肿瘤学-骨肉瘤

CaseCasePresentation-Presenting病情陈 ylameontherightrearSignalment:9yearoldMCgoldenretrievercross History: ylameontherightrearlimb.Usuallyruns2-3EatinganddrinkingNoPU/PDnoc/s/v/d.PhysicalExam5/5lameonrightpelvic右骨盆肢5级破ProblemProblemRightpelviclimblamenessDDs鉴Diagnostic 计CBCWNL血常ChemistrypanelWNL生Thoracic 胸部XRightfemoral 右后肢XFNAofrightfemoralmetaphysis右股干骨后Results结果RadiographsX3viewthoracic 3Results结果RadiographsXRightfemurResults结果Ultrasoundoftheright右骨股超ResultsResults结果FNAofrightfemoral a骨肉AmputationoftherightpelvicRecoveredverywellTreatedwithchemotherapyCarboplatinandadriamycinStillalive11monthslater11Signalment症8yoMC 8Presenting 陈OneyearhistoryintermittentProgressiveoverprevioustwoInitialwork-upat初步检Radiographs:XLefthumerusInitialwork-upatThoracicRadiographs-3胸腔X光－3InitialInitialwork-upatBoneBiopsyInitialTherapyatAmputationofleftthoracic左前肢切Offeredreferralforfollow-up推荐继续化InitialVisittotheVMTH2weekspostamputation切除术后2Referralthoracicradiographsfromweekbefore-nosignofmetastasis1cmSQdiametermassdorsalcervical0.5cmSQmassrightlateral1cmSQmassmedialaspectrightThinBCSSkinMassAspirates皮肤团块抽Rightstifle,rightthorax,right右室，右胸腔，右Plan计Ownerinformedoflikelyskin PoorprognosisBeganCarboplatinchemotherapyat300mg/m2开始静注300mg/m2Returnin3weeksforcontinuedchemotherapyCBCatlocalveterinarianin10-12daysFollowingVisitPE体格检Massesonstifle&thorax-unabletoMassonneck–CBC血常WBC白细胞2,500,NeutPlan计ReturninoneweekforrepeatCBCandcontinuedThirdVisitIntrascapularmass-firm Rightthoracicmass-firm CBCWNLCarboplatin300mg/m2IV卡波铂300/m2Planreturnin4weeksforconmgtinuedCBCatRDVMin10-12and21FourthVisit ngwelluntilthismorningwhenbecameCBCatRDVMonHCT41%;WBC9,700;Neut5,820;PltSQMassesnotdetectableHR120,mmpale,AbdomentenseonFourthVisit四诊CBCHCT22.6%,WBCNeutThoracicRadiographsnosignofmetastsisAbdominalRadiographsdecreasedabdominaldetailFourthVisitAbdominalAbdominalUltrasound-freeabdominalfluid,renalmass-rightkidneyFourthVisitAbdominalTap腹部叩PCV33%,TS6.0nonclottingbloodChem生BUN34,Creat1.2,TPUSG1.033,BenignsedimentLikelymetastasistokidneywithNecropsyresults验尸结Metastasis转RightKidneywithruptureofrenalNecropsyresults验尸结Metastasis转RightthoraxSQtissueLungrightcraniallunglobeLeftKidneySignalment9yearoldMC HistoryDiagnosedwithmulticentric ainJune1996.FinishedchemotherapyinAugust1998. Presented10/99for99年10Ownerreportedtwoweekprogressivelamenessonthefrontleftleg主人称2PhysicalExam全身检WeightbearinglameinfrontleftPainfulonpalpationofmidshaftPainfulonmanipulationofshoulderLymphnodespalpatewithinnormal 触诊正Leftshoulderradiographs–productiveandlyticlesioninproximalhumerusThoracicradiographs胸部XUltrasoundguidedaspirateoflesionnon-Ownerdecidedonlywantedpalliative主人希望进行缓解治Declined 活Paliativeradiation放Received4weeklytreatments接受4周治Withininoneweeknolongerlame. e结MildlamenessinDecember(2在12月轻度跛 四肢骨肉80ofthemalignantbonetumorsArisefromthemedullarycavities(metaphysis)andexpandoutward.