Liver Tumors in Cats and Dogs
Liver Tumors in Cats and Dogs
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猫和狗的肝脏肿瘤
DOI：
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发表时间：
2005
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影响因子：
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通讯作者：
S. Withrow
中科院分区：
文献类型：
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作者：
J. Liptak;W. Dernell;S. Withrow
电子邮件评论/问题至compendium@medimedia.com，传真800-556-3288，或登录www.VetLearn.com影响肝脏的肿瘤可以是原发性的，也可以是转移性的。转移性累及比原发性肝胆肿瘤更常见。猫和狗的原发性肝脏肿瘤分为肝细胞、胆管、间质和神经内分泌四类。在狗身上，这些肿瘤的恶性变异更为常见，而良性肿瘤，特别是胆囊胆管腺瘤，在猫身上更为常见。原发性肝肿瘤在形态学上可分为块状、结节状和弥漫性。巨大肿瘤的预后比结节性、弥漫性或转移性肝肿瘤好，因为手术切除是可能的，而且可以治愈，特别是狗的肝细胞癌和猫的胆管腺瘤和骨髓瘤。相比之下，患有结节性、弥漫性和转移性肝脏肿瘤的猫和狗的治疗选择有限，因为手术通常是不可能的，其他形式的治疗也没有研究过。多灶性，累及多个肝叶；弥漫性损害可能代表肿瘤疾病的最终谱，在所有肝叶中出现多灶性或合并性结节或肝实质弥漫性消失。猫和狗的肝脏肿瘤的预后是由组织学和形态学决定的。大块性肝细胞癌和良性肿瘤的预后良好，因为完全手术切除是可能的，而且它们的生物学行为相对无侵袭性。相比之下，患有任何类型恶性肿瘤的猫和患有恶性肿瘤的狗的预后都很差，除了巨大的HCC。肝胆肿瘤在大约50%的猫和75%的狗中有症状，特别是在患有恶性肿瘤的动物中。最常见的症状是非特异性的，包括食欲不振、体重减轻、嗜睡、呕吐、烦渴/多尿，以及《猫狗肝脏肿瘤简编》（2004年1月）。凝血时间延长和凝血因子异常已在肝胆肿瘤犬中发现，尽管这些很少与临床相关。肝胆肿瘤犬的肝酶通常升高（表2）。肝受累程度与肝酶改变程度无明显相关性；然而，肝酶异常可能提供肿瘤类型的指示，并可能区分原发性和转移性肝肿瘤。碱性磷酸酶（ALP）和丙氨酸转移酶（ALT）在原发性肝肿瘤犬中普遍升高。相比之下，在转移性肝肿瘤犬中，谷草转氨酶（AST）和胆红素更一致地升高。此外，AST:ALT比值小于1与HCC或胆管癌一致，而当比值大于1时更有可能是神经内分泌肿瘤或肉瘤。然而，一般来说，肝酶升高并不是诊断肝胆疾病的特异性指标。肝脏肿瘤犬血清生化特征的其他变化包括低血糖、低白蛋白血症、高球蛋白血症以及餐前和餐后胆汁酸升高。与狗的情况相反，氮血症经常出现在肝胆肿瘤的猫身上，可能是唯一的生化异常，尽管肝酶异常，特别是ALT、AST和总胆红素异常也很常见，并且在患有恶性肿瘤的猫身上明显更高。表1。犬原发性肝脏恶性肿瘤形态学分类频率肿瘤类型块状结节性弥漫性肝细胞癌53%-84% 16%-25% 0% - 19%胆管癌37%-46% 0% - 46% 17%-54%神经内分泌肿瘤0% 33% 67%肉瘤36% 64% 0%腹水癫痫发作并不常见，可能由肝性脑病、副肿瘤性低血糖或中枢神经系统转移引起。黄疸多见于肝外胆管癌或弥漫性神经内分泌肿瘤。然而，这些征象很少有助于区分原发性和转移性肝脏肿瘤与非肿瘤性肝脏疾病。身体检查的结果同样令人失望。高达75%的患有肝脏肿瘤的猫和狗可触及到颅腹部肿块，尽管触诊可能会引起误导，因为肝脏肿大可能在结节性和弥漫性肝脏肿瘤中不存在，或者由于肝脏在颅腹部深至尾侧胸腔的保护位置而错过。血液学和血清生化异常通常是非特异性的。白细胞增多症、贫血和血小板增多症在患有肝肿瘤的狗身上很常见。白细胞增多症可能是由肝脏大肿块相关的炎症和坏死引起的。贫血通常是轻微的，不能再生。贫血的原因尚不清楚，尽管假设包括慢性疾病、炎症、红细胞隔离和缺铁。血小板增多，定义为血小板计数大于500 × 10/μl，在大约50%的大块性HCC犬中可见。提出的血小板增多的原因包括贫血、缺铁、炎性细胞因子和促血小板生成素的副肿瘤产生。贫血和血小板减少症可以在原发性和转移性犬中看到。肝胆肿瘤猫狗血液学及血清生化异常的频率
CE Email comments/questions to compendium@medimedia.com, fax 800-556-3288, or log on to www.VetLearn.com Tumors affecting the liver can be either primary or metastatic. Metastatic involvement is more common than primary hepatobiliary tumors.The four categories of primary hepatic tumors in cats and dogs are hepatocellular, bile duct, mesenchymal, and neuroendocrine. In dogs, malignant variants of these tumors are more common, whereas benign neoplasia, particularly cystic bile duct adenoma, is more frequent in cats. Primary hepatic tumors are morphologically classified as massive, nodular, or diffuse.The prognosis is better for massive tumors than for nodular, diffuse, or metastatic liver tumors because surgical resection is possible and can be curative, particularly for hepatocellular carcinoma in dogs and bile duct adenoma and myelolipoma in cats. In contrast, treatment options are limited for cats and dogs with nodular, diffuse, and metastatic liver tumors as surgery is often not possible and other forms of therapy have not been investigated. multifocal and involve several liver lobes; and diffuse involvement may represent the final spectrum of neoplastic disease with multifocal or coalescing nodules in all liver lobes or diffuse effacement of the hepatic parenchyma. The prognosis for cats and dogs with liver tumors is determined by histology and morphology. The prognosis is good for massive hepatocellular carcinoma (HCC) and for benign tumors because complete surgical resection is possible and their biologic behavior is relatively nonaggressive. In contrast, the prognosis is poor for cats with any type of malignant tumor and for dogs with malignant tumors other than massive HCC. DIAGNOSIS Presenting Signs and Physical Examination Hepatobiliary tumors are symptomatic in approximately 50% of cats and 75% of dogs, especially in animals