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Ask Dr. Laura Devlin, DVM, DABVP Your Own...

Dr. Laura Devlin, DVM, DABVP
Dr. Laura Devlin, DVM, DABVP, Small Animal Veterinarian
Category: Dog
Satisfied Customers: 1752
Experience:  DABVP, Specialist in Canine and Feline Medicine, Veterinarian since 2000
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Our dog was operated on and the cecum was removed. The histopathology

Resolved Question:

Our dog was operated on and the cecum was removed. The histopathology report indicates leiomyosarcoma. A portion of the small intestine was removed which was necrotic but was only infected tissue, no sarcoma.

Can this be treated, and if so what are the modalities.

Thank you,
Manuel Reyes-Otalora
XXX@XXXXXX.XXX
Submitted: 5 years ago via Dog-Health-Guide.
Category: Dog
Expert:  Dr. Laura Devlin, DVM, DABVP replied 5 years ago.
I have seen several cases of these in practice. Can you answer a few more questions for me?

The cecum is located at the junction of the small and large intestine. Do you know if the biopsy report indicated if the margins were clear? That is, does it appear as though your vet was able to remove all of the cancer?

Did your vet include any lymph nodes or also biopsy the liver and spleen during the surgery, and do you have those results?

I hope your dog is recovering well. I look forward to helping you.
Sincerely,
Dr. Devlin

Customer: replied 5 years ago.

Dr. Devlin:

 

Thank you for your reply.

 

Margin is being reviewed by histopathology. We are awaiting the results, but may be afew more days.

I do not believe that Lymph nodes or liver were biopsied.

 

I am inmy office, but need to go home. Can I sign off and log on again?

 

Thank you, Manuel

 

Expert:  Dr. Laura Devlin, DVM, DABVP replied 5 years ago.
Absolutely. I'll reply and it will be ready when you are.

Sincerely,
Dr. D.
Customer: replied 5 years ago.

Dr. Devlin:

 

I am back on line from home. and am waiting for your response.

Manuel

Expert:  Dr. Laura Devlin, DVM, DABVP replied 5 years ago.

Manuel,

 

If special staining was not performed on the biopsy sample (typically you have to request this), you will want to do so. Many tumors initially classified as leiomyosarcomas are really gastrointestinal stromal tumors (GISTs). In general the STs may not be that different and most cases that are completely excised had longterm survival. The prognosis is better with the GIST tumors. I have one patient now who has been under the care of a oncologist since I surgically removed a cecal GIST 1.5 years ago. She did develop a second tumor in her abdomen near her bladder a few months back, but it was resected completely as well. She is doing great!



I've copied and pasted two papers below that discuss survival times based on the tumor type and location. Please note that it is possible to have obtained a cure if the entire tumor was removed. You may also wish to follow up with a veterinary oncologist to discuss follow-up chemotherapy.

Some papers on reclassification of the tumor type based on special stains and length of survival:

Reclassification of small intestinal and cecal smooth muscle tumors in 72 dogs: clinical, histologic, and immunohistochemical evaluation
Vet Surg. June 2007;36(4):302-13.
Ceriel P H J Maas1, Gert ter Haar, Ingrid van der Gaag, Jolle Kirpensteijn

1 Department of Clinical Sciences of Companion Animals, University of Utrecht, Utrecht, The Netherlands.

Abstract

OBJECTIVES: To reclassify canine small intestinal and cecal leiomyoma (LM) and leiomyosarcoma (LMS) into smooth muscle and gastrointestinal stromal tumors (GIST) using histologic and immunohistochemical (IH) analysis and to report clinical findings and survival data. STUDY DESIGN: Retrospective review of cases. ANIMALS: Dogs (n=47) with small intestinal (40 LMS; 7 LM) and 25 dogs with cecal tumors (23 LMS; 2 LM). METHODS: Clinical and survival data were reviewed. Tissue sections were reevaluated for light-microscopic malignancy criteria and examined for expression of SMA, desmin, vimentin, S-100, and CD117 (KIT) by immunohistochemistry. RESULTS: Reclassification resulted in 2 LM, 9 LMS, 19 GIST, and 17 GIST-like tumors in the small intestine and 23 GIST and 2 GIST-like tumors in the cecum. GIST-like tumors were morphologic and IH identical to GIST but lacked KIT expression. No significant difference in survival was observed for tumor type, location, histologic, or IH characteristics; however, dogs with cecal tumors were significantly older in age, presented more commonly with intestinal perforation and peritonitis, and less commonly with weight loss. Cecal tumors had more histologic malignancy criteria than small intestinal tumors. After excision, 1 and 2 year recurrence-free periods were 80.1% and 67.2% for small intestinal and 83.3% and 61.9% for cecal tumors. CONCLUSION: Prognosis for intestinal tumors with histologic smooth muscle appearance is good after excision and not related to tumor type, location, histologic, or IH characteristics. CLINICAL RELEVANCE: Clinical importance could not be demonstrated for reclassification, but may be for future treatment, of intestinal smooth muscle or stromal tumors.

