Spinal neoplasia

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Sections available in full article Introduction, Presenting signs, Age predisposition, Pathogenesis, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Subsequent management, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Laura Garrett DVM DACVIM (Oncology)
Dr Irene Rochlitz BVSc MSc PhD
Dr Agnes Delauche DVM MRCVS DACVIM DECVN AdvCertCIM
Mr David Godfrey BVetMed CertSAD CertSAM DipABVP(Feline practice) CBiol FSB FRCVS

Introduction

  • Relatively uncommon disease.
  • Cause :
    • Extradural neoplasia lymphoma  Lymphoma  most common tumor by far.
    • Primary vertebral neoplasia (chondrosarcoma  Chondrosarcoma  , osteosarcoma  Osteosarcoma  ).
    • Metastatic vertebral neoplasia (mammary  Mammary gland: malignant neoplasia  or thyroid carcinoma  Thyroid gland: neoplasia  ).
  • Signs : neurological deficits, hind limb paresis (depending on the localization along the spinal column).
  • Diagnosis : survey radiographs - myelography, cytological examination of cerebrospinal fluid, response to therapy.
  • Treatment : chemotherapy (for lymphoma); surgical decompression for osteosarcoma.
  • Prognosis : guarded.

Diagnosis

Clinical signs

  • Neurological deficits ie proprioception defects.
  • Cervical pressure   →   forelimb weakness, as well as hindlimbs.
  • Spinal pain.
  • Signs of disseminated lymphoma ie lymphadenopathy.
  • Primary tumor identified.
  • Loss of deep pain sensation (only after loss of voluntary movement ie total paralysis, in the affected limb(s)).

Diagnosis

Differential diagnosis

  • Aortic thromboembolism  Thromboembolism: aorta  .
  • Spinal trauma  Spinal cord: concussion  .
  • Feline infectious peritonitis  Feline infectious peritonitis  .
  • Discospondylitis.
  • Intervertebral disc disease  Intervertebral disk disease  .
  • Vertebral disease.
  • Other granulomatous infections.

Sequelae

Prognosis

  • Guarded: median survival times for lymphoma with chemotherapy 14 weeks.
  • Radiotherapy  Radiotherapy  and chemotherapy  Chemotherapy: general principles  may provide better prognosis.
  • Poor prognosis for non-lymphomatous spinal neoplasia.

Expected response to treatment

  • Resolution of neurological signs should occur within a few days of starting therapy for lymphoma.

Reasons for treatment failure

  • Non-chemosensitive neoplasia (ie not lymphoma).
  • Intradural lymphoma has poorer response due to poor penetration of chemotherapy.
  • Delay in starting treatment and spinal cord damage already irreversible.

Sources

Publications

Refereed papers

  • Lane S B, Kornegary J Net al(1994)Feline spinal lymphosarcoma: A retrospective evaluation of 23 catsJVIM8, 99-104.
  • Spodnick G J, Berg Jet al(1992)Spinal lymphoma in cats: 21 cases (1946-1989)JAVMA200, 373-376.
  • Northington J W & Juliana M M (1978)Extradural lymphosarcoma in six cats.JSAP19, 409.

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