapping are only available to a few referral centers, and there is increasing demand for secondary nodal staging after prior tumor excision at the primary care institution. This retrospective study investigated the feasibility and usefulness of SLN biopsy in dogs with surgical scars resulting from the removal of various solid tumors referred for further staging and/or adjuvant treatment options. Thirty-three dogs with 34 scars underwent SLN biopsy at a median of 50 days after primary tumor excision. An SLN was identified for 31/34 scars, translating to a detection rate of 91.2%. Metastases were identified with histopathology in 13/31 dogs (41.9%) and they all had an excision of a mast cell tumor. SLN biopsy should be suggested in dogs presenting with scars from prior solid tumor excision, considering the observed detection rate and the importance of knowing the metastatic status of the SLN in oncological diseases. Abstract Sentinel lymph node (SLN) biopsy is a well-established staging tool in canine oncology. This study aims to explore the feasibility of SLN biopsy in dogs with scars from prior excised solid malignancies that were referred for further tumor staging and/or adjuvant treatment options. Mapping was either performed using radiopharmaceutical, methylene blue, and/or near-infrared fluorescent (NIRF) imaging. Thirty-three dogs with 34 scars from prior excision of the mast cell tumor (MCT) (n = 29), soft tissue sarcoma (n = 2), oral melanoma (n = 1), subungual melanoma (n = 1), and mammary adenocarcinoma (n = 1) were retrospectively enrolled. Primary treatment consisted of curative intent/wide tumor excisions in 50.0% of dogs and marginal excision in the remaining 50.0%. The median time between tumor excision and SLN biopsy was 50 days (range 17–110 days). The procedure was successful in 31/34 scars, translating to a detection rate of 91.2%. The SLN did not correspond to the regional lymph node in 19/31 scars (61.3%). SLN metastases were histologically identified in 13/31 (41.9%) dogs, all of them affected by MCT. Based on our results, SLN biopsy using lymphoscintigraphy/methylene blue and/or NIRF is feasible in dogs presenting with scars from the prior surgical excision of solid tumors, and should be suggested for accurate nodal staging.
Collapse
|
20
|
Beer P, Rohrer-Bley C, Nolff MC. Near-infrared fluorescent image-guided lymph node dissection compared with locoregional lymphadenectomies in dogs with mast cell tumours. J Small Anim Pract 2022; 63:670-678. [PMID: 35815663 PMCID: PMC9542114 DOI: 10.1111/jsap.13529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/03/2022] [Accepted: 05/25/2022] [Indexed: 12/21/2022]
Abstract
Objectives Near‐infrared fluorescent imaging has been described for intraoperative mapping of the draining lymph nodes in human cancer and canine oral tumours. The aim of this study was to retrospectively describe the results of lymphadenectomies in dogs with mast cell tumours treated either by standard unguided locoregional lymph node dissection or near‐infrared fluorescent image‐guided lymph node dissection. Methods Medical records between 2012 and 2020 were reviewed for dogs that were presented for surgical resection of mast cell tumours with concurrent lymphadenectomy either with (near‐infrared fluorescent image‐guided lymph node dissection) or without near‐infrared fluorescence image guidance (lymph node dissection). The number and location of lymph nodes planned for surgical dissection and actually dissected nodes, presence of metastases and perioperative complications were recorded. Results Thirty‐five patients underwent near‐infrared fluorescent image‐guided lymph node dissection, and 43 lymph node dissections. The number of nodes preoperatively planned for resection were 70 and 68, respectively. Fifty‐eight of those (83%) were identified during near‐infrared fluorescent image‐guided lymph node dissection procedures, compared with 50 (74%) during lymph node dissection. near‐infrared fluorescent image‐guided lymph node dissection resulted in resection of additional fluorescent nodes not corresponding to locoregional nodes in 15 of 35 dogs. Using near‐infrared fluorescent image‐guided lymph node dissection, we identified at least one metastatic node in 68% of dogs (24 of 35) compared with 33% (14 of 43) when lymph node dissection was used without imaging. No complications related to near‐infrared fluorescent imaging were reported. Clinical Significance The present study suggests that near‐infrared imaging is a promising technique for intraoperative detection of the draining lymph nodes in dogs with mast cell tumours. Further validation of the technique is required to assess if near‐infrared fluorescent imaging can detect the true sentinel lymph node.
