Abstract
Simple SummaryApocrine gland anal sac adenocarcinoma (AGASACA) is a locally aggressive tumor with a high metastatic rate to the regional ileo-sacral lymph nodes and later to distant sites. Clinical signs depend on the tumor and regional lymph nodes size or on the paraneoplastic hypercalcemia. Therefore, dogs are often referred for perineal swelling, tenesmus, constipation and/or polyuria, polydipsia. Surgical excision of both the neoplastic anal sac and the metastatic regional lymph nodes represents the standard of care. Adjuvant chemotherapy and/or radiotherapy are also indicated. Prognostic factors include tumor size, hypercalcemia, regional lymph nodes metastasis and tumor histologic features. The aim of the study was to retrospectively evaluate the prognostic significance of tumor Ki67 expression. The authors’ hypothesis was that higher Ki67 index correlated with decreased disease-free interval and overall survival time. Clinical data such as tumor size, regional lymph nodes metastasis and hypercalcemia at presentation and histological features such as tumor pattern, mitotic count, necrosis, inflammatory infiltration, vascular invasion, anisokaryosis, and anisocytosis were also investigated and correlated to the oncologic outcome in the dogs included in the study.Apocrine gland anal sac adenocarcinoma (AGASACA) is locally aggressive and highly metastatic to regional lymph nodes. The aim of this study was to evaluate the prognostic significance of Ki67 in surgically excised AGASACA. Prognostic impact of size, regional lymph nodes metastasis, hypercalcemia, histologic pattern, mitotic count, necrosis, inflammatory and lympho-vascular invasion, anisokaryosis and anisocytosis was also evaluated. Thirty-five dogs were included, twenty-four of which also had metastatic lymph nodes. When the entire population was evaluated, only metastatic disease spread to regional lymph nodes, and necrosis and inflammatory infiltration were correlated to prognosis. When only dogs with metastatic disease were evaluated, size, solid histologic pattern, presence of lymphatic and vascular invasion showed influence on prognosis. Ki67 index was not associated with survival time and disease free interval in any case. The results of this study showed that lymph nodes metastasis at diagnosis reduced disease free interval. Moreover, tumor size greater than 5.25 cm, presence of lymphatic and vascular invasion and a solid histologic pattern were associated with a shorter survival time in dogs with metastasis to regional lymph nodes. Ki67 expression was not significantly associated with prognosis, therefore it could not be considered as a prognostic factor in this tumor type, while the role of hypercalcemia remained unclear.
Highlights
Apocrine gland anal sac adenocarcinoma (AGASACA) is a relative uncommon epithelial neoplasm of the anal sacs, representing 2% of all skin tumors and 17% of all perianal malignancies in dogs [1,2]
Client-owned dogs surgically treated for AGASACA at the Veterinary Teaching Hospital (VTH) of Grugliasco of the University of Torino, between
Dogs with distant metastasis identified during a pre-surgical computed tomographic (CT) staging and those affected by concurrent illnesses that could significantly reduce the survival time were excluded from the study
Summary
Apocrine gland anal sac adenocarcinoma (AGASACA) is a relative uncommon epithelial neoplasm of the anal sacs, representing 2% of all skin tumors and 17% of all perianal malignancies in dogs [1,2]. It occurs in older animals without any breed prevalence; a genetic predisposition has been described for the English Cocker. Dogs can display a variety of clinical signs related to tumor size (perineal swelling, pain, scooting), regional lymph nodes enlargement (tenesmus, constipation) or to paraneoplastic hypercalcemia (polyuria, polydipsia, lethargy). As reported in previous studies, the incidence of this paraneoplastic syndrome is between
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