1
|
Franca A, Stamenova P, Thompson JL. Histopathological diagnosis and surgical complications following bilateral anal sacculectomy for the treatment of unilateral canine apocrine gland anal sac adenocarcinoma: 35 cases (2019-2023). J Small Anim Pract 2024; 65:394-401. [PMID: 38594872 DOI: 10.1111/jsap.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/20/2024] [Accepted: 03/27/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To report the histopathological diagnosis of both anal sacs in dogs undergoing bilateral anal sacculectomy for the treatment of unilateral apocrine gland anal sac adenocarcinoma and to compare the surgical complication rate associated with this procedure in this population with previously published literature. MATERIALS AND METHODS Records were retrospectively reviewed for dogs that underwent bilateral anal sacculectomy for the treatment of apparently unilateral apocrine gland anal sac adenocarcinoma, at a single institute between 2019 and 2023. Clinical staging, surgical treatment, histological findings, intra- and postoperative complications were evaluated. RESULTS Thirty-five dogs were included. Only five of 35 (14%) dogs were found to have histologically normal contralateral anal sacs. Non-neoplastic anal sac disease was found in 23 of 35 (66%) dogs and bilateral apocrine gland anal sac adenocarcinoma was seen in seven of 35 (20%) dogs. None of the dogs diagnosed with bilateral neoplasia had evidence of bilateral neoplasia before surgery despite a thorough work-up. Complications attributable to the primary tumour removal were seen in 9% of dogs intraoperatively and 14% of dogs postoperatively, commonly tumour capsule disruption and surgical site infection, respectively. CLINICAL SIGNIFICANCE Bilateral anal sac disease was diagnosed histologically in the majority of presumed normal anal sacs, with 20% of cases being found to have bilateral apocrine gland anal sac adenocarcinoma. The surgical complication rates of this cohort were comparable to those reported for unilateral anal sacculectomy alone. These findings promote and encourage the use of bilateral anal sacculectomy in cases of suspected unilateral anal sac neoplasia.
Collapse
Affiliation(s)
- A Franca
- Department of Small Animal Surgery, The Royal Dick School of Veterinary Studies, Edinburgh, Scotland
| | - P Stamenova
- Department of Small Animal Surgery, The Royal Dick School of Veterinary Studies, Edinburgh, Scotland
| | - J L Thompson
- Department of Small Animal Surgery, The Royal Dick School of Veterinary Studies, Edinburgh, Scotland
| |
Collapse
|
2
|
Canine Apocrine Gland Anal Sac Adenocarcinoma: A Review. Top Companion Anim Med 2022; 50:100682. [PMID: 35792243 DOI: 10.1016/j.tcam.2022.100682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022]
Abstract
Apocrine gland anal sac adenocarcinoma (AGASAC) is a relatively uncommon tumor in the dog and comprises approximately 17% of perianal malignancies; however, it is one of the most common causes of paraneoplastic hypercalcemia. Clinical signs in affected dogs most commonly are associated with mechanical obstruction caused by the primary tumor or enlarged regional metastatic lymph nodes and the effects of paraneoplastic hypercalcemia when present. Surgical excision of the primary tumor and metastasectomy of affected locoregional lymph nodes is the preferred initial treatment option for most dogs, although radiation therapy and adjuvant chemotherapy are commonly incorporated into multi-modality treatment plans. A significant role for the use of adjuvant chemotherapy has not been clearly demonstrated. Prolonged survival times are possible, especially for dogs with smaller primary tumors and for dogs that undergo further treatments for recurrent disease. In this article, we review the clinical signs, diagnosis, staging, treatment, and prognosis of AGASAC in the dog.
