MCTs and typing

Re: MCTs and typing

Matt Hilary — Tue, 25 Mar 2014 14:09:54 GMT

Thanks Gerry - really appreciate your time and expertise as always.

And thanks JHL for pointing me towards Torrance Diamond - had never heard of them beforehand!

Re: MCTs and typing

james herriot lied — Mon, 24 Mar 2014 17:45:46 GMT

Plus what Gerry said (slid in while I was still one finger typing)

Re: MCTs and typing

james herriot lied — Mon, 24 Mar 2014 17:43:34 GMT

If I could give one piece of advice on MCTs, it would be to have a chat with TDDS about them - no disrespect to your current histopath lab, but Torrance Diamond have an obsession with mast cells that reaches into the Dark Side.

Equally, if the patient's not great post-GA, how is s/he post-sedation? Large MCTs aren't amenable to a quick dab with local, but if you have a few emerging nodules and you know that full-scale surgery with margins isn't going to be possible, then subject to a decent bit of typing off a representative survey, it could help to decimate the numbers. Always a difficult decision with MCTs, but when one's options are limited then quick surgery under minimal restraint may be better than no surgery at all.

But definitely a vote for discussion with TDDS. They've helped to save a few of my patients over the years.

Re: MCTs and typing

Gerry Polton — Mon, 24 Mar 2014 17:32:18 GMT

Hi Matt

This is a very common problem but it is always a tricky one to resolve. I think it is an example of one of those situations where the solution for one patient is not necessarily a good solution for another. In this case, the fact that the dog is 11 years old and had a poor recovery from anaesthesia make me suspect that he might not have another 2-3 years left 'in the tank' if the mast cell tumour problem was not there. (Please feel free to disagree as you know the patient and I do not). On that basis, I would be very inclined to try to manage any further mast cell tumours as conservatively as possible. Many dogs develop multiple mast cell tumours and do not demonstrrate evidence of aggressive or progressive disease for many years, or even ever, in some cases. Since the tumours you have already removed were relatively low grade and were completely removed, I would say that it is relatively likely that any future mast cell tumours are likely to be similarly relatively low grade too.

So, my advice would be for you or this dog's owners to make a map of the dog's skin and to record the sites of any suspicious skin lesions (as well as the sites of the two resected tumours). Over the next six months, I would advise that you check the dog regularly, perhaps every two months or so, and that any new lesions are noted on the map and that measurements are obtained for future comparisons. After six months, if there are no alarming developments, the interval between checks should be increased, perhaps to three or four months, depending on your level of concern and that of your dog's owners. When new lesions arise they should undergo fine needle aspirate; they may not be mast cell tumours. If mast cell tumours are confirmed, do not rush into resection. By all means ask me again at that time about how to proceed. But, my advice, in general terms, is to wait until one of the multiple mast cell tumours present appears to be at risk of becoming a nuisance to the patient, and then consider surgery to remove that one and any others which might be potentially troublesome within a reasonably near timeframe. This is a tricky judgement to make, I would be the first to say. But it is better, in my opinion, to adopt the more conservative approach and to mess up than to adopt an aggressive approach and to mess up. Of course, ideally, we don't mess up.

I don't think that the existing medical therapies have a place in a case like this.

I hope that helps.

Gerry