Implant-associated neoplasia in dogs: 16 cases (1983-2013)

Indications for the removal of implants after fracture healing: A comparison between human and veterinary medicine

Indications for implant removal after fracture healing are still under debate in both human and veterinary medicine. Although hardware removal is a common procedure, it should not be undertaken lightly. Intra and post-operative complications are common and a thorough evaluation of the risks and benefits should be performed. This review aimed to collect and summarise published data on the indications for implant removal in small animals, compare the collected data with human and equine medicine, and investigate the existence of guidelines for this purpose. There is no international consensual agreement for implant removal after fracture healing, neither in small animals nor in human orthopaedics. Decision-making processes are still controversial in some scenarios, thus clear evidence-based protocols for implant removal are needed.

Canine Idiopathic Arteriopathy, Appendicular Bone Infarcts, and Neoplastic Transformation of Bone Infarcts in 108 Dogs (Canis lupus familiaris)

Osteosarcoma (OSA) is the most common primary bone tumor in both dogs and humans. The dog is an important research model for OSA, yet dogs have much higher prevalence of bone tumors than do humans, a disparity that has yet to be explained. Neoplastic transformation of cells within or adjacent to bone infarcts into primary bone tumors has been described in humans but only sparsely characterized in the veterinary literature. In this study, 653 cases of canine bone infarcts were received through a referral veterinary osteopathology service over a 14-y period. We identified an idiopathic disorder affecting the nutrient artery, termed canine idiopathic arteriopathy (CIA), which to our knowledge has no direct counterpart in human medicine. This disorder was documented alongside ischemic necrosis of the medullary cavity in 114 bone infarcts in 108 dogs. We hypothesize that CIA precipitated an ischemic environment, resulting in development of a bone infarct down- stream of the abnormal artery. In 52% (59 of 114) of cases, bone infarcts demonstrated evidence of repair (termed reparative bone infarcts [RBI]), while in 48% (55 of 114) of infarcts, a bone tumor was also present, including pleomorphic sarcoma, OSA, fibrosarcoma, and chondrosarcoma. In some cases, a spectrum of tumors was present. We hypothesize that the ischemic infarct environment provoked bone marrow mesenchymal stem cells (MSCs) to attempt repair of the stroma, and in approximately half of cases, MSCs underwent neoplastic transformation (BINT) to produce tumors. The most common sites of bone infarcts were the distal femur, distal radius, proximal humerus, and distal tibia, coinciding with common sites of canine OSA. The authors propose that CIA leading to bone infarcts and infarct-derived tumors, in combination with possible underdiagnosis of canine bone infarcts and misdiagnosis of some RBI as neoplasia, may contribute to the higher reported proportion of bone tumors in dogs compared with humans.

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

OBJECTIVE

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

STUDY DESIGN

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

METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL SIGNIFICANCE

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

In Vitro Studies on the Influence of Meloxicam on Cytotoxic Activity Induced by Risedronate Sodium in Canine (D-17) and Human (U-2 OS) Osteosarcoma Cell Lines

Simple Summary

The aim of this in vitro study was to reveal the pharmacological interactions between meloxicam and risedronate sodium, used jointly to induce a cytotoxic effect in canine (D-17) and human (U-2 OS) osteosarcoma cell lines. Meloxicam, a non-steroidal anti-inflammatory drug, is capable of intensifying the cytotoxic activity of risedronate sodium routinely used in bone tissue metabolic diseases. The cell cultures were incubated, tested, and evaluated according to standard protocols. The study demonstrated a greater susceptibility of canine osteosarcoma cells in vitro to the investigated drug combination than the human. In both cases, meloxicam alone showed low cytotoxic activity against the tested cell lines, but the two compounds combined were synergic.

Abstract

The study describes the cytotoxic effect against human and canine osteosarcoma (U-2 OS and D-17) cell lines induced by risedronate sodium and meloxicam per se and in combination. Both cell lines were prepared according to standard procedures for cell cultures studies. The cell viability was estimated in both cell lines treated with chosen concentrations of risedronate sodium and meloxicam. The apoptosis assessment was carried out using TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) assay. EC₅₀ values, computed for risedronate sodium and meloxicam cytotoxicity, showed comparable effects against the canine OS cell line in similar concentration of both drugs. In case of human OS, the stronger cytotoxic effect of risedronate sodium was proved. The EC₅₀ values for meloxicam in both cell lines were, statistically, significantly different (* p < 0.05). Moreover, the cytotoxic effect of a combined administration of meloxicam and risedronate sodium in doses 100 µg/mL, compared with the negative control showed statistically significant differences. The human OS cell line was more resistant to both compounds than the canine OS cell line. The apoptotic effect in canine and human osteosarcoma triggered by risedronate sodium and meloxicam was statistically significant (p < 0.05). The cytotoxic effect induced with 100 µg/mL of risedronate sodium proved statistically significant differences between both tested cell lines compared to negative control. The results obtained with 10 and 100 µg/mL of meloxicam were not statistically significant. The study showed the synergic mechanism of action of risedronate sodium and meloxicam, but the concentrations used in vitro will not be possible to achieve in in vivo. Therefore, our results serve as basis only to design future studies on the tissue level.

