2. Haemangiosarcomas
The most aggressive soft-tissue tumour!
Splenic Haemangiosarcoma
• Account for 80% of malignant splenic masses
• Highly malignant
• Haematogenous or transabdomial implantation following
rupture
• Liver, oementum, mesentary, right atrium, lung
3. Storm
• 5 year-old, male, German
Shepard, 51.7kg
• Haemoabdomen
• Splenic haemangiosarcoma
(HSA)
• Splenectomy and
chemotherapy
4. Typical Presentation
• Dog
• Middle-old age
• German Shepherds (GSD), Golden Retriever and
Labradors
• Haemoabdomen
• Abdominal mass
5. Physical Exam
• Pale MM, CRT >2s, tachycardia and poor pulse
quality.
• Fluid wave in abdomen
• Palpable mass
6. Diagnostic Investigation
• Haematology - anaemia, schistocytes, acanhocytes,
thrombocytopaenia, neutrophilic leukocytosis
• Biochemistry - non-specific
• Coagulation tests - PT, APTT, ACT, fibrinogen
concentration and fibrin degradation products
• Abdominal imaging - mass and metastasises
• Abdominocentisis - serosangionous or frank blood
• Echocardiography - pericardial effusion, mass
7. Definitive Diagnosis
• Not all splenic masses are HSA
• Not all haemoabdomens are from HSA
• Gross and U/S DDx - haematoma, haemangioma
• Large mass does not equal malignant mass
• Histopathology is necessary!
8. Tumour Staging
Tumour Node Metastasis
T0 no tumour
N0 no regional LN
involvment
M0 no evidence of
distant metastasis
T1 <5cm confined to
primary site
N1 regional LN
involvement
M1 distant metastasis
T2 >5cm, ruptured,
invading subcutaneous
tissues
N2 distant LN
involvement
T3 invading muscle and
adjacent structures
9. Tumour Staging
Tumour Node Metastasis
T0 no tumour
N0 no regional LN
involvment
M0 no evidence of
distant metastasis
T1 <5cm confined to
primary site
N1 regional LN
involvement
M1 distant metastasis
T2 >5cm, ruptured,
invading subcutaneous
tissues
N2 distant LN
involvement
T3 invading muscle and
adjacent structures
10. Tumour Staging
Tumour Node Metastasis
T0 no tumour
N0 no regional LN
involvment
M0 no evidence of
distant metastasis
T1 <5cm confined to
primary site
N1 regional LN
involvement
M1 distant metastasis
T2 >5cm, ruptured,
invading subcutaneous
tissues
N2 distant LN
involvement
T3 invading muscle and
adjacent structures
11. Tumour Staging
Tumour Node Metastasis
T0 no tumour
N0 no regional LN
involvment
M0 no evidence of
distant metastasis
T1 <5cm confined to
primary site
N1 regional LN
involvement
M1 distant metastasis
T2 >5cm, ruptured,
invading subcutaneous
tissues
N2 distant LN
involvement
T3 invading muscle and
adjacent structures
12. Splenectomy
• Stabilise
• Total splenectomy indicated given high malignancy
• Ligate branches of and the main splenic artery
and gastrosplenic vein
• Explore abdomen for metastasises
• Lavage and change instruments to reduce seeding
13. What To Look For
• Solitary, multifocal or diffuse
• Poorly circumscribed, non-encapsulated, adhere to other organs
• Variable size
• Pale grey dark red purple
• Soft or gelatinous
• Blood filled or necrotic cut surfaces
• Extremely friable
14. Monitoring
• ECG intra and post-operatively
• Prone to ventricular arrhymias
• Hypoxia, hypovlemia, anaemia,
neurohormonal response from handeling
spleen.
• Should resolve in 24-48hrs.
15. Chemotherapy
• Always indicated
• Single agent therapy or
combination protocols
• Brief and incomplete remission
• 30mg/m2 doxorubicin q3wk for
12-18weeks
17. Precautions
• Recommend heart scan prior to starting
• History and haematology prior to each treatment
• Premed - Cerenia and Piriton
• Infuse over 20minutes with 0.9% NaCl into the pre-
placed IV catheter, alternating sites
• Anaphylactic shock - adrenaline, steroids and fluids
• Extravasation - dexrazoxane and ice compress
19. The Future
• Troponin I - cardiac HSA vs idiopathic pericardial
effusion
• Plasma VEGF and urine bFGF concentrations
• Advanced imaging - malignant vs benign
• Blood-based bio markers
• Immunotherapy - vaccine, liposome delivery system
20. Resources
• Merck Veterinary Manual
• BSAVA Small Animal Formulary 8th edition
• Hayes G, Ladlow J (2012) Investigation and management of splenic
disease in dogs, In Practice, 34:250-259
• Withrow, Vail, Page (2013) Withrow and MacEwen’s Small Animal
Clinical Oncology. 5th ed., Saunders
• WATERS D. J., CAYWOOD D. D., HAYDEN D. W., KLAUSNER J.
S. (1988) Metastatic pattern in dogs with splenic
haemangiosarcoma: Clinical implications, Journal of Small Animal
Practice, 29, 805-814
23. • Adult-aged dogs.
• Spontaneous or predisposed by non-pigmented skin and light coats.
• Whippet, Italian Greyhound, white Boxers and pit bulls; Irish
Wolfhound, GSD, Golden Retriver, Hungarian Visla.
• Trunk, hip, thigh and distal extremities.
• Black and red from necrosis and thrombosis, look bruised.
• Moderate malignancy risk (by blood to lung and spleen).
• <0.5cm cryosurgery or laser.
• >0.5cm wide surgical excision.
24. Cardiac Haemangiosarcoma
• Presentation: pericardial tamponade, right heart
failure (exercise intolerance, dyspnea and
ascites)
• Physical exam: ascites, muffled heart sounds,
pulsus paradoxus (pulse Barry with RESP)
• Surgery: palliative pericardectomy, or removal of
right atria masses.
25. Histology Findings
• Immature pleomorphic
endothelial cells
• Vascular spaces containing
blood or thrombi
• Immunohistochemistry for von
Willebrand's factor.
