Haemangiosarcoma on hindleg

Re: Haemangiosarcoma on hindleg

Martin Atkinson — Fri, 20 Jun 2014 16:06:59 GMT

I had a dog with a spontaneously bleeding lateral thoracic wall/axilliary mass diagnosed on wedge biopsy as haemangiosarcoma, I operated with trepidation but was surprised how easily it shelled out and how little it bled and although I wasn't confident I had excised it properly due to fairly indistinct boundaries it came back with adequate margins and has not recurred or metastasised AFAIK in 2 years.

Re: Haemangiosarcoma on hindleg

Mair Tyler — Fri, 20 Jun 2014 15:01:32 GMT

Had the dog in for chest xrays and abdominal scan today. Suspicious areas in lungs and an obvious mass on the liver. :( Don't think we'll be taking the case any further. Frustrating in a healthy young dog... TGIF!

Re: Haemangiosarcoma on hindleg

Tim Charlesworth — Fri, 20 Jun 2014 10:39:49 GMT

[quote user="Mair Tyler"]

Thanks for that advice Tim. To be honest I'm be quite worried about cutting into it because of the amount of bleeding. Do you think doing a punch biopsy would be any safer?? The mass does extend into the subcut tissues and I suspect probably muscle too. Remarkably the dog is not lame and not one bit bothered by it!

[/quote]

I would usually take a wedge rather than a punch biopsy on the basis that wedges are easier to close and tamponade the bleeding and you are less likely to get crush artefact. Having said that I don't think it will make a lot of difference. You could put a small amount of haemostatic sponge (eg Spongostan) into the wound after a punch biopsy which should help. I would biopsy a part of the mass that you think you would be able to bandage afterwards if needs be (often the distal part) but you're very unlikely to have sig problems. I would just warn the owners that they may see some bruising around the biopsy site for a few days. We had one a couple of weeks ago that hadn't bled at all on biopsy and had been presumed to be an invasive lipoma!

Tim

Re: Haemangiosarcoma on hindleg

Mair Tyler — Wed, 18 Jun 2014 22:30:23 GMT

Re: Haemangiosarcoma on hindleg

Tim Charlesworth — Wed, 18 Jun 2014 21:17:33 GMT

Dear Mair, you have some sound advice from Gerry. These tumours often infiltrate deeply and can be very hard to excise unless amputation is being considered. You can get wide lateral margins relatively easily by closing with e.g. a caudal superficial epigastric flap (and this would be great for not so nasty cutaneous tumours) but there is little/no point in doing this unless you can get the deep margin which is why the s/c HSA's seem to have a much higher recurrence rates than the cutaneous ones. Given the implications of this diagnosis (i.e. considering amputation, chemo, even PTS) I would strongly recommend incisional biopsy to get a confirmation of the diagnosis as cytology is not always that accurate with these..

Best of luck,

Tim

PS they can bleed so be prepared!

Re: Haemangiosarcoma on hindleg

Kirsten Simpson — Wed, 18 Jun 2014 15:36:45 GMT

I had one before when I was locuming in Birmingham. Ancient crusty GSD with CDRM and life hanging on the edge already with a haemangiosarcoma on the point of his hock. Removed it and he did fairly well, part of the wound broke down and I then left the locum as it was healing with dressing etc. No idea what happened. First and only one I've ever seen!

Re: Haemangiosarcoma on hindleg

Mair Tyler — Wed, 18 Jun 2014 15:25:59 GMT

Thanks everyone for your advice. Really appreciate it!

The cytology report did say 'suspect haematoma' with other differentials being fibrosarcoma or histiocytic neoplasms. I feel it would be potentially very risky site to biopsy though obviously it'd be nice to have a definite answer. The plan for now is to do chest xrays and abdominal ultrasound and if these are clear, I will probably recommend limb amputation and send the lump for histopath. Unfortunately the dog is not insured.

Re: Haemangiosarcoma on hindleg

Braden Collins — Wed, 18 Jun 2014 14:33:35 GMT

Only thing I can think to add to Gerry's answer is how certain are they of the diagnosis based on a FNA? I think few pathologists (from my experience) would make a call like that from a FNA.

Re: Haemangiosarcoma on hindleg

Utlendigur — Wed, 18 Jun 2014 13:18:57 GMT

Seen two in cats

1. 18mnth DSH with stifle effusion. Initially suspected trauma but very odd xray and was diagnosed on synovial biopsy. Amputated leg with guarded prognosis but the cat was absolutley fine for about 8-9yrs when it got a recurrence on the stump.

2. young adult DSH with what looked like a cut paw, pouring blood from tiny wound between pads. Sutured but it recurred and looked a bit odd. Biopsy = haemangiosarc. Amputated leg and I think it was fine

But cats do their own thing..Never seen it in a dog

Re: Haemangiosarcoma on hindleg

Anonymous — Wed, 18 Jun 2014 10:50:12 GMT

sadly had one in my mothers dog. she was a lovely 5 year old akita with bomb proof behaviour (not typical akita!.

large swelling rapid development on her stifle v painful. fna lots of blood, xr nsf biopsy revealed haemangiosarc (I had problems with post biopsy bleeding as at the time didnt know what i was dealing with!). ended up as an amputation as the chest at the time was clear, she lived another 9 months happy life and went down with chest mets and crashed leading to pts

I had never heard of an haemangiosarc in that sort of area before so was a bit surprised and the prognosis was pretty poor. I didnt go down the chemo route as we didnt feel it was right for her.

sorry to be a bit negative, that was my only case of one.

chris

Re: Haemangiosarcoma on hindleg

Gerry Polton — Wed, 18 Jun 2014 08:28:12 GMT

Hello Mair

This is a big mass and that already gives me cause for concern. Cutaneous and subcutaneous haemangiosarcomas exist on a spectrum of severity which at one end can be cured by wide local excision and at the other end will cause death of the patient within 1-2 months just like their splenic counterparts. We have to look for factors which push us one way or another on that spectrum so that we can make rational decisions about therapy. Certainly the presence of detectable metastasis is a big bad sign. Thoracic radiography and abdominal ultrasonography are helpful. Their usefulness is linked to the capabilities of the machine and the user. CT imaging can give better resolution, but don't let anybody tell you that the output from CT is not subject to the capabilities of machin and user also. Demonstration of metastasis leaves us with no useful treatment options. While this is clearly very sad, it does spare the patient and owner the risk of unnecessary intervention.

Other factors which are known to be associated with prognosis are tumour size (big in this case) and the depth from the skin into which it invades. Superficial cutaneous lesions are cured by surgery in approximately 40% of cases. Subcutaneous tumours have an average life expectancy of one year with wide local excision (or amputation in a case like this potentially) followed by doxorubicin chemotherapy. Tumorus that grow into the underlying muscle have a survival time that is comparable with splenic haemangiosarcoma: six months following complete excision and doxorubicin chemotherapy, less if complete excision is not achieved.

If CT is being performed for detection of possible metastasis, it may make some sense to also image the site of the tumour to define depth of invasion and feasibililty of resection.

Sadly, there are a number of reasons why this tumour may prove a very bad thing. Sorry.

Gerry