NEOPLAZME SKELETNOG SISTEMA PASA I MAČAKA
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1 FVM NEOPLAZME SKELETNOG SISTEMA PASA I MAČAKA Prof dr Nenad Andrić FAKULTET VETERINARSKE MEDICINE UNIVERZITETA U BEOGRADU
2 PRIMARNE NEOPLAZME (KOSTI ILI HRSKAVICA) NEOPLAZME OKOLNOG MEKOG TKIVA KOJI METASTAZIRAJU NA KOSTI NEOPLAZME KOJE METASTAZIRAJU PUTEM KRVI NA KOSTI I SUPROTNO NEOPLAZIME KOŠTANOG SISTEMA: EPIDEMIOLOGIJA < 5% od svih neoplazmi i uglavnom su maligne Češće neoplazme apendikularnog skeleta Češći kod krupnih rasa Retko kod pasa < 15kg Kod pasa srednjih/starijih god, muškog pola Retki kod mačaka, > preko 10 godina Mačke: nema rasne i polne predispozicije Aksijalni skelet Apendikularni skelet
3 ETIOLOGIJA Predilekciono mesto: metafizni deo kosti - proximalni deo humerusa - distalni deo radijusa - distalni deo femura - proximalni deo tibije Češće na prednjim nego na zadnjim ekstremitetima Brzi rast i veće opterećenje mikrotraume Genetski faktor: Rotvajler i Bernadinac Na mestima starih fraktura Proksimalna metafiza Proksimalna epifiza Diafiza Distalna metafiza Distalna epifiza
4 Poreklo neoplazmi PATOLOGIJA Periostealni osteosarkom Multipli mijelom endoosteuma Medularni osetosarkom
5 Klasifikacija neoplazmi skeleta pasa i mačaka - Osteomi - Hondrom (retko) - Enhondrom BENIGNE - Osteohondromi (solitarni ili multipli) - Osteohondromatoza (mačke) MALIGNE - Periostealni osteosarkom - Hondrosarkom - Fibrosarkom Hemangiosarkom - Anaplastični sarkom - Multipli mijelom i limfom Neoplazme okolnog mekog tkiva koji metastaziraju na kosti - Sarkom mekog tkiva Skvamozni karcinom (prsti, vilica) Maligni melanom prstiju Neoplazme koje metastaziraju putem krvi - Karcinomi, neoplazije mamarnog kompleksa i prostate (karcinom pluća kod mačaka-prsti)
6 MALIGNE NEOPLAZME PSI Osteosarkomi % kod krupnih rasa - 50% kod malih rasa Hondrosarkomi Fibrosarkomi Hemangiosarkomi Osteosarkomi Fibrosarkomi MAČKE
7 PONAŠANJE NEOPLAZMI Osteosarcomi brz, destruktivan i invazivan rast Intezivna bol Predispozicija za patološke frakture Vrlo rano metastaziraju (duge cevaste kosti pluća) bubrezi, jetra, slezina i drugu delovi skeleta Aksijalni skelet (lobanja uglavnom) manje agresivni Kod mačaka manje agresivni nego kod pasa (< 20% metastaza) Hondrosarkomi i fibrosarkomi spor rast i retko metastaziraju
8 Paraneoplastični sindrom - Ne postiji specifičan paraneoplastični sindrom - Hiperkalcemija vrlo retko (multipli mijelom ili limfom) Klinički znaci osteosarkoma dugih cevastih kostiju - Šepanje (akutno ili se postepeno pojačava) - Sa i bez bolnog otoka Klinički znaci osteosarcoma aksijalnog skeleta Mandibularne, maksilarne i orbitalne neoplazme - disfagia, bol tokom otvaranja usta i egzoftalmus Nazalne sinusne neoplazme - iscedak iz nosa i epistaksa Neoplazme kičmenog stuba - neurološki znaci
9 DIJAGNOSTIKA NEOPLAZMI SKELETNOG SISTEMA Pregled krvi - serum AP i za kosti specifična AP (primarni osteosarkom) Rendgenografija (primarni tumori kostiju) CT, MRI, Ultrazvuk?!? (neoplazije aksijalnog skeleta) Scintigrafija (metastaze na kostima) Biopsija/citološki pregled aspirata
10 RENDGENOGRAFIJA (PRIMARNI TUMORI KOSTIJU) Osteoliza destrukcija kostne srži i korteksa kosti fokalna ili diseminirana Iregularna, nova kostna formacija pod pravim uglom u odnosu na korteks, skleroza kostne srži, periostalna bujanja na periferiji lezije Codman s triangle Mekotkivni otok sa ili bez kalcifikacije Dijagnoza: primarni maligni tumor kostiju
11 Osteosklerotični osteosarkom distalnog radijusa (Kodmanov trougao) Neoplazija distalnog radijusa sa osteolitičkim promenama
12 Kostna proliferacija sa veoma jasnom definicijom desne maksilarne kosti (osteoma) kod psa Multipli mijelom endoosteuma A) Rendgenski nalaz B) CT nalaz A B
13 T TNM KLASIFIKACIONI SISTEM TUMORA KOSTIJU KOD PASA I MAČAKA - PRIMARNI TUMOR T0 - Nema dokaza za postojanje tumora T1 - Ograničen tumor u meduli i korteksu T2 - Tumor se pruža preko granice periosteuma Multipli tumori mogu biti klasifikovani nezavisno jedan od drugog M - DISTANT METASTASES (UDALJENE METASTAZE) M0 Nema dokaza za postojanje udaljenih metastaza M1 Detektovane su udaljene metastaze (specifična mesta) T opisuje veličinu primarnog tumora i da li je zahvatio susedno tkivo N opisuje susedne(regionalne) lymph nodes koji su zahvaćeni procesom M opisuje udaljene metastaze (širenje tumora sa jednog na drugi deo tela)
14 TERAPIJA OSTEOSARKOMA Apendikularni skelet Lečiti ili ne lečiti?!?!?! - HIRURGIJA!!! - RADIJACIONA TERAPIJA (uklanjanje bola) - HEMOTERAPIJA (slab efekat) Kao dodatna terapija hirurškom pristupu 35% -50% preživi jednu godinu nakon hiruške intervencije - HIRURGIJA Aksijalni skelet Nakon 3-4 meseca recidivi!!!