with malignant tumors. The most common presenting signs are nonspecific and include inappetence, weight loss, lethargy, vomiting, polydipsia/polyuria, and COMPENDIUM 50 January 2004 January 2004 COMPENDIUM Liver Tumors in Cats and Dogs 51 CE hepatic hemangiosarcoma (HSA). Prolonged coagulation times and clotting factor abnormalities have been identified in dogs with hepatobiliary tumors, although these are rarely clinically relevant. Liver enzymes are commonly elevated in dogs with hepatobiliary tumors (Table 2). There is no apparent correlation between the degree of hepatic involvement and the magnitude of liver enzyme alterations; however, liver enzyme abnormalities may provide an indication of the type of tumor and may distinguish primary from metastatic liver tumors. Alkaline phosphatase (ALP) and alanine transferase (ALT) are commonly increased in dogs with primary hepatic tumors. In contrast, aspartate aminotransferase (AST) and bilirubin are more consistently elevated in dogs with metastatic liver tumors. Furthermore, an AST:ALT ratio less than 1 is consistent with HCC or bile duct carcinoma, whereas a neuroendocrine tumor or sarcoma is more likely when the ratio is greater than 1. In general, however, liver enzyme elevations are not specific for the diagnosis of hepatobiliary diseases. Other changes in serum biochemical profile in dogs with hepatic tumors include hypoglycemia, hypoalbuminemia, hyperglobulinemia, and increased preprandial and postprandial bile acids. In contrast to what occurs in dogs, azotemia is often present in cats with hepatobiliary tumors and may be the only biochemical abnormality, although liver enzyme abnormalities, especially in ALT, AST, and total bilirubin, are also common and are significantly higher in cats with malignant tumors. Table 1. Frequency of Morphologic Classifications of Malignant Primary Liver Tumors in Dogs Tumor Type Massive Nodular Diffuse Hepatocellular carcinoma 53%–84% 16%–25% 0%–19% Bile duct carcinoma 37%–46% 0%–46% 17%–54% Neuroendocrine tumor 0% 33% 67% Sarcoma 36% 64% 0% ascites. Seizures, which are uncommon, may be caused by hepatic encephalopathy, paraneoplastic hypoglycemia, or central nervous system metastasis. Icterus is more commonly seen in dogs with extrahepatic bile duct carcinomas or diffuse neuroendocrine tumors. However, these signs rarely assist in differentiating primary and metastatic liver tumors from nonneoplastic hepatic disease. Physical examination findings can be equally unrewarding. A cranial abdominal mass is palpable in up to 75% of cats and dogs with liver tumors, although palpation can be misleading since hepatic enlargement may either be absent in nodular and diffuse forms of liver tumors or missed due to the protected position of the liver in the cranial abdomen deep to the caudal rib cage. Laboratory Tests Hematologic and serum biochemical abnormalities are usually nonspecific. Leukocytosis, anemia, and thrombocytosis are common in dogs with liver tumors. Leukocytosis is probably caused by inflammation and necrosis associated with large liver masses. Anemia is usually mild and nonregenerative. The cause of anemia is unknown, although hypotheses include the presence of chronic disease, inflammation, red blood cell sequestration, and iron deficiency. Thrombocytosis, defined as a platelet count greater than 500 × 10/μl, is seen in approximately 50% of dogs with massive HCC. Proposed causes of thrombocytosis include anemia, iron deficiency, inflammatory cytokines, and paraneoplastic production of thrombopoietin. Anemia and thrombocytopenia can be seen in dogs with primary and metastatic Table 2. Frequency of Hematologic and Serum Biochemical Abnormalities in Cats and Dogs with Hepatobiliary Tumors
影响因子：
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作者：
W. McIntire
通讯作者：
W. McIntire