Would you remove this mass?

Re: Would you remove this mass?

Anthony Dennison — Thu, 19 Mar 2015 11:05:37 GMT

That's the badger.

Re: Would you remove this mass?

Thomas Johnson — Thu, 19 Mar 2015 10:38:01 GMT

[quote user="Anthony Dennison"]

Thanks Tim, in a younger dog I would pursue further staging, though I think I remember Gerry Polton not holding Ki67 index in high regard? Might be my memory playing tricks on me.

[/quote]

I think Gerry's post at the end of this thread is the one your after:

http://www.vetsurgeon.org/forums/p/18050/109432.aspx#109432

Re: Would you remove this mass?

Anthony Dennison — Thu, 19 Mar 2015 09:20:22 GMT

Thanks Tim, in a younger dog I would pursue further staging, though I think I remember Gerry Polton not holding Ki67 index in high regard? Might be my memory playing tricks on me.

Dog is due in for a second post-op check tomorrow. I'm off, but will speak to the vet who will be seeing her. I have discussed further testing with the owner, but we both feel that considering the age of the dog and the sole aim of the surgery was to remove the big swinging lump from her ventral abdomen, this has been a success. Owners are aware of recurrence, but happy with the result so far.

Re: Would you remove this mass?

Tim Charlesworth — Wed, 18 Mar 2015 17:51:03 GMT

That's a fairly unpleasant surprise! I would be concerned that the size and location could indicate a more aggressive course in this dog. It might be worth pursuing a Ki67 stain to give you (and the owner) a little more information about likely prognosis which could be quite guarded here (but remember that the Ki67 data is only relevant for MCT's that have been completely removed). Revision surgery (flaps) would be possible but probably completely inappropriate given age/wishes of the owner. If the owners don't want anything else done then fair enough to leave it alone but I would offer them staging with view to further treatment and would certainly not give them the impression that things won't come back. If they don't want to do anything then just write it in their notes to cover yourselves in case they get angry in a few months that the lumps that you "removed" have come back...

Next time you see them, feel for the sub-lumbar lymph node (trans rectal, feel dorsal just beyond pelvis). If there's a big swelling then I would be concerned for mets,

Tim

Re: Would you remove this mass?

Hannah Wynne Richards — Mon, 16 Mar 2015 11:52:26 GMT

Removing to recomended margins would have been totally impossible.

You've done your best for the patient that was presented to you.

Wynne

Re: Would you remove this mass?

Anthony Dennison — Mon, 16 Mar 2015 11:02:44 GMT

The masses have come back as grade II MCTs, both the perineal masses and the mammary mass. Neither have clear margins, but the mammary mass was so big I cut it away from the large mass of tissue I removed so I'm less worried about that. 10 mitoses per 10 high power fields, so fairly active.

Idexx are offering ki-67 and c-kit PCRs, but she is an old staffie, and I have seen reports like this from younger bull breeds that haven't recurred, so I don't think I'll be pursuing any further staging given the whole aim was just to remove the lump.

Re: Would you remove this mass?

Tricia Goulden — Fri, 13 Mar 2015 21:50:10 GMT

Good news!

Re: Would you remove this mass?

Gillian Mostyn — Fri, 13 Mar 2015 15:33:45 GMT

Well done!

Re: Would you remove this mass?

Hannah Wynne Richards — Fri, 13 Mar 2015 11:48:50 GMT

Well done

Wynne

Re: Would you remove this mass?

Anthony Dennison — Fri, 13 Mar 2015 09:09:43 GMT

Update:

First post-op check today, wound looks good and the owner is really happy, even said the wound looks neat which has really massaged my ego!

Re: Would you remove this mass?

Anthony Dennison — Mon, 09 Mar 2015 16:24:38 GMT

Thanks Tim,

I removed the masses today. The large pendulous one was in fact two solid masses with an awful lot of fat and connective tissue, went from the cranial end (wish I'd seen this first!). Lots of extra little vessels around the caudal superficial epigastric vessels, a lot of oozing, but it came off ok. The two ulcerated masses on the perineum were dermal only and came away easily along the same incision, so there is only one (rather long) incision. Placed intradermals and cruciate skin sutures, only part I'm a bit worried about is there is a little bit of tension just cranial to the vulva.

The mammary masses were actually quite discrete and encapsulated, didn't look as nasty as I thought. Will be interesting to see what the histo comes back as.

Re: Would you remove this mass?