Collapse
|
3
|
Mickelson MA. Updated Concepts in Oncologic Surgery: Apocrine Gland Anal Sac Adenocarcinoma and Mast Cell Tumors. Vet Clin North Am Small Anim Pract 2022; 52:549-580. [DOI: 10.1016/j.cvsm.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
4
|
Williams C, Parys M, Handel I, Serra JC, Lawrence J. Minimal late radiation toxicity and transient early toxicity following postoperative definitive intent conformal radiation therapy (20 × 2.5 Gy) for canine apocrine gland anal sac adenocarcinoma. Vet Radiol Ultrasound 2021; 63:224-233. [PMID: 34904326 DOI: 10.1111/vru.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/21/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Postoperative radiation therapy (RT) may be beneficial for dogs with anal sac apocrine gland adenocarcinoma (ASAC). Clinically significant late toxicities have been reported in up to 65% of dogs with perianal tumors following non-conformal definitive RT, particularly when fractions of 3 Gy or higher are prescribed. The primary objective of this prospective, descriptive study was to evaluate tolerability of a novel 3D conformal RT (3DCRT) protocol in a group of dogs. Dogs with ASAC were prospectively enrolled if clients elected RT following surgery. The planning target volume was prescribed 50 Gy in 2.5 Gy fractions using 6 MV photons and administered over 26 days. Early and late radiation toxicities were graded according to standardized criteria. Thirteen dogs were initially enrolled but 1 was excluded due to a high risk of anesthesia-related mortality. Seven dogs presented with early stage disease. Median follow up time was 771 days (91-2223). Transient grade 3 dermatitis and anusitis developed in all dogs, with resolution within 4 weeks. Two dogs developed transient grade 2 late colitis. Locoregional failure in the irradiated field was documented in one dog at 738 days. All-cause median survival time was 771 days (95% confidence interval: 510 → 2223 days). Findings indicated that this fractionation may be safely administered to the canine anus and pelvic canal using 3DCRT, although acute toxicity should be anticipated. Further prospective studies are needed in order to confirm long-term tolerability and efficacy.
Collapse
Affiliation(s)
- Claire Williams
- The Royal (Dick) School of Veterinary Studies (R(D)SVS) and Roslin Institute, Hospital for Small Animals, Easter Bush Campus, Midlothian, UK.,Willows Veterinary Centre and Referral Service, Solihull, West Midlands, UK
| | - Magdalena Parys
- The Royal (Dick) School of Veterinary Studies (R(D)SVS) and Roslin Institute, Hospital for Small Animals, Easter Bush Campus, Midlothian, UK
| | - Ian Handel
- The Royal (Dick) School of Veterinary Studies (R(D)SVS) and Roslin Institute, Hospital for Small Animals, Easter Bush Campus, Midlothian, UK
| | - Juan Carlos Serra
- The Royal (Dick) School of Veterinary Studies (R(D)SVS) and Roslin Institute, Hospital for Small Animals, Easter Bush Campus, Midlothian, UK
| | - Jessica Lawrence
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul, Minnesota, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
5
|
Wong H, Byrne S, Rasotto R, Drees R, Taylor A, Priestnall SL, Leo C. A Retrospective Study of Clinical and Histopathological Features of 81 Cases of Canine Apocrine Gland Adenocarcinoma of the Anal Sac: Independent Clinical and Histopathological Risk Factors Associated with Outcome. Animals (Basel) 2021; 11:ani11113327. [PMID: 34828058 PMCID: PMC8614406 DOI: 10.3390/ani11113327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 12/26/2022] Open
Abstract
Canine apocrine gland anal sac adenocarcinoma (AGASAC) is a malignant tumour with variable clinical progression. The objective of this study was to use robust multivariate models, based on models employed in human medical oncology, to establish clinical and histopathological risk factors of poor survival. Clinical data and imaging of 81 cases with AGASAC were reviewed. Tissue was available for histological review and immunohistochemistry in 49 cases. Tumour and lymph node size were determined using the response evaluation criteria in the solid tumours system (RECIST). Modelling revealed tumour size over 2 cm, lymph node size grouped in three tiers by the two thresholds 1.6 cm and 5 cm, surgical management, and radiotherapy were independent clinical variables associated with survival, irrespective of tumour stage. Tumour size over 1.3 cm and presence of distant metastasis were independent clinical variables associated with the first progression-free interval. The presence of the histopathological variables of tumour necrosis, a solid histological pattern, and vascular invasion in the primary tumour were independent risk factors of poor survival. Based upon these independent risk factors, scoring algorithms to predict survival in AGASAC patients are presented.
Collapse
Affiliation(s)
- Hannah Wong
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hertfordshire AL9 7TA, UK;
- Correspondence: ; Tel.:+44-(0)-1223-337701
| | - Stephanie Byrne
- Department of Clinical Sciences and Services, Royal Veterinary College, Hertfordshire AL9 7TA, UK; (S.B.); (R.D.); (A.T.); (C.L.)
| | - Roberta Rasotto
- Dick White Referrals, Station Farm, Six Mile Bottom, Cambridgeshire CB8 OUH, UK;
| | - Randi Drees
- Department of Clinical Sciences and Services, Royal Veterinary College, Hertfordshire AL9 7TA, UK; (S.B.); (R.D.); (A.T.); (C.L.)
| | - Angela Taylor
- Department of Clinical Sciences and Services, Royal Veterinary College, Hertfordshire AL9 7TA, UK; (S.B.); (R.D.); (A.T.); (C.L.)
