Canine Hemangiosarcoma. Clinical Update
WSAVA 2002 Congress
Josep Pastor, DVM, PhD
Patología Médica, Facultad de Veterinaria, Universidad Autónoma de Barcelona
Bellaterra, Spain

Hemangiosarcoma (malignant hemangiothelioma, angiosarcoma) is a malignancy of the vascular endothelial cells. The dog is the most frequently affected species. The hemangiosarcoma (HSA) is observed in 0.3 to 2% of all canine necropsies and constitutes about 5% of all malignancies in dogs. Adult dogs (range 8-13 years old) and German shepherd are most frequently affected. Other breeds with high incidence are Golden retriever, Labrador, Boxer, Schnauzer, and Pointer. Cutaneous HSA are overepresented in whippets, Pit bulls, Boxer and Dalmatians. Sex predisposition is not clear.

In dogs, the most common primary sites of HSA are the spleen, right atrium, subcutaneous tissue and liver. However, because this tumor originates from vascular endothelial cells, it can arise from anywhere in the body: bone, bladder, aorta, prostate, muscle, lungs, oral cavity, kidneys and uterus.

The biological behavior of hemangiosarcoma is highly malignant, with both local infiltration and metastases occurring early in the course of the disease. The only exception is the dermal HSA. Metastasis occur to lungs, liver, brain (it is the sarcoma that most often metastasizes to the brain), skin, bone and adrenal glands. Around 80% of the dogs can have metastasis by the time of diagnosis. Up to 25% of dogs with primary splenic HSA have concurrent cardiac involvement, and up to 63% of dogs with right atrial HSA have concurrent metastatic disease.

Clinical signs depend on the tumor size, localization, presence of metastasis, associated coagulopathies (DIC or local consumption) or rupture of the tumor. Patients may have nonspecific signs such as lethargy, anorexia and weight loss or more specific problems such acute dyspnea, pallor, abdominal effusion, or hypovolemic shock secondary to tumor rupture and hemorrhage. The most common physical abnormalities include palpable abdominal mass, intraabdominal fluid wave, arrhythmias, cardiac murmur, muffled heart sounds, venous congestion and signs compatible with cardiac tamponade.

Diagnosis is made by histopathology. However, breed, clinical signs at presentation, CBC, chemistry and coagulation profile findings may suggest HSA. A thorough staging evaluation is essential for accurate treatment recommendations and prognosis. Staging consists of CBC, chemistry and coagulation profile, urinalysis, thoracic radiographs, echocardiogram, electrocardiography and abdominal ultrasound. Findings of increased nucleated RBC, polychromasia, schistocytes, acanthocytes and thrombocytopenia on the CBC strongly suggest HSA.

The current standard of care for HSA is surgical resection of gross disease and adjuvant chemotherapy (table 1).

Table 1. Survival times in dogs with HSA and different treatments.

Treatment

Number of animals

Median survival (days)

Splenectomy with primary HAS

131

19-86

Surgery + mixed bacterial vaccine

10

91

Surgery + mixed bacterial vaccine + VMC

10

117

Surgery + VAC

15

172

Surgery + AC+ L-MTP-PE

16

273

Surgery + AC

32

141-202

Surgery + A

46

60-172

Surgery + AC + Minocycline

17

170

Surgery of cutaneous HSA stage I

10

780

Surgery of cutaneous HSA stage II

10

172

Surgery of cutaneous HSA stage III

5

307

Many studies evaluating the results of chemotherapy have been published. Over the past years, recommendations on medical treatment have shifted from combination chemotherapy to single-agent chemotherapy, because the former had no strong survival advantage compared to doxorubicin therapy alone (table 1).

Other treatment strategies such as antiangiogenic therapy or more specific tumor targets are under investigation. However, the prognosis for dogs with HSA is still guarded. Early diagnosis and aggressive surgical and adjuvant chemotherapy seems to be the best strategy to provide a prolonged survival time and enhance the quality of life of patients with HSA.

References

1.  Brown, N.; Patnaik, A. and MacEwen, E.G. (1985). Canine hemangiosarcoma: retrospective analysis of 104 cases. J. Am. Vet. Med. Assoc. 186:56-58.

2.  Chun, R. (1999). Feline and Canine hemangiosarcoma. Comp. Cont. Educ. 21(7): 622-629.

3.  Clifford, C.A.; Mackin, A.J. and Henry, C.J. (2000). Treatment of canine hemangiosarcoma: 2000 and beyond. J. Vet. Intern. Med. 14:479-485.

4.  Erdem, V. and Pead, M.J. (2000). Haemangiosarcoma of the scapula in three dogs. J. Small. Anim. Pract. 41:461-464.

5.  Fruchter, A.; Miller, C. and O'Grady, M. (1992). Echocardiographic results and clinical considerations in dogs with right atrial/auricular masses. Can. Vet. J. 33:171-174.

6.  Hammer, A.; Couto, C.G.; Swardson, C. et al. (1991). Hemostatic abnormalities in dogs with hemangiosarcoma. J. Vet. Intern. Med. 5:11-14.

7.  Hammer, A.S. and Couto, C.G. (1992). Diagnosing and treating canine hemangiosarcoma. Vet. med. 87:188-201.

8.  Hammer, A.S.; Couto, C.G.; Filppi, J. et al. (1991). Efficacy and toxicity of VAC chemotherapy (Vincristine, doxorubicine, and cyclophosphamide) in dogs with hemangiosarcoma. J. Vet. Intern. Med. 5:160-166.

9.  Hirsch, V.; Jacobsen, J. and Mills, J. (1981). A retrospective study of canine hemangiosarcoma and its association with acanthocytosis. Can. Vet. J. 22:152-155.

10. Lorimer, L.P. and Kitchell, B.E. (2002). How to manage patients with hemangiosarcoma. Vet. Med. 97:46-57.

11. MacEwen, E.G. (2001). Hemangiosarcoma. En Withrow, , S.J. y MacEwen, E.G. Small Animal Clinical Oncology. WB Saunders, Co. Pp.639-646.

12. Ogilvie, G.K.; Powers, B.E.; Mallinckrodt, C.H. et al. (1996). Surgery and doxorubicin in dogs with hemangiosarcoma. J. Vet. Intern. Med. 10:379-384.

13. Sorenson, K.; Duda, L.; Barber, L. et al., (2000). Canine hemangiosarcoma treated with standard chemotherapy and minocycline. J. Vet. Intern. Med. 14:395-398.

14. Spangler, W. y Culbertson, M. (1992). Prevalence, type and importance of splenic diseases in dogs: 1.480 cases (1985-1989). J. Am. Vet. Med. Assoc. 200:829-834.

15. Srebernik, N. and Appleby, E. (1991). Breed prevalence and sides of hemangioma and hemangiosarcoma in dogs. Vet. Rec. 129:408-409.

16. Vail, D.; MacEwen, E.G.; Kurzman, I.D. et al. (1995). Liposome-encapsulated muramyl tripeptide phosphatidylethanolamine adjuvant immunotherapy for splenic hemangiosarcoma in the dog: A randomized multi-institutional clinical trial. Clin. Can. Res. 1:1165-1170.

17. Ward, H.; Fox, L.E.; Calderwood, M.B. et al. (1994). Cutaneous hemangiosarcoma in 25 dogs: a retrospective study. J. Vet. Intern. Med. 8(5):345-348.

Speaker Information
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Josep Pastor, DVM, PhD
Patología Médica, Facultad de Veterinaria
Universidad Autónoma de Barcelona
Bellaterra, Spain


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