11 Year-old, neutered Male Border Collie presented with recurrent high grade soft tissue sarcoma. Evaluating feasibility of hemipelvectomy to eradicate disease.
IMAGING PROTOCOL
High-resolution Vimago™ CT study of the pelvis, abdomen, and thorax. Plain and post contrast series, Spinal recumbency
CT FINDINGS
An ill-defined soft tissue attenuating and heterogeneously enhancing mass lesion is noted at the cardiac base on the left side level with the aortic bulb. The lesion measures approximately 5 cm in diameter. There is a significant mass effect noted onto the trachea, which is displaced to the right side as well as onto the left main stem bronchi and the adjacent lung parenchyma, which reveals region of atelectasis. A mild amount of pericardial effusion is noted. The pulmonary parenchyma is negative for metastatic spread. However, there is marked symmetric enlargement and rounding of the sternal lymph nodes at a diameter of approximately 2.5 cm. Cranial mediastinal and tracheobronchial lymph nodes reveal mild symmetric enlargement with heterogeneous contrast enhancement.
There is a large, elongated, soft tissue, attenuating, heterogeneous mass lesion in the left femoral biceps region expanding the entire soft tissue caudal to the left femur. The mass lesion measures more than 15 cm in length and 10 cm in depth. The proximal origin is immediately adjacent to the pelvic symphysis and ischial bone. The muscular midline is shifted, but not actually crossed. The right hemipelvis is not affected. However, there is a mass effect on the pelvic, penile urethra, and cavernous body. After administration of iodinated contrast media there is marked non-uniform enhancement noted throughout the lesion. The lesion margins are ill-defined. There are no bony changes associated with this lesion. Incidental metaplasia within the distal insertion of the psoas minor muscle next to the minor trochanter of the left femur is noted as well as incidental mild lumbar spondylosis, both of which not associated with the soft tissue mass lesion.
The left superficial inguinal lymph node as well as the hypogastric lymph nodes are within normal limits.
A 1.7 cm left adrenal gland nodule is noted, no vascular invasion is appreciated on the CT study. Incidental small uncomplicated cortical renal cysts are noted.
IMAGING DIAGNOSIS
The computed tomography of the left thigh, pelvis, abdomen and thorax revealed a heart base tumor with mild secondary pericardial effusion, mediastinal lymph node enlargement meeting malignancy criteria, as well as a left-sided adrenal gland nodule. The additional findings may be associated with the primary tumor such as multicentric appearance or metastatic spread of a soft tissue sarcoma/hemangiosarcoma or be an expression of another malignancy being present in parallel. The overall prognosis is poor.
Regarding the original question left-sided hemipelvectomy appears to enable full tumor resection, but neither the safety margins can be implemented as advised in high-grade soft tissue sarcoma without affecting critical structures such as the pelvic and penile urethra nor does the poor overall prognosis owing to the additional findings render this a reasonable clinical decision.
In case final diagnosis and full tumor staging is strived, ultrasound guided sampling of the sternal lymph nodes and pericardial fluid may be attempted, but the clinical impact is limited unfortunately. Consider palliative treatment options such as chemotherapy depending on the owner’s will.
About Dr. Nele Ondreka
Dr. Ondreka works with Sonopath.com, specializing in boutique telemedicine. Dr. Ondreka is a European Specialist in Veterinary Diagnostic Imaging & head of the Diagnostic Imaging Services of the VetSchool, University of Giessen, Germany. Read More...
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