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Tumor na Base do Coração em Canídeo
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Abstract(s)
Este estudo reporta o caso clínico de um Bulldog Francês macho, com 12 anos, referenciado devido a
anorexia, adipsia e apatia. O animal possuía histórico prévio de mastocitoma cutâneo múltiplo,
confirmados por citologia, e excisão anterior de uma massa auricular esquerda confirmada por
citología como mastocitoma. Exames complementares, incluindo radiografias torácicas e abdominais,
evidenciaram uma massa no mediastino cranio-dorsal, sugerindo a possibilidade de metástase ou
tumor primário na base cardíaca, com diagnóstico diferencial de quemodectoma, metástase de
mastocitoma ou linfoma.
Na avaliação clínica inicial, o animal apresentou-se apático, com desidratação subclínica e sinais vitais
estáveis, além da presença de múltiplas massas subcutâneas. A ecocardiografia revelou uma massa de
grandes dimensões (8,39 x 7,80 cm) localizada na base do coração. A citologia por punção aspirativa
da massa foi inconclusiva, predominando eritrócitos e neutrófilos não degenerados, sem evidências
claras de metástase de mastocitoma.
O hemograma não revelou alterações relevantes do ponto de vista clínico. Com base no conjunto de
informações clínicas e imagiológicas, foi presumido o diagnóstico de tumor de base cardíaca, com
suspeita principal de quemodectoma ou metástase de mastocitoma. O tratamento iniciou-se com
toceranib fosfato (3,25 mg/kg a cada 48 horas), associado a prednisolona (1,25 mg/kg/dia) e
difenidramina (3,1 mg/kg/dia) para controlo dos sinais clínicos relacionados com a libertação de
histamina.
Após 11 dias de tratamento, foi efetuada redução da dose de prednisolona em 50% (0,6 mg/kg), devido
à melhoria clínica observada. Aos 18 dias de tratamento, os tutores reportaram episódios leves de
diarreia e vómitos, levando à suspensão temporária da medicação para reavaliação. A resposta
terapêutica revelou uma melhora significativa do estado geral do animal, com uma resolução dos sinais
clínicos que motivaram a consulta (apatia, anorexia e adipsia) e uma redução de um 50% das lesões
cutâneas, embora tenha desenvolvido efeitos adversos relativos ao tratamento (fezes moles e
vómitos). Devido a isto, os tutores optaram por não continuar o tratamento, ocorrendo resolução dos
efeitos adversos com a descontinuação do tratamento.
Este caso ilustra a complexidade do diagnóstico e maneio terapêutico dos tumores mediastínicos em
cães geriátricos, evidenciando a importância da utilização de técnicas diagnósticas multimodais e
estratégias terapêuticas integradas. O uso do toceranib fosfato mostrou-se promissor, embora seja
imprescindível a monitorização rigorosa dos efeitos adversos associados ao tratamento.
This study reports the clinical case of a 12-year-old male French Bulldog referred due to anorexia, adipsia, and apathy. The animal had a previous history of multiple cutaneous mast cell tumors, confirmed by cytology, with excision of a left ear mass confirmed by cytology as a mast cell tumor. Complementary tests, including chest and abdominal radiographs, revealed a mass in the craniodorsal mediastinum, suggesting the possibility of metastasis or a primary tumor at the base of the heart. Chemodectoma, mast cell tumor metastasis and lymphoma were considered the main differential diagnosis. In the initial clinical evaluation, the animal was lethargic, with subclinical dehydration and stable vital signs, in addition to the presence of multiple subcutaneous masses. Echocardiography revealed a large amorphous mass (8.39 x 7.80 cm) located at the base of the heart. Aspiration cytology of the mass was not conclusive, with a predominance of erythrocytes and non-degenerated neutrophils, with no clear evidence of mast cell tumor metastasis. The blood count did not reveal any clinically relevant changes. Based on the clinical and imaging information, a diagnosis of cardiac tumor was presumed, with the main suspicion being chemodectoma or mast cell tumor metastasis. Treatment was initiated with toceranib phosphate (3.25 mg/kg every 48 hours), combined with prednisolone (1.25 mg/kg/day) and diphenhydramine (3.1 mg/kg/day) to control clinical signs related to histamine release. After 11 days of treatment, prednisolone dose was reduced by 50% (0.6 mg/kg) due to the clinical improvement observed. At 18 days of treatment, the owners reported mild episodes of diarrhea and vomiting, leading to temporary suspension of the medication for reassessment. The therapeutic response showed a significant improvement in the animal's general condition, with a resolution of the clinical signs that prompted the consultation (apathy, anorexia, and adipsia) and a 50% reduction in skin lesions. However, adverse effects related to the treatment appeared (loose stools and vomiting). Due to this, the owners opted not to continue the treatment, occurring resolution of the adverse effects with treatment withdrawal. This case illustrates the complexity of the diagnosis and therapeutic management of mediastinal tumors in older dogs, highlighting the importance of using multimodal diagnostic techniques and integrated therapeutic strategies. The use of toceranib phosphate has shown promise, although rigorous monitoring of the adverse effects associated with treatment is essential.
This study reports the clinical case of a 12-year-old male French Bulldog referred due to anorexia, adipsia, and apathy. The animal had a previous history of multiple cutaneous mast cell tumors, confirmed by cytology, with excision of a left ear mass confirmed by cytology as a mast cell tumor. Complementary tests, including chest and abdominal radiographs, revealed a mass in the craniodorsal mediastinum, suggesting the possibility of metastasis or a primary tumor at the base of the heart. Chemodectoma, mast cell tumor metastasis and lymphoma were considered the main differential diagnosis. In the initial clinical evaluation, the animal was lethargic, with subclinical dehydration and stable vital signs, in addition to the presence of multiple subcutaneous masses. Echocardiography revealed a large amorphous mass (8.39 x 7.80 cm) located at the base of the heart. Aspiration cytology of the mass was not conclusive, with a predominance of erythrocytes and non-degenerated neutrophils, with no clear evidence of mast cell tumor metastasis. The blood count did not reveal any clinically relevant changes. Based on the clinical and imaging information, a diagnosis of cardiac tumor was presumed, with the main suspicion being chemodectoma or mast cell tumor metastasis. Treatment was initiated with toceranib phosphate (3.25 mg/kg every 48 hours), combined with prednisolone (1.25 mg/kg/day) and diphenhydramine (3.1 mg/kg/day) to control clinical signs related to histamine release. After 11 days of treatment, prednisolone dose was reduced by 50% (0.6 mg/kg) due to the clinical improvement observed. At 18 days of treatment, the owners reported mild episodes of diarrhea and vomiting, leading to temporary suspension of the medication for reassessment. The therapeutic response showed a significant improvement in the animal's general condition, with a resolution of the clinical signs that prompted the consultation (apathy, anorexia, and adipsia) and a 50% reduction in skin lesions. However, adverse effects related to the treatment appeared (loose stools and vomiting). Due to this, the owners opted not to continue the treatment, occurring resolution of the adverse effects with treatment withdrawal. This case illustrates the complexity of the diagnosis and therapeutic management of mediastinal tumors in older dogs, highlighting the importance of using multimodal diagnostic techniques and integrated therapeutic strategies. The use of toceranib phosphate has shown promise, although rigorous monitoring of the adverse effects associated with treatment is essential.
Description
Keywords
Bulldog Francês Mastocitoma Quemodectoma Toceranib (Palladia®) Tumor cardíaco Tumores neuroendócrinos Cardiac tumor Chemodectoma French Bulldog Mastocytoma Neuroendocrine tumors