Odd presentation of MCT

Re: Odd presentation of MCT

Tim Charlesworth — Mon, 01 Sep 2014 14:52:44 GMT

Hi Matt, MCT's can look very variable and can sometimes looks very "squishy" though as far as I know this hasn't been identified as a prognostic factor!

FNA of the local LN is usually worthwhile, the MCT's often attract surrounding Mast Cells to the tumour site and so it is not uncommon to see some (non-neoplastic) mast cells within the LN aspirates. Although the grading information you have would indicate that a good prognosis is achievable, I suspect that revising the wound may need flap reconstruction. So before doing a big surgery I would want to be as certain as possible that there are no metastases from the primary. I'd have the dog in and sedate it and do an abdominal scan and then take guided aspirates from the liver, spleen, sublumbar and popliteal lymph nodes (+ inguinal if palpable). If they all came back as clear then I would aim to take 2cm lateral margins around the surgical scar and go as deep as possible (ideally including a decent fascial plane but this can be hard in this site). Further (and in theory more accurate) prognostic information could be gained by requesting a Ki67 stain if the o's want more information before committing.. If surgery is not possible/not desirable then I would recommend radiotherapy. Both follow up surgery and postop radiotherapy have been shown to prolong survival for incompletely resected G2 MCT's.

Hope this helps,

Tim

Re: Odd presentation of MCT

Matt Hilary — Mon, 01 Sep 2014 11:46:43 GMT

[quote user="James Laidlaw"]

Could you FNA the local lymph node? Maybe easily done conscious and give better idea of any spread - although you don't want to track cells if you can avoid it I guess..

[/quote]

Thanks James.

While I've removed all grossly abnormal tissue from the site it's likely there are cells left in so regrowth to be expected - it's the required extent of surgery that worries me at this stage!

I've previously been told that FNA of lymph nodes to determine spread is tricky as finding isolated metastasised cells in normal tissue shows up lots of false negatives (though obviously a positive finding would be diagnostic). Might be worth doing regardless - will let more qualified members guide on this!

Re: Odd presentation of MCT

James Laidlaw — Mon, 01 Sep 2014 10:35:54 GMT

Could you FNA the local lymph node? Maybe easily done conscious and give better idea of any spread - although you don't want to track cells if you can avoid it I guess..

Revision surgery may be of benefit if advised - especially while it is still easy to identify the surgical site.

I'm sure more specialist advice will be on the way soon enough too.