Hemangiosarcoma of the Heart

TL;DR. Meget aggressiv karcancer i hjertet: pludselig blødning, tamponade, akut. Forsigtig prognose.

Ofte højre atrium; blod i perikardiet.

Hvad er det?

Ondartet endotelcelletumor. Hos hund ofte højre atrium/aurikel. Ruptur fylder perikardiet og kan give tamponade.

"The age distribution of cats with cardiac tumors is different from that of dogs; about 28% are 7 years old or younger. It is unknown whether reproductive status affects relative risk for cardiac tumors in cats."

Årsager og risikofaktorer

Årsag ukendt; genetisk disposition. Middelaldrende til ældre hunde. Ved hjertemasse også milt og lever.

"Approximately 50% of the tumors originate in the spleen, 25% in the right atrium, 13% in subcutaneous tissue, 5% in the liver, 5% in the liver-spleen-right atrium, and 1% to 2% simultaneously in other organs (i. e. , kidney, urinary bladder, bone, tongue, prostate)."

Tegn at holde øje med

Almindelige

• Kollaps; synkope; svaghed; blege slimhinder; arytmier; dæmpede hjertetoner; højresidig svigt; blodstatusafvigelser

Lejlighedsvise

• Ascites; akantocytter; mislyd

Pludselig svaghed og blege slimhinder advarer om blødning fra hjertetumor.

Diagnostik

• Undersøgelse: dæmpede toner, svage pulser, blege slimhinder
• Ekkokardiografi: primært værktøj

"Echography reveals an intrapericardial cystic mass compressing the cardiac cavities. However, this echographic aspect can be similar to that of a cardiac hemangiosarcoma..."

• Cytologi af perikardvæske: ofte ikke definitiv

"An additional problem with effusions is that they frequently contain reactive mesothelial cells that may resemble neoplastic cells, leading to a false-positive diagnosis of HSA. In general, a presumptive clinical or cytologic diagnosis of HSA should be confirmed histopathologically, if feasible."

• Blodstatus, troponin I, røntgen, bug-UL; histopatologi

Ekkokardiografi viser masse og væske.

Behandling

Akut stabilisering

Perikardiocentese aflaster tamponade.

Kirurgi

Aurikelresektion og/eller partiel perikardektomi (palliativ).

Kemoterapi (VAC)

Vincristine, Doxorubicin, Cyclophosphamide

"Sixty-seven dogs with HSA in different anatomic locations were evaluated retrospectively. All dogs received the VAC protocol, as adjuvant to surgery ( n = 50), neoadjuvant ( n = 3), or as the sole treatment modality ( n = 14). There was no signi ficant difference between the MST [median survival time] of dogs with stage III ( n = 25; 195 days) and stage I/II ( n = 42; 189 days) HSA..."

Støtte

glucocorticoids palliativt muligt.

Prognose

Uden behandling: ofte dage-uger. Kirurgi + VAC: median ~189-195 dage. Kat: begrænsede data.

Forebyggelse

Ingen kendt forebyggelse. Screening-ekko hos risikoracer i middelalder.

Hvornår ringe til dyrlægen

Akut:

• Pludselig kollaps; ekstrem svaghed; blege/blå slimhinder; svær åndenød; synkope; akut bugudspiling

For specifikke racer

Risikoracer:

• German Shepherd Dog
• Golden Retriever
• Labrador Retriever
• American Cocker Spaniel
• English Setter
• Miniature Poodle
• Afghan Hound

Kilder

• Veterinary Internal Medicine, 5th Edition, pages 203, 1220-1222.
• Clinical Echocardiography of the Dog and Cat, page 261.

My highlights & notes

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