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Minnoye S, De Vos S, Beck S, Duchateau L, Hubers M, David S, Fortrie R, de Rooster H. Histopathological features of subcutaneous and cutaneous mast cell tumors in dogs. Acta Vet Scand 2024; 66:53. [PMID: 39354622 PMCID: PMC11445992 DOI: 10.1186/s13028-024-00775-5] [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: 05/13/2024] [Accepted: 09/12/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Mast cell tumors (MCTs) are the most common malignant skin neoplasms in dogs. In the past, the distinction between cutaneous MCTs (cMCTs), originating from the dermis, and subcutaneous MCTs (scMCTs), originating from the subcutaneous tissue, was not made. Histopathological differentiation, including grading, is important for prognosis. However, the Patnaik and Kiupel grading systems were proposed for cMCTs only. The objective of our study was to describe and compare the signalment of dogs with scMCTs and cMCTs and histopathological features, anticipating similarities in both groups. Data of dogs histologically diagnosed with scMCTs or cMCTs between September 2020 and July 2023 were analyzed retrospectively. Signalment, tumor location, histopathological features, completeness of removal and lymph node status were recorded. RESULTS Data on 305 scMCTs and 1291 cMCTs were collected. Breed distribution was different between scMCTs and cMCTs (P < 0.0001). Mitotic count (MC) was not different between scMCTs (1.63) and cMCTs (1.58) (P = 0.8490). Compared to cMCTs, scMCTs more often had anisokaryosis, bizarre nuclei and multinucleation. Kiupel high grade was more often assigned to scMCTs (51/292, 17.5%) than cMCTs (154/1291, 11.9%) (P = 0.009). The odds of MCTs being assigned a high grade in scMCT was 1.578 higher than in cMCTs (95% confidence interval [1.116-2.232]). CONCLUSIONS Histopathological differences between scMCTs and cMCTs were observed. A Kiupel high grade was more often assigned to scMCTs than cMCTs. Whether these histopathological findings correlate with clinical outcome has to be established in additional studies.
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Affiliation(s)
- Stella Minnoye
- Anicura Dierenkliniek Randstad, Frans Beirenslaan 155, Borsbeek, 2150, Belgium.
| | - Shana De Vos
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium
- Cancer Research Institute Ghent, Medical Research Building, University Hospital Ghent, Salisburylaan 133, Merelbeke, 9820, Belgium
| | - Samuel Beck
- Independent Anatomic Pathology Ltd, c/o Moore Scarrott Veterinary, Calyx House, South Road, Taunton, Somerset, TA1 3DU, UK
| | - Luc Duchateau
- Biometrics Research Center, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium
| | - Mike Hubers
- Department of Soft Tissue Surgery, Anicura Medisch Centrum voor Dieren, MCD, Isolatorweg 45, Amsterdam, 1014, The Netherlands
| | - Sieglinde David
- Anicura Dierenkliniek Randstad, Frans Beirenslaan 155, Borsbeek, 2150, Belgium
- Anicura Dierenkliniek Hond en Kat, Emiel Clauslaan 134, Deinze, 9800, Belgium
| | - Ruth Fortrie
- Anicura Dierenkliniek Randstad, Frans Beirenslaan 155, Borsbeek, 2150, Belgium
| | - Hilde de Rooster
- Cancer Research Institute Ghent, Medical Research Building, University Hospital Ghent, Salisburylaan 133, Merelbeke, 9820, Belgium
- Small Animal Department, Ghent University, Salisburylaan 133, Merelbeke, 9820, Belgium
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2
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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.