Collapse
Affiliation(s)
- P Beer
- Vetsuisse Faculty, Clinic for Small Animal Surgery, University of Zurich, Zurich, 8057, Switzerland
| | - C Rohrer-Bley
- Division of Radiation Oncology, Vetsuisse Faculty, University of Zurich, Zurich, 8057, Switzerland
| | - M C Nolff
- Vetsuisse Faculty, Clinic for Small Animal Surgery, University of Zurich, Zurich, 8057, Switzerland
| |
Collapse
|
21
|
Chalfon C, Sabattini S, Finotello R, Faroni E, Guerra D, Pisoni L, Ciammaichella L, Vasconi ME, Annoni M, Marconato L. Lymphadenectomy improves outcome in dogs with resected Kiupel high-grade cutaneous mast cell tumours and overtly metastatic regional lymph nodes. J Small Anim Pract 2022; 63:661-669. [PMID: 35733233 DOI: 10.1111/jsap.13525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Historically, the prognosis for dogs with stage II Kiupel high-grade cutaneous mast cell tumours has been considered poor. OBJECTIVES The aim of this study was to explore the impact of lymphadenectomy on outcome in dogs with Kiupel high-grade cutaneous mast cell tumours and overt regional lymph node metastasis. MATERIAL AND METHODS Data from dogs with completely staged Kiupel high-grade cutaneous mast cell tumours with overt and/or certain regional lymph node metastasis undergoing excision of the primary tumours and adjuvant medical treatment were extracted. Dogs with a cytological diagnosis of regional lymph node metastasis that did not undergo lymphadenectomy were compared with dogs that underwent lymphadenectomy and had a histological diagnosis of overt lymph node metastasis. RESULTS Forty-nine dogs were included, 18 did not undergo lymphadenectomy while 31 underwent lymphadenectomy. Median time to progression was significantly shorter in dogs that did not undergo lymphadenectomy (150 days, 95% confidence interval: 129 to 170) compared to the other dogs (229 days, 95% confidence interval: 191 to 266). Median survival time was also shorter in dogs that did not undergo lymphadenectomy (250 days, 95% confidence interval: 191 to 308) compared to dogs that underwent lymphadenectomy (371 days, 95% confidence interval: 311 to 430). On multivariable analysis, lack of lymphadenectomy was associated with higher risk of overall tumour progression (hazard ratio: 2.05, 95% confidence interval: 1.02 to 4.13), nodal progression (hazard ratio: 3.4, 95% confidence interval: 1.65 to 7.02) and tumour-related death (hazard ratio 3.63, 95% confidence interval: 1.72 to 7.66), whereas tumour size was associated with higher risk of local recurrence (hazard ratio: 3.61, 95% confidence interval: 1.06 to 13). CLINICAL SIGNIFICANCE Regional lymphadenectomy may improve outcome in dogs with biologically aggressive cutaneous mast cell tumours.
Collapse
Affiliation(s)
- C Chalfon
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, 40126, Italy
| | - S Sabattini
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, 40126, Italy
| | - R Finotello
- Depertment of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston, CH64 7TE, UK
| | - E Faroni
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, 40126, Italy
| | - D Guerra
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, 40126, Italy
| | - L Pisoni
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, 40126, Italy
| | - L Ciammaichella
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, 40126, Italy
| | - M E Vasconi
- Centro Veterinario Torinese, Turin, 10153, Italy
| | - M Annoni
- Clinica Veterinaria Tibaldi, Milan, 20141, Italy
| | - L Marconato
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, 40126, Italy
| |
Collapse
|
22
|
Evaluation of Tumor Grade and Proliferation Indices before and after Short-Course Anti-Inflammatory Prednisone Therapy in Canine Cutaneous Mast Cell Tumors: A Pilot Study. Vet Sci 2022; 9:vetsci9060277. [PMID: 35737330 PMCID: PMC9227510 DOI: 10.3390/vetsci9060277] [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: 05/04/2022] [Revised: 05/30/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022] Open
Abstract
Glucocorticoid administration is a common clinical practice that attempts to decrease the inflammation associated with and improve the resectability of canine mast cell tumors (MCTs). However, the impact of neoadjuvant glucocorticoids on the histological features and proliferation indices of canine MCTs is unknown. The objective of this study was to evaluate changes in tumor grade, mitotic count, Ki67, AgNOR, and AgNORxKi67 scores following short-course anti-inflammatory neoadjuvant prednisone in canine patients with MCTs. This was a prospective single-arm pilot study. Client-owned dogs with treatment-naïve cytologically confirmed MCTs were enrolled. Patients underwent an initial incisional biopsy followed by a 10–14-day course of anti-inflammatory prednisone and surgical resection. All histological samples were randomized, masked, and evaluated by a single pathologist. Unstained paired pre- and post-treatment samples were submitted to a commercial laboratory for Ki67 and AgNOR immunohistochemical analysis. There were 11 dogs enrolled with 11 tumors. There were no statistical differences between the pre- and post-treatment histological parameters of mitotic index, Ki67, AgNOR, or Ki67xAgNOR. There were no clinically significant alterations between pre-treatment and post-treatment in the assignment of tumor grades. A short course of anti-inflammatory prednisone does not appear to alter the histological parameters that affect grade determination or significantly alter the proliferation indices in canine MCTs.
