Soft tissue sarcoma at the site of a cut pad!

Re: Soft tissue sarcoma at the site of a cut pad!

Jillian Hall — Thu, 16 Feb 2012 22:01:45 GMT

I went to a CPD course on feline oncology where there was quite a lot of discussion on sarcomas. Although these tumors are all locally invasive and will always carry a risk of local recurrence, the speaker was much more positive about sarcomas on the pad than elsewhere. This was on the basis that the connective tissue structure is very dense, compared to the loose connective tissue surrounding injection site sarcomas, so those nasty invading cells invade much slower, and don't invade as far. He felt that you could successfully treat pad sarcomas with much less radical resection. I can only assume that a similar principle may apply to dogs.

Re: Soft tissue sarcoma at the site of a cut pad!

Bob Russell — Wed, 15 Feb 2012 14:32:48 GMT

The first biopsy was very similar but there was disagreement between pathologists. I questioned the first biopsy result because the history did not seem to fit the clinical picture. We repeated the biopsy to confirm the diagnosis!

It was refreshing for pathologists to disagree but they recommended re-biopsy if the lump came back (it did!).

Re: Soft tissue sarcoma at the site of a cut pad!

Utlendigur — Wed, 15 Feb 2012 13:34:23 GMT

I did see a report of one case of neoplasia in a main pad that was managed by resecting the whole pad, then transposing a digital pad into its place (with concurrent toe amputation).

Just a bit confused as to the histo report mentioning "regrowth" and a previous biopsy - but the history sounds like only one surgery done?

Re: Soft tissue sarcoma at the site of a cut pad!

Bob Russell — Wed, 15 Feb 2012 12:39:01 GMT

[quote user="Mark Rowland"]Only a chest series (which I'm sure was on the plan) :-)

[/quote]

Yes will be done before further surgery. Radiotherapy is out of the question as the family are struggling with big time human medical problems so getting the pet to AHT is out of the question.

I have discussed the case with one of the local soft tissue surgeons and he feels the recurrence risk is high so ultimately amputation is the treatment of choice because of the difficulties getting the wound to heal.

This photo is more recent! I am in two minds as to whether it is better to 'go large' and give the massive margins associated with amputation, hopefully getting it all over in one procedure or be less aggressive but there being a real risk of recurrence.

Re: Soft tissue sarcoma at the site of a cut pad!

Neil Wheadon — Wed, 15 Feb 2012 11:43:41 GMT

I'd agree with Malcolm

I've just dealt with a case that was remarkably similar. It was presented as a stitch pad that hadn't healed from looking like it had been traumatised a week before. Looking at it, it was proliferative and we took an FNA that showed spindle cells. She was a Norfolk of similar age to yours, so took as wide a wedge as I dared, stitched it with mattress sutures, re-bangaged every 4 days, and 2 months later is doing very well. Amputation was definately plan B

The 2 factors I considered were

1) Age. Like yours this was an aged dog. I realise that the first cut is the best but I'd rather chance this and avoid amputation as 'is this fair on an old dog'

2) The owner, she was happy to go this route.

I hope this helps

Neil

Re: Soft tissue sarcoma at the site of a cut pad!

Mark Rowland — Wed, 15 Feb 2012 11:42:45 GMT

Or excision + radiotherapy at AHT?

Re: Soft tissue sarcoma at the site of a cut pad!

Malcolm Ness — Wed, 15 Feb 2012 11:14:00 GMT

Could consider a deep (stop just short of vessels and tendons) and wide (pad +2-3mm) excision with a free skin graft leaving amputation as "plan B" if it recurs. Not without risk and obviously more costly but the patient might get to keep the leg.

Re: Soft tissue sarcoma at the site of a cut pad!

Mark Rowland — Wed, 15 Feb 2012 11:10:15 GMT

Only a chest series (which I'm sure was on the plan) :-)