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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;
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Romańska M, Degórska B, Zabielska-Koczywąs KA. The Use of Sentinel Lymph Node Mapping for Canine Mast Cell Tumors. Animals (Basel) 2024; 14:1089. [PMID: 38612328 PMCID: PMC11010880 DOI: 10.3390/ani14071089] [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: 02/19/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Cancer is the leading cause of death in companion animals. The evaluation of locoregional lymph nodes, known as lymph node mapping, is a critical process in assessing the stage of various solid tumors, such as mast cell tumors (MCTs), anal gland anal sac adenocarcinoma, melanoma, and mammary gland adenocarcinoma. MCTs are among the most prevalent skin malignancies in dogs. Staging is used to describe the extent of neoplastic disease, provide a framework for rational treatment planning, and evaluate treatment results. The aim of this review is to present the current knowledge on sentinel lymph node (SLN) mapping in canine MCTs, its influence on treatment decisions and prognosis, as well as the advantages and limitations of different SLN techniques currently available in veterinary oncology. A search methodology was adopted using the PubMed, Scopus, and Google Scholar databases. Critical analyses of up-to-date research have shown that lymphoscintigraphy can achieve a lymph node detection rate of between 91 and 100%. This method is becoming increasingly recognized as the gold standard in both human and veterinary medicine. In addition, initial studies on a limited number of animals have shown that computed tomographic lymphography (CTL) is highly effective in the SLN mapping of MCTs, with detection rates between 90 and 100%. The first study on contrast-enhanced ultrasound (CEUS) also revealed that this advanced technique has up to a 95% detection rate in canine MCTs. These methods provide non-ionizing alternatives with high detection capabilities. Furthermore, combining computed tomography and near-infrared fluorescence (NIR/NIR-LND) lymphography is promising as each technique identifies different SLNs. Indirect lymphography with Lipiodol or Iohexol is technically feasible and may be also used to effectively detect SLNs. The integration of these mapping techniques into routine MCT staging is essential for enhancing the precision of MCT staging and potentially improving therapeutic outcomes. However, further clinical trials involving a larger number of animals are necessary to refine these procedures and fully evaluate the clinical benefits of each technique.
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Affiliation(s)
| | | | - Katarzyna A. Zabielska-Koczywąs
- Department of Small Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, Nowoursynowska 159c, 02-776 Warsaw, Poland; (M.R.); (B.D.)
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Marouda C, Anagnostou T, Brunetti B, Savvas I, Papazoglou LG, Psalla D. Cutaneous Canine Mast Cell Tumor: The Use of Proliferative Markers (Ki-67 and Ki-67 × AgNOR) in Cytological Samples for Diagnosis and Prognosis. Vet Sci 2024; 11:23. [PMID: 38250929 PMCID: PMC10821150 DOI: 10.3390/vetsci11010023] [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: 12/12/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
A cytological grading system for canine mast cell tumors (MCTs) has been developed, but its integration into clinical routine has been hindered due to its diagnostic limitations. The aim of this study was to assess the prognostic value of Ki-67 and argyrophilic nucleolar organizing region (AgNOR) markers in cytological MCT samples and to determine cut-off values for these markers in correlation with histopathological grading. Cytological samples were collected prior to surgical excision, and histopathological samples were obtained postsurgery from 45 dogs diagnosed with cutaneous mast cell tumors (MCTs). The cytological specimens were classified using a two-tier grading system, and their Ki-67 (average immunopositive nuclei per 100 cells) and AgNOR (average AgNOR counts per 100 nuclei) signaling was assessed. Through receiver operating characteristic (ROC) analysis, cut-off values for Ki-67 and Ki-67 × AgNOR were determined to better align with histopathological grading (classified as low or high grade according to Kiupel's scoring system). Without the inclusion of proliferative markers, there was a 73% agreement between cytological and histopathological grading. The prediction of histopathological grade was slightly more accurate when assessing Ki-67 and Ki-67 × AgNOR signaling in cytological specimens (75% and 80%, respectively) compared to the initial cytological grading. The cytological assessment of canine MCTs proves beneficial for the initial evaluation, and the incorporation of the evaluation of Ki-67 and AgNOR markers may assist in identifying diagnostically highly malignant MCTs.
