Hemangiosarcoma of the Heart

TL;DR. Vrlo agresivan rak srčanih žila: naglo krvarenje, tamponada, hitno. Oprezna prognoza.

Često desni atrij; krv u perikardu.

Što je to?

Zloćudni tumor endotela. U psa često desni atrij/aurikula. Ruptura ispunjava perikard i može uzrokovati tamponadu.

"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."

Uzroci i čimbenici rizika

Uzrok nepoznat; genetska predispozicija. Psi srednje do starije dobi. Uz srčanu masu procijeniti slezinu i jetru.

"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)."

Znakovi na koje treba pripaziti

Česti

• Kolaps; sinkopa; slabost; blijede desni; aritmije; prigušeni tonovi; desnostrano zatajenje; hematološke promjene

Povremeni

• Ascites; akantociti; šum

Nagla slabost i blijede desni upozoravaju na krvarenje srčanog tumora.

Dijagnostika

• Pregled: prigušeni tonovi, slabi pulsi, blijede desni
• Ehokardiografija: primarni alat

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

• Citologija perikardne tekućine: često nije definitivna

"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."

• KKS, troponin I, RTG, UZ abdomena; histopatologija

Ehokardiografija prikazuje masu i tekućinu.

Liječenje

Hitna stabilizacija

Perikardiocenteza rasterećuje tamponadu.

Kirurgija

Rezekcija aurikule i/ili djelomična perikardiektomija (palijativno).

Kemoterapija (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..."

Potpora

glucocorticoids palijativno moguće.

Prognoza

Bez liječenja: često dani-tjedni. Kirurgija + VAC: medijan ~189-195 dana. Mačka: ograničeni podaci.

Prevencija

Nema poznate prevencije. Screening eho u rizičnih pasmina u srednjoj dobi.

Kada zvati veterinara

Hitno:

• Nagli kolaps; ekstremna slabost; blijede/plave desni; teška dispneja; sinkopa; akutno nadimanje trbuha

Za određene pasmine

Rizične pasmine:

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

Izvori

• 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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