15 PROGNOZA Osteosarkom na apendikularnom skeletu Psi: u 90% slučajeva mikrometastatsko oboljenje u vreme dijagnoze primarnog tumora Kod mačaka prognoza je povoljnija Osteosarkom na aksilarnom skeletu Preživljavanje oko 1god (i kod pasa i mačaka) Kod ostalih tumora prognoza mnogo povoljnija
16 NEOPLAZME ZGLOBOVA I PRIPADAJUĆIH STRUKTURA Vrlo retko i kod pasa i kod mačaka Uglavnom kod velikih rasa pasa Prosečna starosna kategorija 8 god (1-12 god) Etiologija nepoznata Maligne neoplazije (sinovijalni sarkom)
17 SINOVIJALNI SARKOM Lokalno agresivna neoplazija Akutna ili protrahirana/ hronična pojava U oko 25-40% slučajeva metastazira Metastaze: regionalni limfni čvorovi, pluća i ostali organi Kliniki znaci Progresivno šepanje praćeno blagim periartikularnim otokom Lakatni i kokso-femoralni zglob
18 Pregled krvi - Nema dijagnostički značaj DIJAGNOSTIKA NEOPLAZMI ZGLOBOVA Rendgenografija - periartikularni otok mekog tkiva - tačkaste osteolize na metafizi ili epifizi kostiju zgloba MRI (SA KONTRASTOM)/CT Rendgen toraksa - nije neophodan Pregled citološkog aspirate/biopsija Sinovijalni sarkom kolenog zgloba
19 T N M KLINIČKI STADIJUMI (TNM) NEOPLAZMI ZGLOBOVA I PRIPADAJUĆIH STRUKTURA KOD PASA I MAČAKA - PRIMARNE NEOPLAZME T0 - Nema dokaza za postojanje neoplazmi T1 - Ograničene neoplazme bez promena u okolnom tkivu T2 - Neoplazma zahvata okolno meko tkivo T3 Neoplazma zahvata zglob i/ili kosti Multipli tumori mogu biti klasifikovani nezavisno jedan od drugog - REGIONALNI LIMFNI ČVOROVI (RLN) N0 Nema dokaza o zahvaćenosti RLN N1 RLN zahvaćeni - DISTANT METASTASES (UDALJENE METASTAZE) M0 - Nema dokaza za postojanje udaljenih metastaza M1 - Detektovane su udaljene metastaze (specifična mesta) T opisuje veličinu primarnog tumora i da li je zahvatio susedno tkivo N opisuje susedne(regionalne) lymph nodes koji su zahvaćeni procesom M opisuje udaljene metastaze (širenje tumora sa jednog na drugi deo tela)
20 TERAPIJA Hirurški pristup - amputacija Radijaciona terapija Hemoterapija - doksorubicin u kombinaciji sa ciklofosfamidom PROGNOZA Period preživljavanja oko 3 godine
21
22 LATERAL RADIOGRAPH OF A LYTIC OSTEOSARCOMA OF THE PROXIMAL HUMERUS IN A DOG.
23 lateral radiograph of an osteosclerotic osteosarcoma of the distal radius in a dog. soft tissues are massively involved
24 LATERAL (A) AND CRANIO-CAUDAL (B) VIEWS OF A FIBROSARCOMA IN A CAT. LYTIC LESION (BLACK ARROWS) IN THE DISTAL PART OF THE SCAPULA
25 Lateral views on bone scintigraphy and radiographs of an osteosarcoma of the distal radius in a dog.
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