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Affiliation(s)
- Christina Marouda
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Tilemahos Anagnostou
- Unit of Anaesthesiology and Intensive Care, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Barbara Brunetti
- Department of Veterinary Medical Sciences, University of Bologna, 40064 Bologna, Italy
| | - Ioannis Savvas
- Unit of Anaesthesiology and Intensive Care, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G. Papazoglou
- Unit of Surgery and Obstetrics, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Dimitra Psalla
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
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Schlein LJ, Thamm DH. Immunohistochemical evidence of NF-kB activation in canine lymphomas, histiocytic sarcomas, hemangiosarcomas, and mast cell tumors. Vet Pathol 2024; 61:20-31. [PMID: 37357953 DOI: 10.1177/03009858231180484] [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: 06/27/2023]
Abstract
Increased or constitutive activation of nuclear factor kappa B (NF-kB) is a feature of many chronic disease processes, including cancer. While NF-kB overactivation has been documented extensively in human oncology, there is a relative paucity of data documenting the same phenomenon in veterinary medicine. To assess NF-kB activity, antibodies to p65 and p100/p52, which are components of NF-kB heterodimers, were first validated for specificity and canine cross-reactivity via Western blot and labeling of immortalized cell pellets. Then, nuclear labeling for these antibodies was assessed via QuPath software in over 200 tumor tissue samples (10 hemangiosarcomas, 94 histiocytic sarcomas, 71 lymphomas, and 28 mast cell tumors) and compared to immunolabeling in appropriate normal tissue counterparts. Greater than 70% of spontaneous canine tumors evaluated in this study had more nuclear p65 and p100/p52 immunoreactivity than was observed in comparable normal cell populations. Specifically, 144/204 (70.58%) of tumors evaluated had positive p65 nuclear labeling and 179/195 (91.79%) had positive p100/p52 nuclear labeling. Surprisingly, greater nuclear p100/p52 reactivity was associated with a longer progression-free survival (PFS) and overall survival (OS) in canine lymphomas. These results provide support and preliminary data to investigate the role of NF-kB signaling in different types of canine cancer.
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6
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Dank G, Buber T, Rice A, Kraicer N, Hanael E, Shasha T, Aviram G, Yehudayoff A, Kent MS. Training and validation of a novel non-invasive imaging system for ruling out malignancy in canine subcutaneous and cutaneous masses using machine learning in 664 masses. Front Vet Sci 2023; 10:1164438. [PMID: 37841459 PMCID: PMC10570610 DOI: 10.3389/fvets.2023.1164438] [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: 02/12/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Objective To train and validate the use of a novel artificial intelligence-based thermal imaging system as a screening tool to rule out malignancy in cutaneous and subcutaneous masses in dogs. Animals Training study: 147 client-owned dogs with 233 masses. Validation Study: 299 client-owned dogs with 525 masses. Cytology was non-diagnostic in 94 masses, resulting in 431 masses from 248 dogs with diagnostic samples. Procedures The prospective studies were conducted between June 2020 and July 2022. During the scan, each mass and its adjacent healthy tissue was heated by a high-power Light-Emitting Diode. The tissue temperature was recorded by the device and consequently analyzed using a supervised machine learning algorithm to determine whether the mass required further investigation. The first study was performed to collect data to train the algorithm. The second study validated the algorithm, as the real-time device predictions were compared to the cytology and/or biopsy results. Results The results for the validation study were that the device correctly classified 45 out of 53 malignant masses and 253 out of 378 benign masses (sensitivity = 85% and specificity = 67%). The negative predictive value of the system (i.e., percent of benign masses identified as benign) was 97%. Clinical relevance The results demonstrate that this novel system could be used as a decision-support tool at the point of care, enabling clinicians to differentiate between benign lesions and those requiring further diagnostics.
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Affiliation(s)
| | - Tali Buber
- HT BioImaging Ltd., Hod Hasharon, Israel
| | - Anna Rice
- HT BioImaging Ltd., Hod Hasharon, Israel
| | | | | | | | - Gal Aviram
- Department Biomedical Engineering, Tel Aviv University, Tel Aviv-Yafo, Israel
| | | | - Michael S. Kent
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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7
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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.
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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
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8
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Talavera Guillén NC, Barboza de Nardi A, Noleto de Paiva F, Dias QC, Pinheiro Fantinatti A, Fávaro WJ. Clinical Implications of Immune Checkpoints and the RANK/RANK-L Signaling Pathway in High-Grade Canine Mast Cell Tumors. Animals (Basel) 2023; 13:1888. [PMID: 37370399 DOI: 10.3390/ani13121888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/13/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Mast cell tumors (MCTs) are the most common malignant cutaneous tumors in dogs, and they present extremely variable biological behavior. The interaction between RANK, RANK-L, and immune checkpoints is frequently detected in the tumor microenvironment, and, together, they participate in every stage of cancer development. Thus, the aim of this study was to characterize the molecular profiles of PD-L1, CTLA-4, RANK/RANK-L signaling pathway, and IFN-γ in primary tumors and lymph node metastases. Formalin-fixed, paraffin-embedded slides of MCTs and metastatic lymph nodes of ten dogs were submitted to immunohistochemical investigations. The results demonstrated that the tumor microenvironment of the high-grade mast cell tumors showed moderate or intense immunolabeling of all proteins, and the lymph node metastases also showed moderate or intense immunolabeling of checkpoint proteins. In addition, MCTs larger than 3 cm were associated with intensified PD-L1 (p = 0.03) in metastatic lymph nodes and RANK-L (p = 0.049) immunoreactivity in the tumor. Furthermore, dogs with a survival time of less than 6 months showed higher PD-L1 immunoreactivity (p = 0.042). In conclusion, high-grade MCT is associated with an immunosuppressive microenvironment that exhibits elevated RANK/RANK-L signaling and enhanced immune checkpoint immunoreactivity, potentially facilitating intratumorally immune escape. These biomarkers show promise as clinical indicators of disease progression and might response to immunotherapy in dogs with high-grade MCTs, thus emphasizing their importance for guiding treatment decisions and improving outcomes.