Collapse
|
23
|
Sabattini S, Faroni E, Renzi A, Ghisoni G, Rigillo A, Bettini G, Pasquini A, Zanardi S, Guerra D, Marconato L. Longitudinal lymph node step-sectioning for the identification of metastatic disease in canine mast cell tumor. Vet Pathol 2022; 59:768-772. [DOI: 10.1177/03009858221088780] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lymph node (LN) metastasis in canine mast cell tumor (MCT) can affect prognosis and postsurgical treatment recommendations; however, routine histological single-section examination may underestimate the incidence of metastases. This prospective study aimed at determining whether longitudinal step-sectioning of the entire LN allows for a more reliable detection of metastases. Dogs with MCT undergoing resection of the primary tumor and regional lymphadenectomy were enrolled. Formalin-fixed LNs were bisected longitudinally, both halves were embedded in paraffin and histological sections prepared at 200 μm steps. The nodal mast cells were classified according to the Weishaar classification. First-section evaluation (FSE; ie, examination of the first section obtained from the blocks) and whole LN step-section evaluation (SSE) were compared. Fifty-eight LNs were included. The median number of sections per LN was 6 (range, 3–28). FSE with toluidine blue (TB) revealed 27 (47%) nonmetastatic (HN0), 14 (24%) premetastatic (HN1), 9 (15%) early metastatic (HN2), and 8 (14%) overtly metastatic (HN3) LNs. SSE with TB resulted in upgrading the LN status in 2 cases (HN2 to HN3; HN0 to HN1). Evaluation of the first section plus an additional step-section resulted in 100% accuracy. Compared with SSE with TB, the accuracy of FSE with HE was 98% for HN3 LNs and 74% for HN2 LNs. FSE appears to reliably allow for the detection of LN metastasis in MCT, although examination of a further parallel section at a 200 μm step may increase the accuracy. A metachromatic stain is recommended for the identification of early metastases.
Collapse
Affiliation(s)
- Silvia Sabattini
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Eugenio Faroni
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Andrea Renzi
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Giulia Ghisoni
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Antonella Rigillo
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Giuliano Bettini
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Arianna Pasquini
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Stefano Zanardi
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Dina Guerra
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Laura Marconato
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
24
|
Guerra D, Faroni E, Sabattini S, Agnoli C, Chalfon C, Stefanello D, Del Magno S, Cola V, Grieco V, Marconato L. Histologic grade has a higher-weighted value than nodal status as predictor of outcome in dogs with cutaneous mast cell tumors and overtly metastatic sentinel lymph nodes. Vet Comp Oncol 2022; 20:551-558. [PMID: 35195937 DOI: 10.1111/vco.12806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Abstract
In canine cutaneous mast cell tumors (cMCTs), histologic grade and clinical stage are the most important prognostic factors, with high-grade tumors and metastatic lymph nodes (LNs) significantly influencing the evolution of disease. However, it is uncertain whether histologic grade and clinical stage should be given equal weighting value in patient prognostication and management. Dogs with low- and high-grade cMCTs and at least one overtly metastatic sentinel LN undergoing standardized treatment, consisting of surgical excision of the cMCT, lymphadenectomy and chemotherapy, were retrospectively included. The aim was to determine whether, at the same clinical stage, histologic grade retained prognostic relevance. Sixty dogs were included: 26 had a high-grade cMCT tumor and 34 had a