Clinical Rounds: Recurrent mast cell tumors in a boxer - Veterinary Medicine
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Clinical Rounds: Recurrent mast cell tumors in a boxer
Make the rounds with these veterinary specialists and residents and see how various combinations of therapy eventually produced a good outcome in this case.



Dr. Bethany Sabatino
Bethany Sabatino, DVM

Mast cell tumors are unique among neoplasms in that they often secrete a variety of vasoactive substances (e.g. heparin, histamine, serotonin) and proteases that can lead to an increased propensity for gastrointestinal ulceration, local or systemic bleeding or bruising, local tissue damage, and hypotension.7 Many of these substances and a variety of inflammatory mediators are also produced in nonneoplastic mast cells as a protective response.8

A key to optimizing the health of all patients with mast cell tumors (especially those with large or metastatic tumors) is daily administration of antihistamines (both H1 and H2 antagonists).9 Proton-pump inhibitors such as omeprazole can be an acceptable alternative to H1 antagonists.10 Conversely, unless a coagulopathy is documented, specific therapy addressing the heparin release from mast cell tumors is typically not necessary. Although plasma therapy in patients with concurrent mast cell tumor and coagulopathy may or may not be effective, it should be considered.11 Therapy with protamine sulfate to treat a coagulopathy may also be beneficial in some dogs.1


Dr. Laura Hammond
Laura Hammond, DVM

In patients with mast cell tumors, the goals of diagnostic imaging are to identify the extent of metastatic disease, guide tissue sampling, and screen for comorbidities. Consistent with these goals, baseline imaging of dogs with mast cell tumors in our institution includes three-view thoracic radiography, abdominal radiography, and abdominal ultrasonography.

Although mast cell tumors do not generally cause nodular pulmonary metastases,12 thoracic radiography allows assessment of intrathoracic lymph nodes and screening for concurrent abnormalities. We use abdominal radiographs for the most accurate assessment of organomegaly.

Abdominal ultrasonography evaluates the echogenicity and architecture of the liver, spleen, and regional lymph nodes and facilitates targeted tissue sampling. As the ultrasonographic appearance of organs infiltrated with malignant mast cells may be normal, ultrasound-guided fine-needle aspiration of the liver and spleen is recommended, regardless of ultrasonographic findings, in all patients suspected of having aggressive forms of mast cell neoplasia.13


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