The occurrence of osteosarcoma after tibial fracture repair in a dog

Background:

There are few detailed reports on implant-associated sarcoma in dogs; however, loose implants, metal type, and infection have not been shown as specific risk factors for this condition.

Case Description:

A 14-year-old spayed female Labrador retriever was referred to our hospital with a main complaint of chronic right hind lameness after previous tibial fracture repair. On radiographs, rupture of the bone plate and screws with swelling of the surrounding soft tissue was observed, and osteosarcoma (OSA) was diagnosed after histopathological examinations. During amputation surgery, a plastic band was found associated with the implant.

Conclusion:

Veterinary surgeons should be aware of implant-associated OSA and refrain from using non-medical materials in the implants. Furthermore, they should recommend the removal of orthopedic implants after fracture repair.

Suspected Radiation-Induced Osteosarcoma in a Domestic Shorthair Cat

A 3-year-old, male neutered domestic shorthair cat, presented for acute onset tail paresis. He was diagnosed with a spindle cell tumour at the level of L7-CD1 and treated with course fractionation radiation therapy. Three years following radiation therapy, the cat developed chondroblastic osteosarcoma of the pelvis, suspected to be secondary to radiation therapy. Hemipelvectomy was performed and the cat was treated with radiation therapy for remaining gross disease. The cat was euthanized 127 days post-operatively due to suspected metastatic disease. Development of radiation-induced tumours should be considered as a rare late complication in cats undergoing radiation therapy.

Breed and anatomical predisposition for canine cutaneous neoplasia in South Africa during 2013

Cutaneous neoplasia occurs commonly in dogs and owners in consultation with their veterinarian must decide when to perform surgery to obtain a histopathological diagnosis. The objective of this study was to identify breed predispositions for canine cutaneous neoplasms and determine factors associated with malignancy. This retrospective case-series evaluated histopathology reports from two veterinary pathology laboratories in South Africa during a six-month study period. Breed predispositions were analysed using log-linear models and risk factors for malignancy were evaluated using binary logistic regression. Data were available for 2553 cutaneous neoplasms from 2271 dogs. The most frequent neoplasms were mast cell tumours (21.1per cent), histiocytoma (9.4per cent), haemangiosarcoma (8.3per cent), melanocytoma (5.8per cent) and lipoma (5.1per cent). Boxers (relative proportion (RP)=38.9; 95% CI 2.3 to 646), pugs (7.6; 1.4 to 41.0), Staffordshire bull terriers (7.0; 1.9 to 26.3), boerboels (3.8; 1.3 to 10.7), Labrador retrievers (2.7; 1.0 to 7.0) and mixed breed dogs (2.2; 1.1 to 4.4) had a higher frequency of mast cell tumours. Jack Russell terriers (OR=2.5; 95% CI 1.8 to 3.5), Rottweilers (2.3; 1.3 to 3.9), pit bull terriers (2.2; 1.1 to 4.3) and Staffordshire bull terriers (1.6; 1.0 to 2.6) were more likely to have malignant neoplasms. Dog signalment might facilitate prognosis determination for cutaneous canine neoplasia before receiving a histopathological diagnosis.

Risk Factors for Development of Canine and Human Osteosarcoma: A Comparative Review

Osteosarcoma is the most common primary tumor of bone. Osteosarcomas are rare in humans, but occur more commonly in dogs. A comparative approach to studying osteosarcoma has highlighted many clinical and biologic aspects of the disease that are similar between dogs and humans; however, important species-specific differences are becoming increasingly recognized. In this review, we describe risk factors for the development of osteosarcoma in dogs and humans, including height and body size, genetics, and conditions that increase turnover of bone-forming cells, underscoring the concept that stochastic mutational events associated with cellular replication are likely to be the major molecular drivers of this disease. We also discuss adaptive, cancer-protective traits that have evolved in large, long-lived mammals, and how increasing size and longevity in the absence of natural selection can account for the elevated bone cancer risk in modern domestic dogs.