low-grade cMCT. Median follow-up was 367 days (range, 187-748) in the high-grade group, and 1208 days (range, 180-2576) in the low-grade group. Median time to progression was significantly shorter in the high-grade group than in the low-grade group (214 days versus not reached; P<0.001), as well as tumor-specific survival (545 days versus not reached; P<0.001). On multivariable analysis, a high histologic grade and incomplete margins retained prognostic significance for both tumor progression and tumor-specific death. In dogs with cMCT and at least one overtly metastatic LN undergoing multimodal treatment, histologic grade significantly correlated with outcome. Overall prognosis was not unfavorable, even in the high-grade group, further supporting that a multimodal therapeutic approach, addressing primary tumor and sentinel LN, should be offered. Whether chemotherapy should be incorporated in the therapeutic planning of low-grade cMCTs remains to be defined. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Dina Guerra
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Eugenio Faroni
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Silvia Sabattini
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Chiara Agnoli
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Carmit Chalfon
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Damiano Stefanello
- Dipartimento di Medicina Veterinaria Università degli Studi di Milano, Lodi, Italy
| | - Sara Del Magno
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Veronica Cola
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| | - Valeria Grieco
- Dipartimento di Medicina Veterinaria Università degli Studi di Milano, Lodi, Italy
| | - Laura Marconato
- Department of Veterinary Medical Sciences, University of Bologna, Ozzano dell'Emilia (Bologna), Italy
| |
Collapse
|
25
|
Thaiwong T, Cirillo JV, Heller J, Kiupel M. Expression of Carboxypeptidase A3 and Tryptase as Markers for Lymph Node Metastasis of Canine Cutaneous Mast Cell Tumors. Front Vet Sci 2022; 9:815658. [PMID: 35237679 PMCID: PMC8882851 DOI: 10.3389/fvets.2022.815658] [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: 11/15/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Detection of metastatic mast cell tumors (MCTs) in lymph nodes is a critical factor for treatment, prognosis, and clinical management. Presence/absence of mast cells in the lymph nodes cannot be used as a sole parameter to determine metastasis due to the inability to differentiate neoplastic from non-neoplastic/inflammatory mast cells. While cytologic and histopathologic classifications for assessment of metastatic MCTs based on the numbers and distribution of mast cells have been developed, inconsistency between the clinical interpretation of these grading schemes and actual metastatic status occurs. The aim of this study is to identify a novel diagnostic tool to accurately predict overt metastatic mast cell tumors in lymph nodes. We investigated the possibility of using RT-qPCR to detect mRNA expression of mast cell-specific genes in lymph nodes with different stages of MCT metastatic classification. We are able to establish a highly sensitive and discriminating RT-qPCR measuring Carboxy peptidase A3 (CPA3) and tryptase mRNA expression and identify the cut-off values with high sensitivity and specificity for overt metastatic MCTs in lymph nodes. An area of future interest would be to expand our analysis of the extent to which cut-off values for these markers in correctly identifying disease status, as well as predicting clinical outcomes and survival times. This would offer valuable information regarding the practical applicability of this technique and may enable us to improve our standards of detection metastasis, including possibility of molecular analysis of cytologic specimens obtained from suspicious nodes subjected to surgical excision.