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Affiliation(s)
- Noelia C Talavera Guillén
- Department of Veterinary Clinics and Surgery, São Paulo State University (UNESP), Jaboticabal 14884-900, Brazil
| | - Andrigo Barboza de Nardi
- Department of Veterinary Clinics and Surgery, São Paulo State University (UNESP), Jaboticabal 14884-900, Brazil
| | - Felipe Noleto de Paiva
- Department of Veterinary Clinics and Surgery, São Paulo State University (UNESP), Jaboticabal 14884-900, Brazil
| | - Queila Cristina Dias
- Department of Structural and Functional Biology, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | | | - Wagner José Fávaro
- Department of Structural and Functional Biology, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
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9
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Preliminary Assessment of Tumor-Associated Tissue Eosinophilia (TATE) in Canine Mast Cell Tumors: Prevalence and Prognostic Relevance and Its Association with Neoangiogenesis. Animals (Basel) 2023; 13:ani13020283. [PMID: 36670824 PMCID: PMC9855198 DOI: 10.3390/ani13020283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Mast cell tumor (MCT) is the most common malignant skin tumor in dogs. In order to gain more information on the prognostic markers in MCT, the role of the eosinophil granulocytes infiltrates was investigated and assessed by the evaluation of tumor-associated tissue eosinophilia (TATE) in 87 canine cutaneous MCTs. In human medicine, high TATE are often described in highly angiogenic tumors: we therefore assessed the vascular endothelial growth factor (VEGF) expression in neoplastic mast cells. TATE and VEGF expression were compared between themselves, with histological grading, immunohistochemical expression of KIT and Ki-67, and with the recurrence. We found a statistically significant correlation between TATE and Patnaik grading (p = 0.041), Kiupel grading (p = 0.022), immunohistochemical KIT expression (p = 0.015), and tumor recurrence (p = 0.000). No associations were observed with Ki-67 and VEGF expression. This is the first evaluation of TATE and its prognostic value in canine MCTs in veterinary oncology. This study suggest that this investigation could be an important source of information for this tumor and for other neoplasms.
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10
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Krimer PM. Inclusion of fibroblasts and collagen fibrils in the cytologic grading of canine cutaneous mast cell tumors. Vet Clin Pathol 2022; 51:464-466. [PMID: 36451516 DOI: 10.1111/vcp.13191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 12/03/2022]
Affiliation(s)
- Paula M Krimer
- Athens Veterinary Diagnostic Laboratory, University of Georgia, Athens, GA, USA
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11
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Paes PRO, Horta RS. Response to letter regarding "inclusion of fibroblasts and collagen fibrils in the cytologic grading of canine cutaneous mast cell tumors". Vet Clin Pathol 2022; 51:467. [PMID: 36451519 DOI: 10.1111/vcp.13215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
| | - Rodrigo S Horta
- Veterinary School, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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12
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Costa VR, Soileau AM, Liu CC, Moeller CE, Carossino M, Langohr IM, Withers SS. Exploring the association of intratumoral immune cell infiltrates with histopathologic grade in canine mast cell tumors. Res Vet Sci 2022; 147:83-91. [PMID: 35490489 PMCID: PMC11293894 DOI: 10.1016/j.rvsc.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/08/2022] [Accepted: 04/19/2022] [Indexed: 02/07/2023]
Abstract
Cutaneous canine mast cell tumors (ccMCTs) vary in their biological behavior, treatment, and prognosis, based on their grade. Immune cell infiltration has been associated with prognosis and response to treatments in some human cancers, and immune-targeting therapeutics are increasingly being explored in veterinary oncology. However, currently little is known about the tumor microenvironment (TME) in ccMCTs. Therefore, the objective of this study was to determine the prevalence of T lymphocytes, T regulatory lymphocytes, PD-1+ cells and macrophages in low- and high-grade ccMCTs. Thirty low-grade and 20 high-grade formalin-fixed paraffin-embedded ccMCT samples were included. Immunohistochemistry (IHC) was performed to detect CD3, FOXP3, Iba1, and PD-1 on sequential sections. Three 400x fields with the highest numbers of CD3+ cells were identified for each tumor. The percentage of CD3+, FOXP3+, and Iba1+ cells, and the number of PD-1+ cells, was quantified in each of these three "hot-spot" fields using ImageJ software. Iba1 expression was significantly greater in high-grade compared to low-grade ccMCTs (mean = 12.5% vs. 9.6%, p = 0.043). PD-1 expression was low overall, but a significantly higher number of PD-1-expressing cells was observed in high-grade ccMCTs (median 1 vs. 0, p = 0.001). No significant difference was noted in CD3 and FOXP3 expression between ccMCT grades. Macrophages and PD-1+ cells were more frequent in high-grade, compared to low-grade ccMCTs. Further studies are needed to define the role of macrophages and rare PD-1+ cells in high-grade ccMCTs.
