Veterinary Society of
Surgical Oncology

Biologic Behaviour

  • HSA is a highly metastatic tumor with microscopic or macroscopic metastatic disease at diagnosis
  • HSA arises from vascular endothelial cells
  • HSA is the 4th most common splenic tumor in cats
  • median age 8-10 years
  • sex predisposition: males
  • no breed predisposition
  • splenic HSA is highly metastatic (60%) with sites including lungs, liver, regional lymph node, mesentery, and brain
  • Clinical Signs

  • non-specific
  • acute presentation: acute dyspnea, pallor, abdominal effusion, and hypovolemic shock secondary to splenic rupture and hemorrhage
  • chronic presentation: lethargy, anorexia, and weight loss
  • Physical Examination

  • palpable abdominal mass with splenomegaly and abdominal fluid wave
  • cardiac abnormalities: arrhythmia, cardiac murmur, and muffled heart sounds
  • Diagnosis

    General Considerations

  • splenic HSA and hemangioma have similar ultrasonographic and gross appearance and are difficult to differentiate
  • Laboratory Findings

  • hematology: anemia and morphological changes to red blood cells such as nucleated erythrocytes, polychromasia, poikilocytes, anisocytes, shistocytes, and reticulocytes
  • morphologic changes due to iron loss, altered hepatic lipoprotein metabolism, microangiopathic disease, or DIC and sluggish flow through abnormal vascular channels resulting in increased membrane fragility
  • neutrophilic leukocytosis is common due to either stress or tumor rupture and necrosis
  • thrombocytopenia due to DIC, but may form part of Kasabach-Merritt syndrome
  • Kasabach-Merritt syndrome is characterized by an enlarging vascular tumor, thrombocytopenia, anemia, prolonged PT and APTT, decreased FDP, and increased fibrin split products
  • thrombocytopenia (75%-90%), fragmented red blood cells (80%), and DIC (50%) are common findings
  • anemia and DIC associated with blood loss is common in cats with visceral HSA
  • Survey Radiographs

  • 2 metastatic patterns in dogs with HSA:
  • widely disseminated nodular pattern (common)
  • diffuse interstitial pattern (uncommon)
  • false-negative results are high: 22% from splenic HSA and > 50% for right atrial HSA
  • Ultrasonography

  • abdominal ultrasonography is a highly accurate and sensitive tool for splenic evaluation
  • primary HSA: mixed pattern of anechoic and hyperechoic regions
  • metastatic HSA: diffusely anechoic or hypoechoic appearance
  • ultrasound-guided FNA or needle-core biopsy contraindicated due to risk of seeding and low diagnostic yield
  • Electrocardiography

  • ventricular arrhythmias are commonly associated with HSA due to hypoxia, anemia, or hypovolemia
  • Clinical Staging

    Treatment

    Surgical Management

  • total splenectomy recommended
  • Chemotherapy

  • doxorubicin 30 mg/m2 q 2-3 weeks for 5 doses
  • ± cyclophosphamide 100-150 mg/m2
  • complications: neutropenia (common), severe gastroenteritis, cardiotoxicity, and sepsis
  • Prognosis

  • mean ST 22 weeks
  • 100% metastatic rate
  • SPLENIC HEMANGIOSARCOMA

    T0

    No evidence of neoplasia

    Primary Tumor

    T1

    Tumor < 5 cm in diameter and confined to primary site

    T2

    Tumor ≥ 5 cm in diameter, ruptured, or invading subcutaneous tissue

    N0

    No evidence of regional lymph node involvement

    N1

    Regional lymph node involvement

    Node

    M0

    No evidence of metastasis

    M1

    Evidence of distant metastasis with site specified

    Metastasis

    T3

    Tumor invading adjacent structures including muscle

    N2

    Distant lymph node involvement

       
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