Difference between revisions of "Labrador with changed appearance"

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| Stratified squamous epithelium covering the tissue is ulcerated. The epithelial tissue is proliferative and contiguous in places with a mass present below. The underlying collagen is infiltrated by a solid mass of proliferating squamous epithelial tissue. The epithelial tissue occurs as masses, trabeculae or nests with minimal stromal tissue. The epithelial cells are variable in size; they have large nuclei with prominent nucleoli; mitotic figures are frequent.
 
| Stratified squamous epithelium covering the tissue is ulcerated. The epithelial tissue is proliferative and contiguous in places with a mass present below. The underlying collagen is infiltrated by a solid mass of proliferating squamous epithelial tissue. The epithelial tissue occurs as masses, trabeculae or nests with minimal stromal tissue. The epithelial cells are variable in size; they have large nuclei with prominent nucleoli; mitotic figures are frequent.
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Latest revision as of 18:11, 4 October 2012

Signalment:

9-year-old male neutered Labrador Retriever

Chief complaint:

For the last three months he had not been eating well at home and would not eat dry food so the clients had changed him to tinned food. Two weeks ago the clients noticed the change in him that led to this consultation.



1

What did you find question, based on the photograph, when you examined this dog?

Please select an option Incorrect. Look more closely at the photograph. Incorrect. Look more closely at the photograph. Incorrect. Look more closely at the photograph. Correct! Incorrect. Look more closely at the photograph.

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2

What cranial nerve innervates this muscle?

Please select an option Incorrect. Review anatomy and choose again. Correct. Incorrect. Review anatomy and choose again. Incorrect. Review anatomy and choose again. Incorrect. Review anatomy and choose again.

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3

You examine the dog further and can feel a large mass located at the caudal part of the ramus of the mandible. When you open his mouth you see a large tumour. What is the most common oral tumour seen in the dog?

Please select an option Incorrect. Review oral tumours and choose again. Incorrect. Review oral tumours and choose again. Correct. Incorrect. Review oral tumours and choose again. Incorrect. Review oral tumours and choose again.

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4

Based on your knowledge of oral tumours which of the above carries the best prognosis (i) and which carries the worst prognosis (ii)?

Please select an option Incorrect. Review oral tumours and choose again. Incorrect. Review oral tumours and choose again. Incorrect. Review oral tumours and choose again. Incorrect. Review oral tumours and choose again. Correct

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5

What do you recommend to your client?

Please select an option Incorrect. You have made a judgement without attempting to evaluate your patient. Understandably your client is not satisfied and goes for a second opinion. Correct Incorrect. That would not benefit your patient and would literally just make a mess. Your client decides to get a second opinion. Incorrect. Your client wants to know if anything further can be done for his dog and therefore seeks a second opinion. Incorrect. You need a better idea of the extent of the tumour and exactly what it is before deciding on options.

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Histopathology report
Stratified squamous epithelium covering the tissue is ulcerated. The epithelial tissue is proliferative and contiguous in places with a mass present below. The underlying collagen is infiltrated by a solid mass of proliferating squamous epithelial tissue. The epithelial tissue occurs as masses, trabeculae or nests with minimal stromal tissue. The epithelial cells are variable in size; they have large nuclei with prominent nucleoli; mitotic figures are frequent.

6

Your client went ahead with the CT scan and biopsy and now wants to know what you found. The biopsy report is available for you to examine but unfortunately the diagnosis is missing so you will have to interpret it for your client. Review the Histopathology report and make your diagnosis.

Please select an option Incorrect. Making a wrong diagnosis affects the treatment plan and prognosis. Correct. Incorrect. Making a wrong diagnosis affects the treatment plan and prognosis. Incorrect. Making a wrong diagnosis affects the treatment plan and prognosis. Incorrect. Making a wrong diagnosis affects the treatment plan and prognosis.

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7

You next review the CT scan. What are your findings based on the scan?

Please select an option Incorrect. Your client is not convinced and gets a second opinion. Incorrect. Your client is not convinced and gets a second opinion. Incorrect. Your client is not convinced and gets a second opinion. Correct. Incorrect. Your client is not convinced and gets a second opinion.

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8

What is the treatment of choice for oral squamous cell carcinoma in the dog?

