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Compendium June 2006 (Vol 28, No 6)

Abstract Thoughts (June 2006)

by Joseph Harari, MS, DVM, DACVS

    Schwartz SG, Mitchell SL, Keating JH, et al: Liver lobe torsion in dogs: 13 cases (1995-2004). JAVMA 228(2):242-247, 2006.

    Abstract: In this retrospective study from a veterinary teaching hospital, the clinical and pathologic features of liver lobe torsion in 12 dogs were described. One dog had two separate episodes of torsion. The median age of the dogs was 10 years, and the median body weight was 81.4 lb (37 kg). No specific breed disposition was identified. The median duration of clinical signs (i.e., vomiting, lethargy, anorexia) was 3 days.

    The most common hematologic abnormalities were mature neutrophilia and leukocytosis; the most common biochemical abnormalities were high alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase concentrations. Results of clotting profiles were normal in nine of 11 cases. Abdominal radiography and ultrasonography were useful in identifying a hepatic mass. Celiotomy and liver lobectomy were performed in 12 of 13 cases; a predilection for a particular lobe was not documented. All liver lobes examined via histology had evidence of inflammation, necrosis, and thrombosis. Eleven of 13 dogs survived the perioperative period, and 50% of cases had postoperative complications, such as anemia, dysrhythmia, hypoalbuminemia, and vomiting. At a median follow-up of 14 months, all 11 dogs were alive and asymptomatic.

    In this retrospective study from a veterinary teaching hospital, the clinical and pathologic features of liver lobe torsion in 12 dogs were described. One dog had two separate episodes of torsion. The median age of the dogs was 10 years, and the median body weight was 81.4 lb (37 kg). No specific breed disposition was identified. The median duration of clinical signs (i.e., vomiting, lethargy, anorexia) was 3 days.

    The most common hematologic abnormalities were mature neutrophilia and leukocytosis; the most common biochemical abnormalities were high alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase concentrations. Results of clotting profiles were normal in nine of 11 cases. Abdominal radiography and ultrasonography were useful in identifying a hepatic mass. Celiotomy and liver lobectomy were performed in 12 of 13 cases; a predilection for a particular lobe was not documented. All liver lobes examined via histology had evidence of inflammation, necrosis, and thrombosis. Eleven of 13 dogs survived the perioperative period, and 50% of cases had postoperative complications, such as anemia, dysrhythmia, hypoalbuminemia, and vomiting. At a median follow-up of 14 months, all 11 dogs were alive and asymptomatic.

    Commentary: Liver lobe torsion has been infrequently described in the veterinary literature. The results of this study should alert clinicians to consider the condition in large dogs with vague clinical and imaging abdominal abnormalities as well as elevated liver enzymes. Timely diagnosis and surgical treatment offer a good prognosis; a delay may lead to hepatic necrosis and abscessation, which would negatively affect morbidity. It is interesting to note that previous descriptions of a greater rate of left lateral lobe torsion were not confirmed by these authors. Perhaps more clinical reviews will shed light on the inciting cause of this condition.

    Lymph Node Metastases In Dogs With Appendicular Osteosarcoma

    Hillers KR, Dernell WS, Lafferty MH, et al: Incidence and prognostic importance of lymph node metastases in dogs with appendicular osteosarcoma: 228 cases (1986-2003). JAVMA 226:1364-1367, 2005.

    The hypothesis that regional lymph node metastasis in dogs with appendicular osteosarcoma would be rare but associated with a poorer prognosis was evaluated by retrospective examination of the medical records of 228 dogs with histologic confirmation of disease at the time of amputation. Signalment, affected site, initial serum alkaline phosphatase level, chemotherapy, disease-free interval, and survival time were reviewed.