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Affiliation(s)
- Victoria R Costa
- Louisiana State University, School of Veterinary Medicine, Department of Veterinary Clinical Sciences, 1909 Skip Bertman Dr., Baton Rouge, LA 70803, USA
| | - Aimee M Soileau
- Louisiana State University, School of Veterinary Medicine, Department of Veterinary Clinical Sciences, 1909 Skip Bertman Dr., Baton Rouge, LA 70803, USA
| | - Chin-Chi Liu
- Louisiana State University, School of Veterinary Medicine, Department of Veterinary Clinical Sciences, 1909 Skip Bertman Dr., Baton Rouge, LA 70803, USA
| | - Cambri E Moeller
- Louisiana State University, School of Veterinary Medicine, Department of Veterinary Clinical Sciences, 1909 Skip Bertman Dr., Baton Rouge, LA 70803, USA
| | - Mariano Carossino
- Louisiana State University, Department of Pathobiological Sciences, 1909 Skip Bertman Dr., Baton Rouge, LA 70803, USA; Louisiana State University, Louisiana Animal Disease Diagnostic Laboratory (LADDL), River Rd, #1043, Baton Rouge, LA 70803, USA
| | - Ingeborg M Langohr
- Louisiana State University, Department of Pathobiological Sciences, 1909 Skip Bertman Dr., Baton Rouge, LA 70803, USA; Louisiana State University, Louisiana Animal Disease Diagnostic Laboratory (LADDL), River Rd, #1043, Baton Rouge, LA 70803, USA
| | - Sita S Withers
- Louisiana State University, School of Veterinary Medicine, Department of Veterinary Clinical Sciences, 1909 Skip Bertman Dr., Baton Rouge, LA 70803, USA.
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13
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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.
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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
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De Vos S, Demeyere K, De Cock H, Devriendt N, Schwarzkopf I, Fortrie R, Roggeman T, Meyer E, De Spiegelaere W, de Rooster H. Comparison of serum tryptase as a diagnostic oncological marker in canine versus human mast cell neoplasms. Res Vet Sci 2022; 151:90-95. [DOI: 10.1016/j.rvsc.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/20/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022]
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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.
