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1 Internal spread
Muzzle MCT in a Boston terrier; Histologic features: High-grade (grade 3) tumor, high mitotic index (>5
note the marked enlargement of mitotic figures in 10 high-power fields), presence of c-kit mutation, high
the left mandibular lymph node.
Metastatic MCT was confirmed
Ki-67 score (>1.8); the latter 2 require special testing on biopsy specimens
via cytologic testing.
All factors must be considered when attempting to predict how an individual MCT will act.
Evidence of lymph node or internal metastasis signifies aggressive behavior, although some
dogs with lymph node metastasis can live for years. In cases without metastasis, the histo-
logic features listed are the gold standard of behavior prediction, but even they may be
inaccurate at times.
Imaging TREATMENT
Conducting staging tests before tumor
removal is recommended when negative Treatment is based on prognostic factors
prognostic indicators are present. Staging tests (tumor grade, mitotic index, and stage) and
may be conducted after tumor removal if his- potential for systemic disease:
tologic evaluation reveals a high-grade MCT Surgical excision (2- to 3-cm margins) is
or high mitotic index. the mainstay of therapy for low- to inter-
mediate-grade tumors (grade 1 or 2) with a
Abdominal Ultrasonography low mitotic index.
When MCTs are present caudally, abdominal Radiation can be used in cases with
ultrasonography is used to assess the spleen incomplete margins to help prevent local
(Figure 4) and liver. Fine-needle aspiration of recurrence. FIND MORE
these organs may be useful, especially when a Systemic adjuvant therapy should be con- For step-by-step
lesion is visible. sidered for tumors with negative prognostic instructions on how to
Abdominal ultrasonography is also critical for factors and if the potential for systemic perform fine-needle
assessing sublumbar lymph nodes when an MCT disease exists. aspiration, see
is present on the caudal aspect of a patient. Procedures Pro:
A cytologist needs to assess whether the Surgical Fine-Needle Aspiration
appearance, number, and clustering of mast Wide (23 cm around, 1 tissue plane deep to in the June 2010
cells suggest metastasis. tumor) surgical excision should be performed. issue of Clinicians
If wide margins are not achievable, narrow Brief, available at
Thoracic Radiography debulking surgery may be used, followed by cliniciansbrief.com/
MCTs rarely metastasize to the lungs; how- radiation therapy. journal.
ever, thoracic radiographs may be helpful in
evaluating sternal lymph nodes if the tumor is Radiation
on the ventral abdomen or if visceral disease Radiation therapy has good efficacy in
exists. preventing local regrowth after incomplete
resection.
Additional Diagnostics It also may be used against bulky disease as
Fine-needle aspiration of regional lymph palliative therapy, with potential to shrink a
nodes is critical even if the lymph nodes are bulky mass substantially.
not enlarged.
CONTINUES
Adjunct Medication
Antihistamines and GI mucosal protectants
should be used as needed.
All dogs with bulky MCTs should begin
receiving histamine-1 (diphenhydramine) and
histamine-2 (famotidine) blockers for life or
until disease remission.
Omeprazole may be used for refractory gastric
ulcers.
NSAIDs must be used with caution in dogs
with MCTs because these patients are predis-
posed to gastric ulceration. Do not use
NSAIDs if the dog is receiving prednisone or
a targeted therapy drug.
Client Education
4 It is important to explain the unpredictable
nature of MCTs (despite assessment of prog-
Ultrasound image of MCTs in the spleen of a dog with systemic mast cell
disease. The patients primary tumor was located on the muzzle and controlled nostic factors) to clients.
for 1 year until systemic progression occurred. Some patients without negative prognostic
factors will develop systemic, aggressive dis-
Medical ease, while others with negative factors will
Chemotherapy may be beneficial for bulky,
not relapse or have metastasis.
Even local recurrence is unpredictable, with
nonexcisable local disease or for treatment or
prevention of systemic disease in dogs with reported recurrence rate of 70% for incom-
negative prognostic factors. pletely resected tumors.
Vinblastine and lomustine have shown
efficacy. FOLLOW-UP
Prednisone has some antitumor effects; it
also helps decrease local swelling, which Patient Monitoring
may be confused with an antitumor If treating bulky disease, monitor response to
response. therapy and adjust treatment as needed.
Prednisone is often combined with If patient has finished therapy with no
other chemotherapy agents. remaining evidence of disease, check for
Targeted therapy includes tyrosine kinase recurrence or new tumors at 1 month, every
inhibitors, which block c-kit signaling; 3 months for 1.5 years, and every 6 months
toceranib phosphate, which is approved in thereafter.
the United States; and masitinib, which
recently received conditional approval. Future
Indications for these drugs are the same as Some dogs are prone to developing MCTs,
for chemotherapy. Safety and efficacy of regardless of whether it is a new tumor or
combining targeted drugs with chemother- systemic disease from a previous tumor.
apy are under investigation. Any new mass should be aspirated and evalu-
As with chemotherapy agents, adverse ated, then staged and treated as described
effects also occur with targeted therapy. previously.
MCT = mast cell tumor The most common adverse effects of
toceranib phosphate are diarrhea, anorexia,
and weight loss. Concurrent medications
may be beneficial and include omeprazole,
famotidine, and diphenoxylateatropine.
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