Difference between revisions of "Labrador cross with mass on antebrachium"
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<center><WikiQuiz | <center><WikiQuiz | ||
questionnumber="2" | questionnumber="2" | ||
− | question="What do you understand about the behaviour of soft-tissue sarcomas (STS)?" | + | question="Review the histopathology report. What do you understand about the behaviour of soft-tissue sarcomas (STS)?" |
choice1="Locally minimally invasive but generally a high rate of early metastasis" | choice1="Locally minimally invasive but generally a high rate of early metastasis" | ||
choice2="Locally minimally invasive and generally a low rate of metastatic disease" | choice2="Locally minimally invasive and generally a low rate of metastatic disease" | ||
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<center><WikiQuiz | <center><WikiQuiz | ||
questionnumber="6" | questionnumber="6" | ||
− | question="" | + | question="What would you choose to do next?" |
− | choice1="" | + | choice1="Abdominal ultrasound for staging purposes " |
− | choice2="" | + | choice2="Thoracic radiographs for staging purposes " |
− | choice3="" | + | choice3="Thoracic computed tomography (CT) for staging purposes " |
− | choice4="" | + | choice4="Bone marrow biopsy for staging purposes " |
− | choice5="" | + | choice5="Palpation of regional lymph node and FNA of this lymph node if enlarged." |
− | correctchoice=" | + | correctchoice="2, 5" |
− | feedback1="" | + | feedback1="'''Incorrect'''. Although this is reasonable to check for intercurrent disease, it is unlikely that a grade 2 STS would metastasize to intra-abdominal organs so not your next choice. This option is more appropriate for high-grade or anaplastic STS." |
− | feedback2="" | + | feedback2="'''Correct'''. This is the commonest site for metastatic disease for STS. However, you should also assess your regional lymph nodes, as in option e." |
− | feedback3="" | + | feedback3="Although correct, it is probably not money well spent, given that the metastatic rate for grade 2 STS is only up to 20% and this is expected to occur late in the course of disease. Thoracic radiographs are adequate for staging purposes in this case." |
− | feedback4="" | + | feedback4="This is of little or no value in this case." |
− | feedback5="" | + | feedback5="Correct. STS can metastasize to regional lymph nodes, so you should try and demonstrate evidence of metastasis with FNA before surgery, as this may change the prognosis and thus the client’s willingness to treat. However, cytology of regional lymph nodes may not be adequate for staging and histopathology is better to prove lymph node metastasis. It is important to remove enlarged regional lymph nodes at the time of surgery and send for histopathology just to be sure. You should also take thoracic radiographs for staging purposes, as lung is the most common site for metastasis of STS. Choose again." |
image= ""> | image= ""> | ||
</WikiQuiz></center> | </WikiQuiz></center> |
Revision as of 18:35, 28 September 2012
Signalment:
- 7-year-old male neutered Labrador cross
Presenting sign:
- 7 x 5 cm firm mobile mass on the caudal aspect of the proximal antebrachium, which has grown over the past three months. Otherwise clinically well, with no evidence of lameness and no other history of illness. Physical exam is otherwise within normal limits.
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What would be your next step? |
Histopathology report |
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Gross pathology One pot is submitted:biopsy of the leg. A pece of pale tan resilient tissue measuring 7 x 5 x 5 mm. A representative section is placed in Cassette A. Histopathology This is a section of a tumour composed of sheets of neoplastic pleomorphic polyhedral to spindle cells with a mitotic index approximating 1-2 mitoses per high power field. They are accompanied by minimal collagen. The neoplastic cells have mild karyomegaly and nucleolar prominence together with abundant eosinophilic, vacuolated cytoplasm. Diagnosis Cutaneous soft-tissue sarcoma, grade 2. Comments This diagnosis is in keeping with the previous cytological findings. The minimal collagen and cytoplasmic vacuolation evident in this case raises the possibility of liposarcoma as a more specific diagnosis. In any case, this tumour is likely to be characterized by infiltrative local growth but negligible tendency for metastatic spread. |
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Review the histopathology report. What do you understand about the behaviour of soft-tissue sarcomas (STS)? |
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What is the metastatic rate of grade 2 STS? |
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What is the metastatic rate of grade 1 STS? |
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What is the metastatic rate of grade 3 STS? |
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What would you choose to do next? |
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