| | - Simon L. Priestnall
- Department of Pathobiology and Population Sciences, Royal Veterinary College, Hertfordshire AL9 7TA, UK;
| | - Chiara Leo
- Department of Clinical Sciences and Services, Royal Veterinary College, Hertfordshire AL9 7TA, UK; (S.B.); (R.D.); (A.T.); (C.L.)
| |
Collapse
|
6
|
Morello EM, Cino M, Giacobino D, Nicoletti A, Iussich S, Buracco P, Martano M. Prognostic Value of Ki67 and Other Clinical and Histopathological Factors in Canine Apocrine Gland Anal Sac Adenocarcinoma. Animals (Basel) 2021; 11:ani11061649. [PMID: 34199347 PMCID: PMC8228493 DOI: 10.3390/ani11061649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Apocrine gland anal sac adenocarcinoma (AGASACA) is a locally aggressive tumor with a high metastatic rate to the regional ileo-sacral lymph nodes and later to distant sites. Clinical signs depend on the tumor and regional lymph nodes size or on the paraneoplastic hypercalcemia. Therefore, dogs are often referred for perineal swelling, tenesmus, constipation and/or polyuria, polydipsia. Surgical excision of both the neoplastic anal sac and the metastatic regional lymph nodes represents the standard of care. Adjuvant chemotherapy and/or radiotherapy are also indicated. Prognostic factors include tumor size, hypercalcemia, regional lymph nodes metastasis and tumor histologic features. The aim of the study was to retrospectively evaluate the prognostic significance of tumor Ki67 expression. The authors’ hypothesis was that higher Ki67 index correlated with decreased disease-free interval and overall survival time. Clinical data such as tumor size, regional lymph nodes metastasis and hypercalcemia at presentation and histological features such as tumor pattern, mitotic count, necrosis, inflammatory infiltration, vascular invasion, anisokaryosis, and anisocytosis were also investigated and correlated to the oncologic outcome in the dogs included in the study. Abstract Apocrine gland anal sac adenocarcinoma (AGASACA) is locally aggressive and highly metastatic to regional lymph nodes. The aim of this study was to evaluate the prognostic significance of Ki67 in surgically excised AGASACA. Prognostic impact of size, regional lymph nodes metastasis, hypercalcemia, histologic pattern, mitotic count, necrosis, inflammatory and lympho-vascular invasion, anisokaryosis and anisocytosis was also evaluated. Thirty-five dogs were included, twenty-four of which also had metastatic lymph nodes. When the entire population was evaluated, only metastatic disease spread to regional lymph nodes, and necrosis and inflammatory infiltration were correlated to prognosis. When only dogs with metastatic disease were evaluated, size, solid histologic pattern, presence of lymphatic and vascular invasion showed influence on prognosis. Ki67 index was not associated with survival time and disease free interval in any case. The results of this study showed that lymph nodes metastasis at diagnosis reduced disease free interval. Moreover, tumor size greater than 5.25 cm, presence of lymphatic and vascular invasion and a solid histologic pattern were associated with a shorter survival time in dogs with metastasis to regional lymph nodes. Ki67 expression was not significantly associated with prognosis, therefore it could not be considered as a prognostic factor in this tumor type, while the role of hypercalcemia remained unclear.
Collapse
Affiliation(s)
- Emanuela Maria Morello
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy; (E.M.M.); (D.G.); (A.N.); (S.I.); (P.B.)
| | - Marzia Cino
- Department of Medical-Veterinary Science, Univesrity of Parma, Strada del Taglio 10, 43126 Parma, Italy;
- Correspondence: ; Tel.: +39-0521034786
| | - Davide Giacobino
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy; (E.M.M.); (D.G.); (A.N.); (S.I.); (P.B.)
| | - Arturo Nicoletti
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy; (E.M.M.); (D.G.); (A.N.); (S.I.); (P.B.)
| | - Selina Iussich
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy; (E.M.M.); (D.G.); (A.N.); (S.I.); (P.B.)
| | - Paolo Buracco
- Department of Veterinary Sciences, University of Torino, Largo Braccini 2, 10095 Grugliasco, Italy; (E.M.M.); (D.G.); (A.N.); (S.I.); (P.B.)
