Hemangiosarcoma in a Dog: Unusual Presentation and Increased Survival Using a Complementary/Holistic Approach Combined with Metronomic Chemotherapy

Abstract

This case report documents the clinical and pathologic findings in a 12-year-old terrier mix with intraocular and splenic hemangiosarcoma. Pathologic findings in both the spleen and globe were consistent with hemangiosarcoma with a low mitotic count. Initial treatment consisted of enucleation and then splenectomy followed by one cycle of conventional doxorubicin chemotherapy. Due to poor tolerance, a subsequent treatment regimen consisted of metronomic chemotherapy with chlorambucil combined with an alternative/complementary regimen of I'm-Yunity (polysaccharopeptide) and Yunnan Baiyao. Follow-up thoracic radiographs and abdominal ultrasounds over a period of 24 months showed no evidence of pulmonary, hepatic, or right atrial metastases, during which time the patient had an excellent quality of life. However, shortly after achieving two-year survival, the patient developed new onset seizures unresponsive to anticonvulsant therapy. Therefore, a decision was made to euthanize the dog given that the most likely etiology of the seizures was a brain tumor. Overall, this is an exceptional treatment response given the poor survival statistics of hemangiosarcoma even with conventional chemotherapy. However, additional clinical pharmacology and clinical trial data are needed to further support the use of a complementary/holistic approach in combination with metronomic chemotherapy.

Metastatic Cardiac Hemangiosarcoma in a 6 Year Old Wheaten Terrier Mix

“…It is possible that cytoreductive surgery may have a significant role in controlling the disease process and/or the multimodal approach, including metronomic therapy, which allows a longer survival time. This case also complements a recent case report [36] that documented long-term survival in a dog diagnosed with hemangiosarcoma in the eye and in the spleen, and that was treated with surgery and Coriolus versicolor extract as part of a multimodal approach. Randomized controlled prospective trials are ideal and essential to truly characterize the benefit of alternative approaches like Coriolus versicolor extract combined with traditional chemotherapy.…”

Bilateral ocular metastatic melanoma of unknown primary (MUP) in a dog

“…This case report illustrates that ocular signs (particularly anterior uveitis) may be the first clinical indication of disseminated neoplasia and a complete diagnostic investigation of these patients is essential 4 7 11. Bilateral ocular involvement and the multifocal carpet‐like growth pattern of neoplastic melanocytes lining the inner surface of the uveal tract, in the absence of a distinct intraocular uveal mass, was consistent with metastatic melanoma and further supported by findings of disseminated melanoma at postmortem examination 3 16.…”

“…Ocular metastasis is a differential diagnosis for canine uveitis and occurs infrequently in dogs despite an abundant blood supply to the uveal layer 1 2. Round cell tumours, specifically lymphoma and histiocytic sarcoma, are the most common tumours to secondarily involve the canine eye,3 4 whereas metastasis of malignant melanoma and various other tumour types are uncommonly reported 5–11. Ophthalmic presentation is unilateral or bilateral and is similar in all types of metastatic tumour, including visual deficits, ocular discomfort, uveitis, iris mass lesions and secondary glaucoma 3–11.…”

Hemangiosarcoma in German shepherd dog

“…The tissue section doesn't reveal much tumor cells as much of the field is covered by hemorrhages in the tissue. Hemangiosarcoma (HSA), an aggressive, malignant tumor originating from vascular endothelial cells, is the most common splenic tumor in dogs, accounting for 51% to 66% of all splenic neoplasms [1][2][3][4] . Canine HSA is locally infiltrative and readily metastasizes hematogenously through lymphatic drainage or via local seeding after tumor rupture [3][4][5] .…”

“…Most commonly seen clinical signs are lethargy, anorexia, episodic occurrence of tumour in dogs and presence of fluid filled abdomen. The spleen is the most common site for the occurrence of visceral hemangiosarcoma with noticeable hemiabdomen and chances of organ rupture [2] . When tumour ruptures, it also leads to anaemic condition which can be revealed through pale mucous membrane.…”