HEMANGIOSARCOMA
Pathogenesis
•HSA is a malignant neoplasm arising from endothelial cells
•dermal HSA accounts for 14% of primary HSA
•vascular stasis, radiation therapy, trauma, and sun exposure are predisposing factors in humans
•HSA has been experimentally induced in dogs with UV radiation and solar radiation may be involved in spontaneous development of cutaneous HSA in dogs
Signalment
•sex predisposition: male
•breed predisposition: GSD, Boxer, Whippet, and Pit Bull Terrier
•dermal HSA is usually rapidly growing solitary, poorly circumscribed mass with early ulceration and infiltration
•≥ 1 cutaneous HSA may represent metastatic disease
•however, multicentricity is a feature of canine HSA with up to 18% of primary cutaneous HSA presenting with multiple lesions
Diagnosis
•hemostatic disorders are common and coagulation profile and bleeding times should be assessed
•staging is important to assess whether cutaneous lesions are primary or metastatic lesions from a primary HSA in the spleen, right auricle, or liver
Clinical Stage
•clinical staging is based on location within the dermis or association with the dermis:
•stage I: dermal
•stage II: hypodermal
•stage III: muscle
Treatment
•wide surgical resection for stage I HSA
•wide surgical resection (i.e., limb amputation) and adjunctive chemotherapy (i.e., doxorubicin, cyclophosphamide, and vincristine) for stage II and III HSA
•radiation therapy is ineffective
Prognosis
•prognosis is guarded
•30% metastatic rate and MST 780 days for stage I HSA
•10% metastatic rate and MST 172 days for stage II HSA
•60% metastatic rate and MST 307 days for stage III HSA
•MST for hypodermal HSA following surgery and chemotherapy: 425 days
•good prognostic factors in humans include small tumor size (< 5 cm) and lymphocytic infiltration around tumor
HEMANGIOMA
•no breed or sex predilection
•gross appearance: solitary, well circumscribed, unencapsulated, red-to-black colour, and located in subcutaneous and dermoepidermal tissue
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DERMAL HEMANGIOMA AND HEMANGIOSARCOMA
T0
No evidence of neoplasia
T1
Tumor < 5 cm in diameter and confined to primary site
Primary Tumor
T2
Tumor ≥ 5 cm in diameter, ruptured, or invading subcutaneous tissue
T3
Tumor invading adjacent structures including muscle
N0
No evidence of lymph node involvement
N1
Regional lymph node involvement
Node
M0
No evidence of metastasis
M1
Evidence of distant metastasis with site specified
Metastasis
N2
Distant lymph node involvement
Clinical Stage
I
II
III
T
T01
T1-2
T2-3
N
N0
N0-1
N0-2
M
M0
M0
M1