Collapse
Affiliation(s)
- Tuddow Thaiwong
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, Lansing, MI, United States
- *Correspondence: Tuddow Thaiwong
| | - Juliana V. Cirillo
- Departamento de Patologia, Facultad de Medicina Veterinaria y Zootecnia, Universidade de São Paulo, São Paulo, Brazil
| | - Jane Heller
- School of Animal and Veterinary Services, Faculty of Veterinary Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Matti Kiupel
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, Lansing, MI, United States
- Department of Pathobiology and Diagnostic Investigation, Michigan State University, East Lansing, MI, United States
| |
Collapse
|
26
|
Mason SL, Pittaway C, Gil BP, Russak OM, Westlake K, Berlato D, Benoit J, Morris J, Dobson JM. Outcomes of adjunctive radiation therapy for the treatment of mast cell tumors in dogs and assessment of toxicity: A multicenter observational study of 300 dogs. J Vet Intern Med 2021; 35:2853-2864. [PMID: 34672378 PMCID: PMC8692218 DOI: 10.1111/jvim.16264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
Background Radiation therapy is commonly used as an adjunct to incomplete surgical excision in dogs with mast cell tumors (MCT), but the optimal dose and fractionation regimen have yet to be determined. Hypothesis We assessed outcomes (time to local recurrence, patient survival and toxicity) of a large population of dogs with MCT that received adjunctive radiation therapy. Animals Three hundred dogs with 302 MCT treated using adjunctive radiation therapy. Methods Retrospective observational study. Clinical records of 4 veterinary radiation centers were reviewed. Results Local recurrence rates were similar regardless of radiation protocol with 6.6% of patients developing recurrent cutaneous MCT at a median of 526 days. Local recurrence rate was similar between high and low‐risk MCT. Mast cell tumor related death was reported in 19% of all dogs, with 13% of dogs with low‐risk MCT dying of their disease compared to 29% of dogs with high‐risk MCT. No SC MCT (SCMCT) recurred after radiation therapy and only 7% of dogs with SCMCT were reported to have died of their disease. Mild late toxicity was common in both protocols and severe late toxicity occurred in 1.9% of dogs many years after treatment. Conclusions and Clinical Importance Our study supports the use of adjunctive radiation for the long‐term control of incompletely or narrowly excised cutaneous and SCMCT in dogs. More moderate dose and fractionation protocols may be appropriate in the adjunctive treatment of low‐risk MCT in dogs. Large multicenter prospective studies are required to establish the optimal dose and fractionation for MCT of different risk categories.
Collapse
Affiliation(s)
- Sarah L Mason
- Southfields Veterinary Specialists, Basildon, United Kingdom.,Queens Veterinary School Hospital-Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Charles Pittaway
- Queens Veterinary School Hospital-Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom.,Dick White Referrals, Cambridge, United Kingdom
| | - Begona Pons Gil
- Southfields Veterinary Specialists, Basildon, United Kingdom
| | - Onne-Marju Russak
- Dick White Referrals, Cambridge, United Kingdom.,Animal Health Trust, Newmarket, United Kingdom
| | - Katie Westlake
- Queens Veterinary School Hospital-Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Davide Berlato
- AniCura Animal Oncology and Imaging Center, Hünenberg, Switzerland.,Animal Health Trust, Newmarket, United Kingdom
| | - Jérôme Benoit
- Southfields Veterinary Specialists, Basildon, United Kingdom
| | | | - Jane Margaret Dobson
- Queens Veterinary School Hospital-Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
27
|
Bellamy E, Berlato D. Canine cutaneous and subcutaneous mast cell tumours: a review. J Small Anim Pract 2021; 63:497-511. [PMID: 34671978 DOI: 10.1111/jsap.13444] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/26/2021] [Accepted: 09/06/2021] [Indexed: 01/12/2023]
Abstract
Cutaneous and subcutaneous mast cell tumours are common neoplasms in the dog. While the majority can be treated with adequate local therapy alone, a subset demonstrates a biologically aggressive behaviour associated with local recurrence or metastasis. This article reviews the diagnosis and tumour staging of canine mast cell tumours alongside treatment options and the evidence supporting their use. In addition, prognostic markers are evaluated to highlight how one can recognise mast cell tumours that may behave in a biologically aggressive manner as well as the challenges of tumours that are large, infiltrative or in locations not amenable to wide surgical excision.