Association of tibial plateau leveling osteotomy with proximal tibial osteosarcoma in dogs

OBJECTIVE To assess for any association between a history of tibial plateau leveling osteotomy (TPLO) and subsequent development of proximal tibial osteosarcoma in dogs. DESIGN Matched case-control study. ANIMALS 34 client-owned dogs in which proximal tibial osteosarcoma was diagnosed between January 2005 and December 2012 (cases) and 79 dogs without osteosarcoma, matched 3:1 to cases (when possible) by age, breed, and initial examination date (controls). PROCEDURES Information on each case and control was collected from the medical records and other sources regarding date of birth, sex and neuter status, body weight, breed, and whether TPLO had been performed ≥ 1 year ago. A multivariable conditional logistic regression model was constructed to evaluate associations of body weight and history of TPLO with the outcome of proximal tibial osteosarcoma in dogs. RESULTS After adjusting for body weight in the multivariable model, dogs with a history of TPLO were 40 times as likely to develop proximal tibial osteosarcoma as were dogs with no history of TPLO. In addition, each 1-kg (2.2-lb) increase in body weight was associated with an 11% increase in the odds of proximal tibial osteosarcoma. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that dogs with a history of TPLO were at increased risk of developing osteosarcoma of the proximal region of the tibia relative to dogs with no such history. Therefore, it is important for proximal tibial osteosarcoma to be included among the differential diagnoses for new or worsening hind limb lameness in dogs that underwent TPLO ≥ 1 year previously.

Cutaneous non-epitheliotropic T-cell lymphoma associated with a fracture site in a cat

Case summary

A 7-year-old male neutered domestic shorthair cat presented for investigation of a swelling over the right forelimb. Radiographs of the right forelimb revealed significant lysis and soft tissue swelling surrounding a previously implanted surgical plate, used to repair a fracture of the distal radius 5 years prior. The implant was removed, and a biopsy was collected. Histopathological analysis and immunohistochemistry diagnosed a non-epitheliotropic T-cell cutaneous lymphoma. Staging confirmed multiple regional lymph node involvement. The cat was started on a CHOP-based protocol (vincristine, doxorubicin, cyclophosphamide and prednisolone). At week 4, the disease progressed both locally and within the regional lymph nodes. The primary lesion became severely ulcerated and the cat was euthanased, 42 days post-diagnosis.

Relevance and novel information

This is the first report of a cutaneous non-epitheliotropic lymphoma developing at the site of a previous traumatic fracture and metal implant. The cat's response to chemotherapy was poor and euthanasia was performed owing to progressive disease. More investigation is required to understand the role that malignant transformation could have at sites of chronic inflammation, bone fractures and surgical implants.

Long-term Formation of Aggressive Bony Lesions in Dogs with Mid-Diaphyseal Fractures Stabilized with Metallic Plates: Incidence in a Tertiary Referral Hospital Population

The incidence of complications secondary to fracture stabilization, particularly osteolytic lesions and bony tumor formation, has long been difficult to evaluate. The objective of this study was to describe the long-term incidence of aggressive bony changes developing in dogs with long bone diaphyseal fractures stabilized by metallic bone plates compared to a breed-, sex-, and age-matched control group. The medical records of a tertiary referral center were retrospectively reviewed for dogs that matched each respective criterion. Signalment, history, cause of death (if applicable), and aggressive bony changes at previous fracture sites were recorded. Ninety dogs met the criteria for inclusion in the fracture group and were matched with appropriate control dogs. Four of the dogs in the fracture group developed aggressive bony changes at the site of previous fracture repairs most consistent with osseous neoplasia. One lesion was confirmed with cytology as neoplastic. The population of dogs was mixed with regard to breed and body weight, but all dogs with aggressive bony lesions were male. Incidence of aggressive bony lesion formation in the fracture group was 4 (4.4%) and was 0 (0%) in the control group; three (75%) of the affected dogs in the fracture group included cerclage as a component of their primary fracture stabilizations. Incidence of aggressive bony lesions in the fracture group compared to the control group was determined to be statistically significant (p = 0.0455), as was the incidence of cerclage among dogs affected by aggressive bony lesions compared to the rest of the fracture group (p = 0.0499). Development of aggressive bony lesions is an uncommon complication of fracture fixation. Additional research is needed to further identify and elucidate the long-term effects of metallic implants in dogs.