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Τhe Effect of Opioid Administration on Cytologic and Histopathologic Diagnosis of Canine Cutaneous Mast Cell Tumors Treated by Surgical Excision. Vet Sci 2022; 9:vetsci9050202. [PMID: 35622730 PMCID: PMC9143400 DOI: 10.3390/vetsci9050202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/17/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Mast cell tumor (MCT) is a frequent cutaneous tumor in dogs, with a variable biological behavior. Studies correlate cytologic and histopathologic features of MCTs with their biological behavior, prognosis, and response to treatment. The use of preoperative opioids is common in canine patients undergoing surgical removal of these tumors. Certain opioids can induce or downregulate mast cell degranulation and influence cancer progression. The aim of the present study was to investigate whether the administration of morphine or butorphanol during surgical excision of canine cutaneous MCTs affects their cytologic and histopathologic appearance, thus influencing cytologic and histopathologic grading. This was a prospective, blinded, randomized, cohort clinical study. Forty-five dogs with cutaneous MCTs were randomly allocated into three groups according to preanaesthetic medication: dexmedetomidine combined with morphine (group M) or butorphanol (group B) or normal saline (group C). Cytologic specimens and histopathologic samples were obtained both prior to and after surgery. Samples were graded according to Kiupel’s and Patnaik’s systems, examined immunohistochemically for Ki-67 protein (Ki-67) and c-kit proto-oncogene product (KIT) expression, and histochemically for argyrophilic nucleolar organizing regions (AgNORs). Based on both Kiupel’s and Patnaik’s systems, no statistically significant differences were noted concerning the number of cases with grading discrepancies in grades allocated prior to versus after surgery among the groups. The same applied for cytological grading and immunohistochemical and histochemical evaluation. It seems that administration of morphine or butorphanol as part of the preanesthetic medication for surgical removal of canine cutaneous mast cell tumors does not influence histopathologic and cytologic grading of MCTs.
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Pinello K, Baldassarre V, Steiger K, Paciello O, Pires I, Laufer-Amorim R, Oevermann A, Niza-Ribeiro J, Aresu L, Rous B, Znaor A, Cree IA, Guscetti F, Palmieri C, Dagli MLZ. Vet-ICD-O-Canine-1, a System for Coding Canine Neoplasms Based on the Human ICD-O-3.2. Cancers (Basel) 2022; 14:1529. [PMID: 35326681 PMCID: PMC8946502 DOI: 10.3390/cancers14061529] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/07/2023] Open
Abstract
Cancer registries are fundamental tools for collecting epidemiological cancer data and developing cancer prevention and control strategies. While cancer registration is common in the human medical field, many attempts to develop animal cancer registries have been launched over time, but most have been discontinued. A pivotal aspect of cancer registration is the availability of cancer coding systems, as provided by the International Classification of Diseases for Oncology (ICD-O). Within the Global Initiative for Veterinary Cancer Surveillance (GIVCS), established to foster and coordinate animal cancer registration worldwide, a group of veterinary pathologists and epidemiologists developed a comparative coding system for canine neoplasms. Vet-ICD-O-canine-1 is compatible with the human ICD-O-3.2 and is consistent with the currently recognized classification schemes for canine tumors. It comprises 335 topography codes and 534 morphology codes. The same code as in ICD-O-3.2 was used for the majority of canine tumors showing a high level of similarity to their human counterparts (n = 408). De novo codes (n = 152) were created for specific canine tumor entities (n = 126) and topographic sites (n = 26). The Vet-ICD-O-canine-1 coding system represents a user-friendly, easily accessible, and comprehensive resource for developing a canine cancer registration system that will enable studies within the One Health space.
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Affiliation(s)
- Katia Pinello
- Departamento de Estudo de Populações, Vet-OncoNet, ICBAS, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal;
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
| | - Valeria Baldassarre
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80138 Naples, Italy; (V.B.); (O.P.)
| | - Katja Steiger
- Institute of Pathology, School of Medicine, Technical University of Munich, 81675 Munich, Germany;
| | - Orlando Paciello
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, 80138 Naples, Italy; (V.B.); (O.P.)
| | - Isabel Pires
- Associate Laboratory for Animal and Veterinary, Science-AL4AnimalS Animal and Veterinary Research Centre (CECAV), University of Trás-os-Montes and Alto Douro (UTAD), 5001-801 Vila Real, Portugal;
| | - Renée Laufer-Amorim
- School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu 18618-681, SP, Brazil;
| | - Anna Oevermann
- Division of Neurological Sciences, DCR-VPH, Vetsuisse Faculty, University of Bern, 3012 Bern, Switzerland;
| | - João Niza-Ribeiro
- Departamento de Estudo de Populações, Vet-OncoNet, ICBAS, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal;
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal
- Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), 4050-600 Porto, Portugal
| | - Luca Aresu
- Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy;
| | - Brian Rous
- National Disease Registration Service, NHS Digital, London SE1 8UG, UK;
| | - Ariana Znaor
- International Agency for Research on Cancer, IARC, 69372 Lyon, France; (A.Z.); (I.A.C.)
| | - Ian A. Cree
- International Agency for Research on Cancer, IARC, 69372 Lyon, France; (A.Z.); (I.A.C.)
