Veterinary Society of
Surgical Oncology

GENERAL CONSIDERATIONS

Biologic Behaviour

  • smooth muscle tumors are the most common intestinal mesenchymal tumor
  • mean age 9 years (range, 4-14 years)
  • sites: small intestine and cecum
  • 50% have localized peritonitis as a result of tumor rupture
  • intestinal leiomyosarcoma has been reported as a cause of nephrogenic diabetes insipidus in 1 dog
  • 38%-54% metastatic rate with metastatic sites including the liver, spleen, lungs, kidneys, and diaphragm

CLINICAL FEATURES

Clinical Signs

  • anorexia, weight loss, intermittent vomiting, and diarrhea
  • severe, persistent vomiting is occasionally observed if proximal small intestinal tumor causes obstruction

Diagnosis

Physical Examination

  • palpable abdominal mass and cachexia are common
  • other findings include dehydration and abdominal pain

Laboratory Tests

  • anemia and leukocytosis are common in dogs with non-lymphoid intestinal tumors
  • anemia and hypoglycemia are common in dogs with intestinal leiomyosarcoma
  • mesenchymal tumors are associated with microcytic hypochromic anemia, hypoproteinemia, and mild leukocytosis

Abdominal Radiographs

  • abdominal mass, obstruction, or persistent irregularity of bowel appearance are identified in 25% of small intestinal tumors and nearly 50% of non-lymphoid intestinal tumors
  • abdominal mass is detected in 60% of canine mesenchymal small intestinal tumors

Contrast Radiography

  • intestinal mass identified in 57% of dogs with non-lymphoid intestinal tumors
  • contrast radiographs: mural lesions include luminal filling defect, intestinal wall thickening, mucosal ulceration, abnormal positioning of intestinal loops, and constricting annular lesions

Ultrasonography

  • intestinal mass identified in 87% (13/15) dogs with non-lymphoid small intestinal tumors
  • loss of wall layering is an excellent predictive factor for differentiating intestinal neoplasia from enteritis in dogs (99% v 12%) with intestinal tumors 50.9-times more likely to have loss of wall layering
  • intestinal tumors also have significant increases intestinal wall thickness (15 mm v 6 mm) and are significantly less likely to have diffuse intestinal involvement (2% v 72%)

Exploratory Celiotomy

  • definitive diagnosis with exploratory celiotomy and biopsy
  • leiomyomas and sarcomas are usually large solitary masses growing through serosa

TREATMENT

Surgery

  • debilitation and hypoproteinemia may complicate treatment
  • exploratory celiotomy with resection and end-to-end anastomosis with 4-8 cm margins and serosal patching
  • mesenteric and regional lymph nodes should be assessed ± aspirated

Prognosis

  • MST 13.0-21.3 months after surgical resection
  • 1-year survival rate 75% and 2-year survival rate 66%
  • 54% metastatic rate, but metastasis is not a poor prognostic factor with a MST 21.7 months

SMALL INTESTINAL LEIOMYOMA AND LEIOMYOSARCOMA

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