Tim Charlesworth — Mon, 09 Mar 2015 12:46:57 GMT

I would aim to remove this mass not debulk. If you remove, start your dissection at the caudal aspect and dissect down to the caudal superficial epigastric artery/vein and ligate them both (these are the main vessels which come off the main vessels that course through the inguinal canal). If you dissect 1-2cm cranial to the mass then you can pick up the same 2 vessels. If you tie them off then you have just stopped the vast majority of blood supply to the tumour which you should then be able to "lift off" from the external rectus sheath unless it has invaded (in which case take the fascia with it). If you start debulking it (depends on your definition I grant you) you will get a lot of bleeding and probably quickly wish you hadn't started it! The Px will depend on the histo type/stage (don't forget to feel/sample LN's (inguinal, popliteal, sublumbar) as well as taking x-rays..)

Tim

Re: Would you remove this mass?

CatherineThomas — Fri, 06 Mar 2015 08:12:21 GMT

Yes, but beware that prognosis could still be poor. I did one a couple of months ago. Had seemed fine other then the presence of the mass before surgery. Pre-op thoracic xrays were clear, owner refused pre-op bloods and histology. There was a lot of capillary bleeding during the op, used a lot of cautery but still oozing, placed pressure bandage afterwards but still had problems with on-going haemorrhage over the first 24hrs. Then there was massive oedema around the wound and down the hind leg which took 2-3 weeks to settle, during this time she was losing weight and deteriorating so was put to sleep about a month after surgery.

Re: Would you remove this mass?

Noweia — Fri, 06 Mar 2015 00:23:41 GMT

I had one of these a few weeks ago - looked like would come off nicely... then we realised she had a pyo on top of it!

Went ahead and operated after a night on fluids and she's currently doign very well!

Re: Would you remove this mass?

Michael Woodhouse — Thu, 05 Mar 2015 17:22:48 GMT

[quote user="Neil Wheadon"]If I had a £1 for every owner that says their dog or had been told that their dog is too old for an anaesthetic.......... [/quote]

Who are these vets?

I too would remove the lump. They can do really, really well.

Re: Would you remove this mass?

Neil Wheadon — Thu, 05 Mar 2015 16:48:22 GMT

I had a 17 year old cat a few months ago. It had a pedunculated mass over it's ribs and was the size of a damson. 3ml of local and 5 staples later, the owner was delighted and said that the cat was almost kitten like again, making me wonder how debilitating these masses actually are

Neil

Re: Would you remove this mass?

Anthony Dennison — Thu, 05 Mar 2015 16:04:50 GMT

Thanks everyone, I'll ring the owner and book it in!

Re: Would you remove this mass?

mariette asselbergs — Thu, 05 Mar 2015 15:58:03 GMT

Actually, I did my own first UK dog, put up for PTS because of grapefruit size ulcerated mammary tumour, and she lived for 6 years afterwards. (Took off two more mammary tumours in the following years, but she did not die of metastatic cancer).

Mariette

Re: Would you remove this mass?

KMurphy — Thu, 05 Mar 2015 15:56:28 GMT

Think how much better this dog is going to feel afterwards. If she's fit for it then definitely go ahead! Age is but a number... :)

Re: Would you remove this mass?

mariette asselbergs — Thu, 05 Mar 2015 15:55:08 GMT

Unless firmly attached underneath I think it is worthwhile to take off; I have done a few of those who would have to be PTS for welfare reasons and they lived another 6 months or so without the horrible football under their belly. And I agree with others, this anaesthesia risk because of old age, what do you have to loose?

Mariette

Re: Would you remove this mass?

Neil Wheadon — Thu, 05 Mar 2015 15:47:20 GMT

9 times out of 10 the PTS reason will be that the mass has ulcerated. I saw a case last night that had done this and there was exudate all over the place. Then it's an emergency operation or PTS. If the owner is happy and the risks explained then why not remove it?

If I had a £1 for every owner that says their dog or had been told that their dog is too old for an anaesthetic.......... (Need an icon for can of worms Arlo)

Neil

PS Drat, the smiley was supposed to go by the can of worms, not the entire post.

Re: Would you remove this mass?

Evelyn Barbour-Hill — Thu, 05 Mar 2015 15:40:17 GMT

[quote user="Anthony Dennison"]Is this a sensible plan[/quote]

Yes.

Re: Would you remove this mass?

Will McMullan — Thu, 05 Mar 2015 15:29:30 GMT

Age in and of itself is not a major risk factor for anaesthetic safety. Health is. If the dog is fit and has reasonable bloods pre-op, and no lung mets, I would definitely debulk these masses. Agree that you should inform the owner re margins and possibility of recurrence.

Re: Would you remove this mass?

Hannah Wynne Richards — Thu, 05 Mar 2015 15:03:13 GMT

It's probably already spread, but if it's starting to ulcerate, it will soon become a welfare problem unless removed. I'd go ahead, having made it very clear to the owner that I'm not even attempting a cure - and had this written down on the consent form.

Wynne