| | - Marina Martano
- Department of Medical-Veterinary Science, Univesrity of Parma, Strada del Taglio 10, 43126 Parma, Italy;
| |
Collapse
|
7
|
Barnes DC, Demetriou JL. Surgical management of primary, metastatic and recurrent anal sac adenocarcinoma in the dog: 52 cases. J Small Anim Pract 2017; 58:263-268. [PMID: 28245066 DOI: 10.1111/jsap.12633] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 09/19/2016] [Accepted: 11/10/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To report the outcomes and complications of a cohort of dogs with primary and recurrent anal sac adenocarcinoma managed with surgery as the first-line treatment. To report the use of lymph node cytology for identification of metastatic disease. METHODS Retrospective review of case records of a single referral centre population of dogs diagnosed with anal sac adenocarcinoma. RESULTS Fifty-two clinical cases were identified. Altered ultrasonographic appearance of lymph nodes was highly consistent with metastatic disease as assessed by cytology and histopathology. Seven of 58 (12%) perineal surgeries had reported minor complications and seven (12%) others required further surgical intervention. Minor controllable intraoperative bleeding was the only complication noted associated with lymph node extirpation in two of 39 (5%) metastectomy procedures. Six dogs (12%) suffered local recurrence and 22 (42%) developed subsequent or recurrent nodal metastatic disease. From the time of detection of disease recurrence, median additional survival associated with a second surgical intervention was 283 days. CLINICAL SIGNIFICANCE Coeliotomy for lymph node metastatectomy in dogs with adenocarcinoma of the anal sac has low morbidity and should be considered in patients presenting with evidence of regional metastatic disease both at initial presentation and with recurrent disease.
Collapse
Affiliation(s)
- D C Barnes
- Dick White Referrals, Six-Mile-Bottom, Cambridgeshire, CB8 0UH, UK
| | - J L Demetriou
- Dick White Referrals, Six-Mile-Bottom, Cambridgeshire, CB8 0UH, UK
| |
Collapse
|
8
|
Meier V, Polton G, Cancedda S, Roos M, Laganga P, Emmerson T, Rohrer Bley C. Outcome in dogs with advanced (stage 3b) anal sac gland carcinoma treated with surgery or hypofractionated radiation therapy. Vet Comp Oncol 2016; 15:1073-1086. [PMID: 27278807 DOI: 10.1111/vco.12248] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/28/2016] [Accepted: 05/20/2016] [Indexed: 02/02/2023]
Abstract
Stage 3b anal sac gland carcinoma (ASGC) can be life-threatening. A surgical approach is not always possible or may be declined. Dogs with stage 3b ASGC treated with surgery or conformal radiation therapy (RT) with 8 × 3.8 Gy (total dose 30.4 Gy, over 2.5 weeks) were retrospectively evaluated. Patient characteristics, median progression-free interval (PFI) and median survival time (MST) were compared. Twenty-eight dogs were included; 15 underwent surgery, 13 underwent RT. At the time of presentation, 21% showed life-threatening obstipation and 25% showed hypercalcaemia. PFI and MST for surgery cases were 159 days (95% CI: 135-184 days) and 182 days (95% CI: 146-218 days), both significantly lower than for RT cases with 347 days (95% CI: 240-454 days) and 447 days (95% CI: 222-672 days), (P = 0.01, P = 0.019). Surgery as well as RT led to a fast relief of symptoms. PFI and survival of surgical patients were significantly inferior to that of a comparable patient group treated with conformal hypofractionated RT.
Collapse
Affiliation(s)
- V Meier
- Division of Radiation Oncology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - G Polton
- North Downs Specialist Referrals, Surrey, UK
| | - S Cancedda
- Centro Oncologico Veterinario, Sasso Marconi, Italy
| | - M Roos
- Department of Biostatistics, Epidemiology Biostatistics and Prevention Institute, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - P Laganga
- Centro Oncologico Veterinario, Sasso Marconi, Italy
| | - T Emmerson
- North Downs Specialist Referrals, Surrey, UK
| | - C Rohrer Bley
- Division of Radiation Oncology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| |
Collapse
|
9
|
|
10
|
Mellett S, Verganti S, Murphy S, Bowlt K. Squamous cell carcinoma of the anal sacs in three dogs. J Small Anim Pract 2014; 56:223-5. [DOI: 10.1111/jsap.12264] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 07/21/2014] [Accepted: 07/27/2014] [Indexed: 12/01/2022]
Affiliation(s)
- S. Mellett
- UCD School of Veterinary Medicine; University College Dublin; Dublin
| | - S. Verganti
- Small Animal Oncology; Animal Health Trust; Suffok Newmarket
| | - S. Murphy
- Small Animal Oncology; Animal Health Trust; Suffok Newmarket
| | - K. Bowlt
- Small Animal Oncology; Animal Health Trust; Suffok Newmarket
| |
Collapse
|