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Apocrine Gland Anal Sac Adenocarcinoma in Cats: 30 Cases (1994–2015)

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Apocrine Gland Anal Sac Adenocarcinoma in Cats: 30 Cases (1994–2015) Small Animals Apocrine gland anal sac adenocarcinoma in cats: 30 cases (1994–2015) Pierre M. Amsellem DVM, MS OBJECTIVE To describe the signalment, clinical signs, biological behavior, and outcome Ryan P. Cavanaugh DVM for cats with apocrine gland anal sac adenocarcinoma (AGASACA) that Po-Yen Chou BVM, MVM underwent surgical excision. Nicholas J. Bacon MA, VetMB DESIGN Sandra P. Schallberger DrMedVet Retrospective case series. James P. Farese DVM ANIMALS Charles A. Kuntz DVM, MS 30 client-owned cats. Julius M. Liptak BVSC, MVetClinStud PROCEDURES Databases of 13 Veterinary Society of Surgical Oncology member–affiliated William T. N. Culp VMD institutions were searched for records of cats with a histologic diagnosis of Cecilia S. Robat DVM AGASACA that underwent tumor excision. For each cat, information re- garding signalment, clinical signs, diagnostic test results, treatment, and out- Barbara E. Powers DVM, PhD come was extracted from the medical record. The Kaplan-Meier method From the Department of Companion Animals, Atlan- was used to determine median time to local recurrence (TLR), disease-free tic Veterinary College, University of Prince Edward Is- land, Charlottetown, PE C1A 4P3, Canada (Amsellem, interval (DFI), and survival time. Cox regression was used to identify fac- Chou); the Department of Small Animal Clinical Sci- tors associated with TLR, DFI, and survival time. ences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610 (Cavanaugh, Bacon, RESULTS Schallberger, Farese); Southpaws Specialty Surgery for Perineal ulceration or discharge was the most common clinical sign in af- Animals Hospital and Consulting Suites, 3 Roper St, fected cats. Eleven cats developed local recurrence at a median of 96 days Moorabbin, VIC 3189, Australia (Kuntz); Alta Vista Animal Hospital, 2616 Bank St, Ottawa, ON K1T 1M9, after AGASACA excision. Incomplete tumor margins and a high nuclear Canada (Liptak); the Department of Clinical Sciences pleomorphic score were risk factors for local recurrence. Nuclear pleo- and Matthew J. Ryan Veterinary Hospital, School of morphic score was negatively associated with DFI. Local recurrence and a Veterinary Medicine, University of Pennsylvania, Phila- high nuclear pleomorphic score were risk factors for death. Median DFI and delphia, PA 19104 (Culp); UW Veterinary Care, School of Veterinary Medicine, University of Wisconsin-Mad- survival time were 234 and 260 days, respectively. ison, Madison, WI 53706 (Robat); and Veterinary Di- agnostic Laboratory, College of Veterinary Medicine CONCLUSIONS AND CLINICAL RELEVANCE and Biomedical Sciences, Colorado State University, Results indicated that, in cats, perineal ulceration or discharge should raise Fort Collins, CO 80523 (Powers). Dr. Amsellem’s suspicion of AGASACA and prompt rectal and anal sac examinations. Local present address is Department of Veterinary Clinical recurrence was the most common life-limiting event in cats that underwent Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108. Dr. Cavanaugh’s surgery for treatment of AGASACA, suggesting that wide margins should be present address is Department of Small Animal Clini- obtained whenever possible during AGASACA excision. Efficacy of chemo- cal Sciences, School of Veterinary Medicine, Ross Uni- therapy and radiation therapy for treatment of cats with AGASACA requires versity, Basseterre, St Kitts and Nevis. Drs. Chou and further investigation. (J Am Vet Med Assoc 2019;254:716–722) Culp’s present address is Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616. Dr. Bacon’s present addresses are Fitzpatrick Referrals— Oncology and Soft Tissue, 70 Priestley Rd, Guildford, GU2 7AJ, England; and Faculty of Health and Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford, GU2 7XH, England. Dr. Schallberger’s present address is Tierklinik Ts Ag, Burgerstrasse 11, CH-3600 Thun, Switzerland. Dr. Farese’s present ad- dress is North Bay Veterinary Surgical Services Inc, Kentfield, CA 94914. Dr. Robat’s present address is Veterinary Emergency Service/Veterinary Specialty Center, 1612 N High Point Rd, Middleton, WI 53562. Address correspondence to Dr. Amsellem (amsellem@ umn.edu). ABBREVIATIONS pocrine gland anal sac adenocarcinoma is an un- AGASACA Apocrine gland anal sac adenocarcinoma Acommon tumor in cats.1 In fact, the veterinary CI Confidence interval literature contains only 4 single-cat case reports,2–5 1 DFI Disease-free interval case series6 of 4 cats, and a large retrospective study7 MST Median survival time NPS Nuclear pleomorphic score of 64 cats in which AGASACA is described. Report- PTHrp Parathyroid hormone–related protein ed treatment options include surgery alone, surgery TLR Time to local recurrence plus adjuvant chemotherapy (carboplatin), and sur- 716 JAVMA | MAR 15, 2019 | VOL 254 | NO. 6 Small Animals gery followed by radiation therapy and carboplatin were 1.5 times the expected size and at least 10% of chemotherapy.2–7 Local