源于骨髓腔（干骨后端）和扩张的 四肢骨肉Predisposingfactors预判因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易发Front:Distalradius,ProximalHind:Distalfemur,Proximal 四肢骨肉Clinicalpresentation临床表Lameness(intermittentprogressivetononweightLater-swelling,painfulto 四肢骨肉DifferentialsPrimarybonea,a,纤维肉 a,血管瘤 a瘤MetastaticboneFungalinfections:CoccidiomycosisRadiographsXBothlytic,productiveormixedGenerallydonotcrossjointsMostoftenmetaphysealUltrasoundguidedaspirates超声指导抽BreaksincortexOftennondiagnosticBonebiopsy骨髓活JamshidibiopsyneedleJamshidiBiopsyfromcenterof Oftennon-diagnosticStaging分3viewthoracicradiographs1张X光<10%havevisiblepulmonarymetastasisat Staging分Bonescan骨扫MostoftennobonymetastasisattimeofStaging分Othersitesofmetastasis其它转移部Regionallymphnode,skin,kidneys,部分 Treatment-治疗－手 切AlleviatespainMostdogsrecoverwellStandardofcare照顾标Surgeryalone-单独手Mediansurvivalof19 平均存活1910%aliveatoneyearwithamputation治疗－保留肢Maintainsfunctionindogsthatareobeseorwithconcurrentorthopedicdisease.Mostreportsandsuccessesaredistalradial However,LiptaketalpresentedacasereportinVetSurg,2005,ofalimbspareoftheproximalfemur(allografttechnique)2005LiptaketalpresentedinVetAutovsAllograftTreatment-Limb肢体保Complications:(reportedat并发症 Regrowthoftumor,infection,plate重生肿瘤 ，移植失治疗－化Chemotherapy-manyprotocolsintheThreeto6cyclesofeitheraplatinumordoxorubicinbasedchemotherapyprotocol.Mediansurvivaltimesforsingleagenttherapy-260-300days(10-12months)10%aliveat2years治疗－化Baileyetal-JVIM-24dogs24Treatedwithamputation/limbsparefollowedbycombinationchemotherapy-carboplatin(175mg/m2IVday1)anddoxorubicin(15mg/m2day2)givenona21daycycleforamaxof4cycles疗程1：300mg/m2IV，疗程2－3：30mg/m2MedianDFI-195 平均DFI－195MedianSurvival235days平均存活235Theprotocolwaswelltolerated,butdidnotprovideanyimprovementoverhistoricalsingleagentprotocols.治疗－化Kentetal-JVIM,32dogs32Treatedwithamputation/limbsparefollowedbycombinationchemotherapyofalternatingdosesofcarboplatin(300mg/m2IV)anddoxorubicin(30mg/m2IV)every21daysforatotalof3cycles.21天为1个疗程，共3疗程疗程1：300mg/m2IV，疗程3：30mg/m2IV)Medianprogressionfreesurvival-227MedianSurvival320days平均存活3201yearsurvivalrate- 12yearsurvivalrate- 2Minimal Treatment-Pain Doesnotincreasesurvival Alleviates MaytemporarilydecreasechanceofpathologicBisphosphonates治疗－双磷酸Afamilyofdrugscharacterizedbytheirabilitytoinhibitboneresorption-byinhibitingosteoclasticactivity.Theyalsoinhibitcancercellproliferation,induceapoptosisininvitrocellcultures,inhibitangiogenesis,inhibitMMPs,haveeffectsoncytokinesandgrowthfactorsandare Clinicalapplications-therapyforhypercalcemia,inhibitionofbonemetastasis,andtherapyforbonepain.治疗－双磷酸Fanetal-JVIM-EvaluationofIVPamidronateadministrationin33cancerbearingdogswithprimaryorsecondaryboneinvolvementThebiologicactivitywasassessedprospectivelyin10dogswithOSA-in4/10dogstherewasanimprovementinpain

Prognostic预后因YoungdogsappeartohaveshortersurvivaltimesandmoreaggressivediseasePresenceofmetastaticlesionsatthetimeofElevat