| | - Franco Guscetti
- Institute of Veterinary Pathology, Vetsuisse Faculty, University of Zurich, 8057 Zurich, Switzerland;
| | - Chiara Palmieri
- School of Veterinary Science, Gatton Campus, The University of Queensland, Gatton, QLD 4343, Australia
| | - Maria Lucia Zaidan Dagli
- School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo 05508-270, SP, Brazil;
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18
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Diagnosis, Prognosis and Treatment of Canine Cutaneous and Subcutaneous Mast Cell Tumors. Cells 2022; 11:cells11040618. [PMID: 35203268 PMCID: PMC8870669 DOI: 10.3390/cells11040618] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/27/2022] [Accepted: 02/03/2022] [Indexed: 02/07/2023] Open
Abstract
Mast cell tumors (MCTs) are hematopoietic neoplasms composed of mast cells. It is highly common in dogs and is extremely important in the veterinary oncology field. It represents the third most common tumor subtype, and is the most common malignant skin tumor in dogs, corresponding to 11% of skin cancer cases. The objective of this critical review was to present the report of the 2nd Consensus meeting on the Diagnosis, Prognosis, and Treatment of Canine Cutaneous and Subcutaneous Mast Cell Tumors, which was organized by the Brazilian Association of Veterinary Oncology (ABROVET) in August 2021. The most recent information on cutaneous and subcutaneous mast cell tumors in dogs is presented and discussed.
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19
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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.
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Affiliation(s)
- E Bellamy
- Dick White Referrals, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
| | - D Berlato
- AniCura AOI Center AG, Hünenberg, 6331, Switzerland
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20
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Miller AD, Avallone G, Chambers J, Rasotto R. Special focus on diagnostic veterinary oncologic pathology. Vet Pathol 2021; 58:764-765. [PMID: 34196248 DOI: 10.1177/03009858211027357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Avallone G, Rasotto R, Chambers JK, Miller AD, Behling-Kelly E, Monti P, Berlato D, Valenti P, Roccabianca P. Review of Histological Grading Systems in Veterinary Medicine. Vet Pathol 2021; 58:809-828. [PMID: 33769136 DOI: 10.1177/0300985821999831] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tumor grading is a method to quantify the putative clinical aggressiveness of a neoplasm based on specific histological features. A good grading system should be simple, easy to use, reproducible, and accurately segregate tumors into those with low versus high risk. The aim of this review is to summarize the histological and, when available, cytological grading systems applied in veterinary pathology, providing information regarding their prognostic impact, reproducibility, usefulness, and shortcomings. Most of the grading schemes used in veterinary medicine are developed for common tumor entities. Grading systems exist for soft tissue sarcoma, osteosarcoma, multilobular tumor of bone, mast cell tumor, lymphoma, mammary carcinoma, pulmonary carcinoma, urothelial carcinoma, renal cell carcinoma, prostatic carcinoma, and central nervous system tumors. The prognostic relevance of many grading schemes has been demonstrated, but for some tumor types the usefulness of grading remains controversial. Furthermore, validation studies are available only for a minority of the grading systems. Contrasting data on the prognostic power of some grading systems, lack of detailed instructions in the materials and methods in some studies, and lack of data on reproducibility and validation studies are discussed for the relevant grading systems. Awareness of the limitations of grading is necessary for pathologists and oncologists to use these systems appropriately and to drive initiatives for their improvement.
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Affiliation(s)
- Giancarlo Avallone
- Department of Veterinary medical Sciences (DIMEVET), 9296University of Bologna, Ozzano dell'Emilia, Italy
| | | | - James K Chambers
- Laboratory of Veterinary Pathology, 13143The University of Tokyo, Tokyo, Japan
| | - Andrew D Miller
- Department of Biomedical Sciences, Section of Anatomic Pathology, 43317Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Erica Behling-Kelly
- Department of Population Medicine and Diagnostic Sciences, Section of Clinical Pathology, 43317Cornell University College of Veterinary Medicine, Ithaca, NY, USA
| | - Paola Monti
- 170851Dick White Referrals, Six Mile Bottom, Cambridgeshire, UK
| | - Davide Berlato
- 170851AniCura Animal Oncology and Imaging Center, Hünenberg, Switzerland
| | - Paola Valenti
- 534741Clinica Veterinaria Malpensa, Samarate (VA), Italy
| | - Paola Roccabianca
- Department of Veterinary Medicine (DIMEVET), 9304University of Milano, Lodi (LO), Italy
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