Hemangiosarcoma of the Heart

TL;DR. Zeer agressieve kanker van hartvaten: plotselinge bloeding, tamponnade, spoed. Voorzichtige prognose.

Meestal rechter atrium; bloed in het pericard.

Wat is het?

Maligne endotheelcel tumor. Bij de hond vaak rechter atrium/aurikel. Ruptuur vult de pericardzak en kan tamponnade veroorzaken.

"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."

Oorzaken en risicofactoren

Oorzaak onbekend; genetische predispositie. Middelbare tot oudere honden. Bij hartmassa ook milt en lever beoordelen.

"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)."

Signalen

Vaak

• Collaps; syncope; zwakte; bleke slijmvliezen; aritmieën; gedempte harttonen; rechterhartfalen; bloedafwijkingen (trombocytopenie, schistocyten)

Soms

• Ascites; acanthocyten; hartgeruis

Plotselinge zwakte en bleke slijmvliezen waarschuwen voor cardiale tumorbloeding.

Diagnose

• Onderzoek: gedempte tonen, zwakke pulsen, bleke slijmvliezen
• Echocardiografie: primair hulpmiddel

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

• Cytologie pericardvocht: vaak niet bewijzend

"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."

• CBC, troponine I, thoraxfoto's, abdominale echo; histopathologie (referentie)

Echocardiografie toont massa en vocht.

Behandeling

Spoedstabilisatie

Pericardiocentese verlicht tamponnade.

Chirurgie

Aurikelresectie en/of partiële pericardiectomie (palliatief).

Chemotherapie (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..."

Supportief

glucocorticoids palliatief mogelijk.

Prognose

Zonder behandeling: vaak dagen tot weken. Chirurgie + VAC: mediaan ~189-195 dagen. Kat: beperkte data.

Preventie

Geen bekende preventie. Screening-echo bij risicorassen vanaf middelbare leeftijd; schoon resultaat garandeert niets.

Wanneer de dierenarts bellen

Spoed:

• Plotselinge collaps; extreme zwakte; bleke/blauwe slijmvliezen; ernstige ademnood; syncope; acute buikzwelling

Voor specifieke rassen

Risicorassen:

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

Bronnen

• Veterinary Internal Medicine, 5th Edition, pages 203, 1220, 1221, 1222.
• Clinical Echocardiography of the Dog and Cat, page 261.

My highlights & notes

New note