Collapse
Affiliation(s)
- E Bellamy
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
| | - D Berlato
- AniCura AOI Center AG, Hünenberg, 6331, Switzerland
| |
Collapse
|
28
|
Fejös C, Troedson K, Ignatenko N, Zablotski Y, Hirschberger J. Extensive staging has no prognostic value in dogs with low-risk mast cell tumours. Vet Comp Oncol 2021; 20:265-275. [PMID: 34564910 DOI: 10.1111/vco.12773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 12/16/2022]
Abstract
In canine mast cell tumours (MCTs), distant metastasis (DM) occurs infrequently. However, high-risk MCTs or tumours with certain negative prognostic factors (NPFs) are those more prone to develop metastatic disease. Accordingly, a thorough workup might not be necessary for MCTs lacking NPFs. The objective of this study was to evaluate the rate of DM and, therefore, the benefit of extensive staging in dogs presenting with and without NPFs. Furthermore, the association between the selected NPFs and DM was assessed, and factors that may have influenced outcome were evaluated. Dogs presenting with at least one NPF (Patnaik III/Kiupel high-grade, LN metastasis, rapid growth, ulceration, recurrence, high-risk location) were defined as high-risk and without as low-risk MCTs. Ninety-nine dogs were included, with 49% of MCTs in the high-risk and 51% in the low-risk group. All seven dogs with DM were identified in the high-risk group; 43% were Patnaik III/Kiupel high-grade tumours. The median survival time (MST) for this subgroup was 84 days. Patnaik III/Kiupel high-grade and rapid growth were NPFs significantly associated with DM at staging. Furthermore, a significant difference (p < .001) in MST was demonstrated between the high-risk and low-risk groups (899 days vs. not reached). NPFs significantly associated with outcome were rapid growth, presence of DM at staging, and surgical tumour excision. These results indicate that extensive staging in the absence of NPFs does not seem to be beneficial. On the other hand, by using the selected NPFs, a subset of MCTs prone to DM can be identified.
Collapse
Affiliation(s)
- Csilla Fejös
- Clinic of Small Animal Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilian University, Munich, Germany
| | - Karin Troedson
- Clinic of Small Animal Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilian University, Munich, Germany
| | - Nataliia Ignatenko
- Clinic of Small Animal Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilian University, Munich, Germany
| | - Yury Zablotski
- Clinic of Small Animal Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilian University, Munich, Germany
| | - Johannes Hirschberger
- Clinic of Small Animal Medicine, Faculty of Veterinary Medicine, Ludwig-Maximilian University, Munich, Germany
| |
Collapse
|
29
|
Assessing the Risk of Nodal Metastases in Canine Integumentary Mast Cell Tumors: Is Sentinel Lymph Node Biopsy Always Necessary? Animals (Basel) 2021; 11:ani11082373. [PMID: 34438830 PMCID: PMC8388797 DOI: 10.3390/ani11082373] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 12/18/2022] Open
Abstract
The recent literature supports the sentinel lymph node (SLN) biopsy in dogs with MCT due to discrepancy with the regional lymph node and the high percentage of occult metastasis. However, the SLN biopsy includes additional anesthesiologic, diagnostic, and surgical procedures, and additional costs. The study aimed to assess the association between clinicopathological variables and SLN status, determining the identification of dogs at lower risk of SLN metastases. Dogs with integumentary MCT were admitted to the lymphoscintigraphic mapping and subsequent biopsy of SLN. The association between clinicopathological variables of MCT and SLN status was statistically tested, both considering occult and overt metastasis together (HN2-HN3) and overt metastasis (HN3) alone. Fifty low-grade cutaneous MCT and 16 subcutaneous MCT were included. A small to moderate association between integumentary MCT ≥ 3 cm and HN2-HN3 SLN was found. A strong association of integumentary MCT dimension and subcutaneous MCT with HN3 SLN occurred. Dimension of low-grade cutaneous and subcutaneous MCT seems to correlate with SLN status, but additional study should confirm this data before excluding small MCT to the SLN biopsy. On the contrary, the study results induce a solid suggestion for mapping and biopsy of the SLN in MCT > 3 cm and subcutaneous MCT.
Collapse
|
30
|
Di Virgilio F, Belluzzi E, Santos M, Caraty J, Bongartz A, Deneuche A. Practice patterns about the role of palliation in veterinary surgical oncology. Vet Comp Oncol 2021; 19:750-758. [PMID: 34260820 DOI: 10.1111/vco.12754] [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: 12/23/2020] [Revised: 06/29/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
Whether surgical palliative therapy is appropriate for oncologic veterinary patients is an increasing concern as pet age increases because of improved care. In this study, an online survey (available for 30 days), comprising 100 questions with structured response options, was administered to 492 diplomates of the European College of Veterinary Surgeons (ECVS). The survey queried the technical, ethical, social, medical, and financial aspects of surgical palliative therapy for oncologic veterinary patients. Responses were received from 155 ECVS diplomates (31.5%, n = 155/492). Palliative surgery was a relatively common intervention in veterinary oncology, with 50% of respondents (n = 77.5/155) indicating that 75%-100% of oncological surgeries performed were palliative. The presence of metastasis was judged as a key determinant when deciding to perform palliative oncological surgery by 41% of the respondents (n = 63.5/155). The survey revealed that the most commonly performed procedures in palliative oncological surgery were marginal resection, debulking, and amputation. In contrast to human medicine, palliative limb-sparing surgery, stent placement, and embolization were rarely used in veterinary settings, mainly because of a general lack of expertise among veterinarians, elevated costs, and recourse to euthanasia. Taken together, the survey results highlight the need for appropriate guidelines in the field of oncological surgery. To establish general guidelines and direct veterinarians towards the most appropriate judgement, understanding how and what veterinary surgeons manage palliative oncological surgery and how they perceive the main ethical, social, medical, and financial concerns are essential. Such guidelines will lead to better care for ailing animals and will facilitate the path to healing for owners.