Please select an option Correct. Incorrect. Your client is unhappy with your knowledge of his dog’s condition. You can review the chapter on oral tumours in North and Banks, Small Animal Oncology. Incorrect. Your client is unhappy with your knowledge of his dog’s condition. You can review the chapter on oral tumours in North and Banks, Small Animal Oncology. Incorrect. Your client is unhappy with your knowledge of his dog’s condition. You can review the chapter on oral tumours in North and Banks, Small Animal Oncology. Incorrect. Your client is unhappy with your knowledge of his dog’s condition. You can review the chapter on oral tumours in North and Banks, Small Animal Oncology.

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9

The problem in this case is that the tumour is extremely large and located caudally so even with a hemimandibulectomy medial margins would not be achieved and adjuvant radiation would be required. Your client is concerned about such a large surgery and wants to know if there are any alternative options. Can you suggest another option?

Please select an option Incorrect. This has already been discussed. Incorrect. This would be unlikely to have a major impact on this tumour, especially when a superior treatment option is available. Incorrect. This would be unlikely to have a major impact on this tumour, especially when a superior treatment option is available. Correct. Choose again.

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10

It was decided to go ahead with a course of neoadjuvant radiotherapy with the goal of shrinking the tumour to reduce surgical dose. Before starting treatment however it is important to complete staging. What is required to stage this patient fully?

Please select an option Incorrect. An additional diagnostic procedure is required in this case. Choose again. Incorrect. An additional diagnostic procedure is required in this case. Choose again. Correct. A CT scan was performed and a lymph node biopsy was negative. Incorrect. Your client wants the very best for his dog and so decides to take him to another veterinary surgeon. Choose again. Choose again.

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11

You now review the contrast-enhanced thoracic CT scan. Based on the image, what do you tell your client?

Please select an option Correct. Incorrect. Unfortunately your client takes your advice and euthanizes his dog. Incorrect. Your client is concerned that he would be putting the animal through a lot but wouldn’t have very long because of the metastasis and so decides on euthanasia. Incorrect. Your client is concerned that he would be putting the animal through a lot but wouldn’t have very long because of the metastasis and so decides on euthanasia. Incorrect. Your client is concerned that he would be putting the animal through a lot but wouldn’t have very long because of the metastasis and so decides on euthanasia.

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12

Why would an excisional lymph node biopsy of the submandibular lymph node be superior to a fine-needle aspirate?

Please select an option Incorrect. Choose again. Incorrect. Incorrect. Choose again. Correct. Incorrect. Choose again.

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13

Radiotherapy went well and the tumour shrank, permitting a reduced surgical dose. The patient underwent a caudal mandibulectomy. What is the most common acute side-effect of irradiating the oral cavity?

Please select an option Incorrect. Choose again. Incorrect. Choose again. Correct Incorrect. Choose again. Incorrect. Choose again.

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14

What is the most common delayed effect of irradiating the oral cavity?

Please select an option Incorrect. Choose again. Correct Incorrect. Choose again. Incorrect. Choose again. Incorrect. Choose again.

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15

In view of the successful elimination of the primary, what do you consider the patient’s long-term prognosis to be?

Please select an option Incorrect. This is what we would hope but local recurrence or metastatic spread is still a possibility. Incorrect. This is what we would hope but local recurrence or metastatic spread is still a possibility. Incorrect. This is what we would hope but local recurrence or metastatic spread is still a possibility. Correct. Incorrect. He should have a better prospect than 6 months.

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16

Your client had a cat that had exactly the same problem and he wants to know if she could have had the same treatment. What do you tell your client about oral squamous cell carcinoma in the cat?

Please select an option Incorrect. Review oral squamous cell carcinoma in the cat. Incorrect. Review oral squamous cell carcinoma in the cat. Incorrect. Review oral squamous cell carcinoma in the cat. Correct. Incorrect. Review oral squamous cell carcinoma in the cat.

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17

Currently, what is the treatment of choice for cats with oral squamous cell carcinoma?

Please select an option Correct. Incorrect. Q15&17 are general knowledge questions and do not relate to your ability to manage your patient. Incorrect. Q15&17 are general knowledge questions and do not relate to your ability to manage your patient. Incorrect. Q15&17 are general knowledge questions and do not relate to your ability to manage your patient. Incorrect. Q15&17 are general knowledge questions and do not relate to your ability to manage your patient.

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Elsevier logo This resource was adapted from North and Banks, Small Animal Oncology provided by Elsevier Health Sciences as part of the PublishOER Project. book image