腫瘤學(xué)-骨肉瘤

CaseCasePresentation-Presenting病情陳 ylameontherightrearSignalment:9yearoldMCgoldenretrievercross History: ylameontherightrearlimb.Usuallyruns2-3EatinganddrinkingNoPU/PDnoc/s/v/d.PhysicalExam5/5lameonrightpelvic右骨盆肢5級(jí)破ProblemProblemRightpelviclimblamenessDDs鑒Diagnostic 計(jì)CBCWNL血常ChemistrypanelWNL生Thoracic 胸部XRightfemoral 右后肢XFNAofrightfemoralmetaphysis右股干骨后Results結(jié)果RadiographsX3viewthoracic 3Results結(jié)果RadiographsXRightfemurResults結(jié)果Ultrasoundoftheright右骨股超ResultsResults結(jié)果FNAofrightfemoral a骨肉AmputationoftherightpelvicRecoveredverywellTreatedwithchemotherapyCarboplatinandadriamycinStillalive11monthslater11Signalment癥8yoMC 8Presenting 陳OneyearhistoryintermittentProgressiveoverprevioustwoInitialwork-upat初步檢Radiographs:XLefthumerusInitialwork-upatThoracicRadiographs-3胸腔X光－3InitialInitialwork-upatBoneBiopsyInitialTherapyatAmputationofleftthoracic左前肢切Offeredreferralforfollow-up推薦繼續(xù)化InitialVisittotheVMTH2weekspostamputation切除術(shù)后2Referralthoracicradiographsfromweekbefore-nosignofmetastasis1cmSQdiametermassdorsalcervical0.5cmSQmassrightlateral1cmSQmassmedialaspectrightThinBCSSkinMassAspirates皮膚團(tuán)塊抽Rightstifle,rightthorax,right右室，右胸腔，右Plan計(jì)Ownerinformedoflikelyskin PoorprognosisBeganCarboplatinchemotherapyat300mg/m2開(kāi)始靜注300mg/m2Returnin3weeksforcontinuedchemotherapyCBCatlocalveterinarianin10-12daysFollowingVisitPE體格檢Massesonstifle&thorax-unabletoMassonneck–CBC血常WBC白細(xì)胞2,500,NeutPlan計(jì)ReturninoneweekforrepeatCBCandcontinuedThirdVisitIntrascapularmass-firm Rightthoracicmass-firm CBCWNLCarboplatin300mg/m2IV卡波鉑300/m2Planreturnin4weeksforconmgtinuedCBCatRDVMin10-12and21FourthVisit ngwelluntilthismorningwhenbecameCBCatRDVMonHCT41%;WBC9,700;Neut5,820;PltSQMassesnotdetectableHR120,mmpale,AbdomentenseonFourthVisit四診CBCHCT22.6%,WBCNeutThoracicRadiographsnosignofmetastsisAbdominalRadiographsdecreasedabdominaldetailFourthVisitAbdominalAbdominalUltrasound-freeabdominalfluid,renalmass-rightkidneyFourthVisitAbdominalTap腹部叩PCV33%,TS6.0nonclottingbloodChem生BUN34,Creat1.2,TPUSG1.033,BenignsedimentLikelymetastasistokidneywithNecropsyresults驗(yàn)尸結(jié)Metastasis轉(zhuǎn)RightKidneywithruptureofrenalNecropsyresults驗(yàn)尸結(jié)Metastasis轉(zhuǎn)RightthoraxSQtissueLungrightcraniallunglobeLeftKidneySignalment9yearoldMC HistoryDiagnosedwithmulticentric ainJune1996.FinishedchemotherapyinAugust1998. Presented10/99for99年10Ownerreportedtwoweekprogressivelamenessonthefrontleftleg主人稱(chēng)2PhysicalExam全身檢WeightbearinglameinfrontleftPainfulonpalpationofmidshaftPainfulonmanipulationofshoulderLymphnodespalpatewithinnormal 觸診正Leftshoulderradiographs–productiveandlyticlesioninproximalhumerusThoracicradiographs胸部XUltrasoundguidedaspirateoflesionnon-Ownerdecidedonlywantedpalliative主人希望進(jìn)行緩解治Declined 活Paliativeradiation放Received4weeklytreatments接受4周治Withininoneweeknolongerlame. e結(jié)MildlamenessinDecember(2在12月輕度跛 四肢骨肉80ofthemalignantbonetumorsArisefromthemedullarycavities(metaphysis)andexpandoutward.