recurrence6,7 and metastasis nuclei varied in shape, and 3 = at least 25% of nuclei to the sublumbar lymph nodes and lungs have been were > 2 times the expected size and at least 25% of reported.4,6 In the largest retrospective study,7 the nuclei varied in shape. The mitotic index was scored on MST was only 90 days. However, 29 of the 64 (45%) a scale of 1 to 3, where 1 = < 15 mitotic figures/10 hpf, cats of that study7 underwent surgical excision or de- 2 = 15 to 29 mitotic figures/10 hpf, and 3 = ≥ 30 mi- bulking of the tumor, and the outcomes for cats that totic figures/10 hpf. The extents of scirrhous reac- underwent surgical excision were not clearly report- tion, necrosis, and inflammation were also scored on ed. Thus, the outcome for cats with AGASACA that are a scale of 1 to 3, where 3 = severe reaction, necrosis, treated with curative-intent surgical excision rather or inflammation. All scores were summed to create than debulking remains unclear. The purpose of the a cumulative histopathologic score, which was then study reported here was to describe the signalment, categorized into 3 grades, where grade 1 = a cumula- clinical signs, laboratory and diagnostic imaging find- tive histopathologic score ≤ 8, grade 2 = a cumulative ings, treatment, outcome, and factors associated with histopathologic score between 9 and 12, and grade 3 outcome for cats with AGASACA that underwent cu- = a cumulative histopathologic score ≥ 13. The pres- rative-intent surgical excision of the tumor. ence or absence of squamous or sebaceous changes and local or vascular invasion was recorded but was Materials and Methods not used in the scoring or grading scheme. Case selection criteria Data analysis The study proposal was approved by the research Descriptive statistics were generated. Outcomes committee of the Veterinary Society of Surgical On- of interest were TLR, DFI, and survival time. Time to cology. Participating members of the Veterinary Soci- local recurrence was defined as the time from surgery ety of Surgical Oncology were asked to search their to local recurrence. For TLR analysis, cats that did not medical record databases for cats with a histopatho- have local recurrence at the time of follow-up or were logic diagnosis of AGASACA and a complete medical lost to follow-up were censored, whereas cats that de- record. Only cats that underwent tumor excision by veloped local recurrence or died but did not undergo means of anal sacculectomy were included in the a complete necropsy were not censored. The DFI was study. Cats that underwent tumor debulking or bi- defined as the interval between surgery and detec- opsy only were excluded from the study. tion of local recurrence or regional (nodal) or distant Medical records review metastasis. For DFI analysis, cats that were lost to For each cat included in the study, information ex- follow-up, died for reasons unrelated to AGASACA, or tracted from the medical record included sex, breed, that had not developed local recurrence or metastasis body weight, age at time of surgery, clinical signs, du- at the time of last follow-up were censored. Survival ration of clinical signs (from date of first clinical signs time was defined as the interval between the date of to date of surgery), maximal dimension of the mass, surgery and death. For survival analysis, death or eu- preoperative serum total calcium concentration, stag- thanasia because of AGASACA-related problems was ing test results, type of surgery performed, surgery considered an event. Cats that were lost to follow-up, date, histopathologic diagnosis, completeness of sur- still alive at the time of the last follow-up, or that died gical tumor margins, details of adjuvant chemother- for reasons unrelated to AGASACA were censored. apy or radiation therapy (when administered), date Cats that died for an unknown reason and cats that and site of local recurrence or metastasis, and date did not undergo necropsy were assumed to have died and cause of death when available. Completeness of from the disease and were not censored. surgical tumor margins was determined on the basis The Kaplan-Meier method was used to determine of the original histopathologic report issued by the the median TLR, median DFI, MST, and 1-, 2-, and attending pathologist and was not standardized. 3-year survival rates, and the log-rank test was used to compare survival curves. Cox regression analysis was Histologic review used to evaluate the association between indepen- When available, archived histologic slides or tis- dent variables and each outcome of interest. Indepen- sue blocks of masses excised from study cats were dent variables assessed included age, body weight, reviewed by a board-certified veterinary pathologist clinical signs, duration of clinical signs, maximal (BEP) to confirm the diagnosis and to subjectively or dimension of the mass, presence of hypercalcemia, objectively assess various histologic criteria, which presence of enlarged sublumbar lymph nodes preop- were evaluated by use of a scoring system that was eratively, completeness of tumor excision, administra- arbitrarily created by the pathologist.
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