Collapse
Affiliation(s)
| | - Elena Belluzzi
- Department of Surgery, Clinique Vétérinaire Bongartz, Liège, Belgium
| | - Marisa Santos
- Department of Surgery, Clinique Vétérinaire Vet24, Marcq en Baroeul, France
| | - Johan Caraty
- Department of Surgery, Clinique Vétérinaire Bongartz, Liège, Belgium
| | | | - Aymeric Deneuche
- Department of Surgery, Clinique Vétérinaire Vet24, Marcq en Baroeul, France
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Oliveira MT, Campos M, Lamego L, Magalhães D, Menezes R, Oliveira R, Patanita F, Ferreira DA. Canine and Feline Cutaneous Mast Cell Tumor: A Comprehensive Review of Treatments and Outcomes. Top Companion Anim Med 2020; 41:100472. [PMID: 32891740 DOI: 10.1016/j.tcam.2020.100472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/10/2020] [Accepted: 08/31/2020] [Indexed: 12/19/2022]
Abstract
Mast cell tumor (MCT) or mastocytoma is one of the most frequent malignant cutaneous tumors in the dog, and the second most frequent in the cat. Several mast cell tumor therapeutic approaches have been proposed in the past years for dogs and cats, resulting in very distinct outcomes. The current comprehensive literature review presents a critical approach to the scientific information published about the MCTs treatments and the subsequent prognosis and survival times, in dogs and in cats diagnosed with MCTs. A systematic review of the literature following the Cochrane principles and methodology was performed. The authors resorted to MEDLINE, Scopus, Google Scholar and Web of Science databases to select the 133 publications with evidence-based treatments for MCTs in companion animals. Results of the review suggest that the recommended treatment, prognosis and survival times for dogs and cats with MCTs depends at all times on the clinical staging, histological grade and location of the tumor.
Collapse
Affiliation(s)
- Maria Teresa Oliveira
- MED - Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal; Departamento de Medicina Veterinária, Escola de Ciências e Tecnologia, Universidade de Évora, Pólo da Mitra, Núcleo da Mitra, 7000 Évora, Portugal.
| | - Marco Campos
- Universidade de Évora, Pólo da Mitra, Núcleo da Mitra, 7000 Évora, Portugal
| | - Luís Lamego
- Universidade de Évora, Pólo da Mitra, Núcleo da Mitra, 7000 Évora, Portugal
| | - Diogo Magalhães
- Universidade de Évora, Pólo da Mitra, Núcleo da Mitra, 7000 Évora, Portugal
| | - Rui Menezes
- Universidade de Évora, Pólo da Mitra, Núcleo da Mitra, 7000 Évora, Portugal
| | - Renato Oliveira
- Universidade de Évora, Pólo da Mitra, Núcleo da Mitra, 7000 Évora, Portugal
| | - Francisco Patanita
- Universidade de Évora, Pólo da Mitra, Núcleo da Mitra, 7000 Évora, Portugal
| | - David A Ferreira
- MED - Mediterranean Institute for Agriculture, Environment and Development, Instituto de Investigação e Formação Avançada, Universidade de Évora, Pólo da Mitra, Ap. 94, 7006-554 Évora, Portugal; Departamento de Medicina Veterinária, Escola de Ciências e Tecnologia, Universidade de Évora, Pólo da Mitra, Núcleo da Mitra, 7000 Évora, Portugal
| |
Collapse
|