源于骨髓腔（干骨后端）和擴(kuò)張的 四肢骨肉Predisposingfactors預(yù)判因Largeandgiantbreeddogs大型和巨型Middleagedtooldagedogs(median8中年至老年Nosexpredilection 差Breedpredilectionfor 犬易Sitesofpreviousfracture曾骨折 四肢骨肉Sitepredilections易發(fā)Front:Distalradius,ProximalHind:Distalfemur,Proximal 四肢骨肉Clinicalpresentation臨床表Lameness(intermittentprogressivetononweightLater-swelling,painfulto 四肢骨肉DifferentialsPrimarybonea,a,纖維肉 a,血管瘤 a瘤MetastaticboneFungalinfections:CoccidiomycosisRadiographsXBothlytic,productiveormixedGenerallydonotcrossjointsMostoftenmetaphysealUltrasoundguidedaspirates超聲指導(dǎo)抽BreaksincortexOftennondiagnosticBonebiopsy骨髓活JamshidibiopsyneedleJamshidiBiopsyfromcenterof Oftennon-diagnosticStaging分3viewthoracicradiographs1張X光<10%havevisiblepulmonarymetastasisat Staging分Bonescan骨掃M(jìn)ostoftennobonymetastasisattimeofStaging分Othersitesofmetastasis其它轉(zhuǎn)移部Regionallymphnode,skin,kidneys,部分 Treatment-治療－手 切AlleviatespainMostdogsrecoverwellStandardofcare照顧標(biāo)Surgeryalone-單獨(dú)手Mediansurvivalof19 平均存活1910%aliveatoneyearwithamputation治療－保留肢Maintainsfunctionindogsthatareobeseorwithconcurrentorthopedicdisease.Mostreportsandsuccessesaredistalradial However,LiptaketalpresentedacasereportinVetSurg,2005,ofalimbspareoftheproximalfemur(allografttechnique)2005LiptaketalpresentedinVetAutovsAllograftTreatment-Limb肢體保Complications:(reportedat并發(fā)癥 Regrowthoftumor,infection,plate重生腫瘤 ，移植失治療－化Chemotherapy-manyprotocolsintheThreeto6cyclesofeitheraplatinumordoxorubicinbasedchemotherapyprotocol.Mediansurvivaltimesforsingleagenttherapy-260-300days(10-12months)10%aliveat2years治療－化Baileyetal-JVIM-24dogs24Treatedwithamputation/limbsparefollowedbycombinationchemotherapy-carboplatin(175mg/m2IVday1)anddoxorubicin(15mg/m2day2)givenona21daycycleforamaxof4cycles療程1：300mg/m2IV，療程2－3：30mg/m2MedianDFI-195 平均DFI－195MedianSurvival235days平均存活235Theprotocolwaswelltolerated,butdidnotprovideanyimprovementoverhistoricalsingleagentprotocols.治療－化Kentetal-JVIM,32dogs32Treatedwithamputation/limbsparefollowedbycombinationchemotherapyofalternatingdosesofcarboplatin(300mg/m2IV)anddoxorubicin(30mg/m2IV)every21daysforatotalof3cycles.21天為1個(gè)療程，共3療程療程1：300mg/m2IV，療程3：30mg/m2IV)Medianprogressionfreesurvival-227MedianSurvival320days平均存活3201yearsurvivalrate- 12yearsurvivalrate- 2Minimal Treatment-Pain Doesnotincreasesurvival Alleviates MaytemporarilydecreasechanceofpathologicBisphosphonates治療－雙磷酸Afamilyofdrugscharacterizedbytheirabilitytoinhibitboneresorption-byinhibitingosteoclasticactivity.Theyalsoinhibitcancercellproliferation,induceapoptosisininvitrocellcultures,inhibitangiogenesis,inhibitMMPs,haveeffectsoncytokinesandgrowthfactorsandare Clinicalapplications-therapyforhypercalcemia,inhibitionofbonemetastasis,andtherapyforbonepain.治療－雙磷酸Fanetal-JVIM-EvaluationofIVPamidronateadministrationin33cancerbearingdogswithprimaryorsecondaryboneinvolvementThebiologicactivitywasassessedprospectivelyin10dogswithOSA-in4/10dogstherewasanimprovementinpain

Prognostic預(yù)后因YoungdogsappeartohaveshortersurvivaltimesandmoreaggressivediseasePresenceofmetastaticlesionsatthetimeofElevat