Clinical and immunohistochemical differentiation of gastrointestinal stromal tumors from leiomyosarcomas in dogs: 42 cases (1990-2003)
J Am Vet Med Assoc. May 2007;230(9):1329-33.
Kelli N Russell1, Stephen J Mehler, Katherine A Skorupski, Jennifer L Baez, Frances S Shofer, Michael H Goldschmidt

1 Matthew J. Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.

Abstract

OBJECTIVE: To reexamine (via immunohistochemical techniques) canine tissue samples that had been previously classified as gastrointestinal leiomyosarcomas (GILMSs), identify and differentiate gastrointestinal stromal tumors (GISTs) from GILMSs, and compare the biological behavior and clinical course of GISTs and GILMSs in dogs. DESIGN: Retrospective case series. ANIMALS: 42 dogs. PROCEDURES: Medical records of 42 dogs for which a histologic diagnosis of GILMS was confirmed were reviewed for signalment, clinical signs, physical examination findings, results of initial diagnostic tests, surgical findings, adjunctive treatment, location of the tumor, completeness of resection, and outcome after surgery. Archived tumor tissue specimens from each dog were restained via immunohistochemical techniques to differentiate tumor types. Long-term follow-up information was obtained from the medical record or through telephone interviews with owners and referring veterinarians. RESULTS: On the basis of immunohistochemical findings, 28 of 42 tumors were reclassified as GISTs and 4 were reclassified as undifferentiated sarcomas; 10 tumors were GILMSs. In dogs, GISTs developed more frequently in the cecum and large intestine and GILMSs developed more frequently in the stomach and small intestine. Median survival times for dogs with GISTs and GILMSs were 11.6 and 7.8 months, respectively; if only dogs surviving the perioperative period were considered, median survival times were 37.4 and 7.8 months, respectively. These differences, however, were not significant. CONCLUSIONS AND CLINICAL RELEVANCE: In dogs, many previously diagnosed GILMSs should be reclassified as GISTs on the basis of results of immunohistochemical staining. The biological behavior of these tumors appears to be different.

 

I hope this information was helpful. I'm pulling for you and your dog. Please let me know how things go, or if you have any other questions.

Sincerely,

Dr. Devlin

Customer: replied 5 years ago.

Dr. Devlin:

Thank you for your response and pulling for Riley. He is a sweetheart!!

One of the studies mentions CD117 (KIT). Does this mean that if it the tumor is tested for CD 117, and it is positive for this protein, that it could be treated with STI-571 [GLIVEC] as is being done with human patients with relative high success?

 

Manuel

Expert:  Dr. Laura Devlin, DVM, DABVP replied 5 years ago.
In people, receptor tyrosine kinases are the drugs of choice. Gleevec is prohibitively expensive for most dogs, but there is a RTK inhibitor that hopefully will be released for mast cell tumors in dogs within the next several months. I am sure that people will start trying that for their patients wtih aggressive GISTs.

We are still learning much about these tumors in dogs.

You're welcome. I know what it means to have a special dog in your life. I hope he does well for you.
Sincerely,
Dr. D.

Customer: replied 5 years ago.

Dr. Devlin:

 

Riley lives in Tampa with one of our daughters. I am not sure of your location, but do you know any sarcoma oncologists in the Tampa, Florida area?

 

Is Gleevec the same as GLIVEC? and has it been shown to work on canines? What is the cost [order of magnitude?]

Also what are some of the RTK inhibitors that are being tested?

 

Thank you, Manuel

 

Customer: replied 5 years ago.

Dr. Devlin: I have received 2 notifications of responses since your above response at 11:01, but there has been no text.You have been very helpful and informative, and will wait for your response. Perhaps there is a glitch somewhere.

 

Thank you, Manuel

 

 

Expert:  Dr. Laura Devlin, DVM, DABVP replied 5 years ago.
Hi, Manuel,

I was overcome with drowsiness last night!

Yes, it is Imatinib, the same medication. Costs for humans range around $3000 a month, so very high depending on the weight of your dog and dose. I don't have any experience with it, but can give you information on locating a veterinary oncologist. There is a specialty practice in Tampa with 3 veterinary oncologist:
http://www.floridaveterinaryspecialists.com/medical/specialty9.cfm

Yes, there have been promising research with TK inhibitors in dogs, a good portion with mast cell tumors. Last I checked there were no veterinary-approved drugs, but Imatinib was being used. For more information, you may need to check directly with an oncologist.

Sincerely,
Dr. D
Dr. Laura Devlin, DVM, DABVP, Small Animal Veterinarian
Category: Dog
Satisfied Customers: 1752
Experience: DABVP, Specialist in Canine and Feline Medicine, Veterinarian since 2000
Dr. Laura Devlin, DVM, DABVP and 6 other Dog Specialists are ready to help you
Customer: replied 5 years ago.

Dr. Thank you so much for the valuable information.

You have been very helpful. We are on or way to pick up Riley and will be able to discuss with the current vet options based on your comments.

 

Thank you again and best regards XXXXX XXXXX of us, including Riley.

 

Manuel Reyes-Otalora

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