    Of 228 dogs meeting the inclusion criteria, 10 (4.4%) had histologic evidence of regional lymph node metastasis. For dogs without such metastasis, the median disease-free interval and median survival time were significantly longer than those for dogs with metastasis (238 versus 48 days, and 318 versus 59 days, respectively). The only factor significantly associated with regional lymph node status was the number of chemotherapy doses, although this finding was likely related to early development of complications in dogs with metastases, so that additional chemotherapy was not given.

    Key Findings:

    • Despite the study limitations (i.e., retrospective nature, degree of treatment variation), the authors concluded that regional lymph node metastasis is rare in dogs with appendicular osteosarcoma and that dogs with metastasis have a poorer prognosis than do dogs without metastasis.
    • Given the association of lymph node status with survival, better determination of metastatic status (e.g., via immunohistochemistry) may help guide treatment.

    Treatment Of Esophageal Sarcomas In Dogs By Partial Esophagectomy With Single-Layer Closure

    Ranen E, Shamir MH, Shahar R, Johnston DE: Partial esophagectomy with single layer closure for treatment of esophageal sarcomas in 6 dogs. Vet Surg 33:428-434, 2004.

    Partial esophagectomy (PE) as a treatment of esoph­a­ge­al sarcoma in six dogs that had had palliative surgery was evaluated by reviewing medical record data (i.e., signalment, history, physical examination results, complete blood cell count, surgical procedure, tumor classification, postoperative treatment, complications).

    The most common clinical signs were vomiting, melena, and weight loss. Endoscopy, rather than radiography, aided the diagnosis and treatment. Five dogs had indirect or direct evidence of spirocercosis; the most common tumors were fibrosarcoma or osteosarcoma. Surgery involved thoracotomy and PE on the side opposite the mass, which was attached to the esophageal wall by a single pedicle and was removed by a full-thickness incision with 1-cm margins. Closure was by a single layer of interrupted sutures. No major complications occurred. Doxorubicin was given to five dogs. The survival time, with good quality of life, was 2 to 16 months, with one dog alive 20 months after surgery.

    Key Findings:

    • PE using one layer of sutures is an effective, safe, and simple palliative technique for removing sarcomas of the distal thoracic esophagus.
    • Spirocerca lupi contributed to esophageal sarcoma development. Dogs recover from surgery quickly and have a good quality of life.
    • No conclusions could be made about the effectiveness of postoperative chemotherapy.

    Outcome Of Dogs With Mast Cell Tumors In The Inguinal Or Perineal Region Versus Other Cutaneous Locations

    Sfiligoi G, Rassnick KM, Scarlett JM, et al: Outcome of dogs with mast cell tumors in the inguinal or perineal region versus other cutaneous locations: 124 cases (1990-2001). JAVMA 226:1368-1374, 2005.

    To determine whether, as previously suggested, mast cell tumors (MCTs) in inguinal and perineal areas are associated with higher recurrence rates and shorter survival times than MCTs in other regions, medical records of 37 dogs with MCTs in these areas and 87 dogs with MCTs in other cutaneous locations were analyzed by both uni- and multivariate methods. Sex; breed; age; tumor histologic grade, number, size, and location; treatments, including completeness of excision; disease-free interval (DFI); relapse; and survival time were evaluated.

    All dogs had surgical excision. The following were significantly associated with a shorter DFI: incomplete excision, high tumor grade, metastasis, systemic treatment (by univariate analysis), and tumor grade and treatment type (by multivariate analysis). Study dogs receiving systemic chemotherapy were four times as likely to have relapse. The following were significantly associated with a shorter survival: an age older than 8 years, tumor relapse, and metastasis at diagnosis. Study limitations included sample size, case selection bias, and retrospective design.

    Key Findings:

    • Despite prior anecdotal information, dogs with MCTs in inguinal or perineal areas did not have a worse prognosis (i.e., DFI or survival time) than dogs with MCTs in other cutaneous locations.
    • Treatment should be based on histologic grade and clinical stage; the value of systemic chemotherapy has not been determined.


     

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