8개월령의 단모종 집고양이가 감소된 식욕과 활력 저하로 내원하였다. 진단을 위한 영상 검사에서 종격동의 종괴와 종격동 림프절의 비대 소견을 확인할 수 있었다. 이어서 진행한 세침흡인술 검사로, 악성 림프구를 다수 확인할 수 있었으며, 이 고양이는 다발성 림프종 (병기 V-b)로 진단되었다. 치료는 COP프로토콜을 사용하였으며, 완전 완화를 확인할 수 있었지만, 항암 치료를 시작한 후 314일 째 재발과 함께 중추신경계로 전이된 소견을 확인할 수 있었다. 구조화학 요법을 실시하여, 단기적으로는 임상증상의 큰 개선을 확인할 수 있었지만, 부분완화만이 관찰되었으며, 처음 내원 부터 약 383일 정도 생존하였다. 부검과 조직병리학적 검사를 통해, 다발성의 T 세포 림프종으로 확인하였으며, 뇌에서도 병변을 확인할 수 있었다.
8개월령의 단모종 집고양이가 감소된 식욕과 활력 저하로 내원하였다. 진단을 위한 영상 검사에서 종격동의 종괴와 종격동 림프절의 비대 소견을 확인할 수 있었다. 이어서 진행한 세침흡인술 검사로, 악성 림프구를 다수 확인할 수 있었으며, 이 고양이는 다발성 림프종 (병기 V-b)로 진단되었다. 치료는 COP 프로토콜을 사용하였으며, 완전 완화를 확인할 수 있었지만, 항암 치료를 시작한 후 314일 째 재발과 함께 중추신경계로 전이된 소견을 확인할 수 있었다. 구조화학 요법을 실시하여, 단기적으로는 임상증상의 큰 개선을 확인할 수 있었지만, 부분완화만이 관찰되었으며, 처음 내원 부터 약 383일 정도 생존하였다. 부검과 조직병리학적 검사를 통해, 다발성의 T 세포 림프종으로 확인하였으며, 뇌에서도 병변을 확인할 수 있었다.
An 8-month-old domestic shorthair cat presented with decreased activity and anorexia. Diagnostic imaging revealed cranial mediastinal mass and enlarged mesenteric lymph nodes. Fine needle aspirates showed a marked increase in malignant lymphocytes. Multicentric lymphoma (stage V-b) was diagnosed. Th...
An 8-month-old domestic shorthair cat presented with decreased activity and anorexia. Diagnostic imaging revealed cranial mediastinal mass and enlarged mesenteric lymph nodes. Fine needle aspirates showed a marked increase in malignant lymphocytes. Multicentric lymphoma (stage V-b) was diagnosed. The cat treated with COP protocol chemotherapy, and complete remission was induced. CNS relapse developed 314 days after the initiation of chemotherapy. Treatment with rescue protocol greatly reduced the clinical signs for a short period. The cat was in partial remission for 33 days and overall survival time was 383 days. Multicentric T-cell lymphoma with brain involvement was confirmed after necropsy by histopathology and immunohistochemistry.
An 8-month-old domestic shorthair cat presented with decreased activity and anorexia. Diagnostic imaging revealed cranial mediastinal mass and enlarged mesenteric lymph nodes. Fine needle aspirates showed a marked increase in malignant lymphocytes. Multicentric lymphoma (stage V-b) was diagnosed. The cat treated with COP protocol chemotherapy, and complete remission was induced. CNS relapse developed 314 days after the initiation of chemotherapy. Treatment with rescue protocol greatly reduced the clinical signs for a short period. The cat was in partial remission for 33 days and overall survival time was 383 days. Multicentric T-cell lymphoma with brain involvement was confirmed after necropsy by histopathology and immunohistochemistry.
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문제 정의
Feline secondary CNS LSA is a malignancy for which there is limited published information, particularly in regard to treatments and outcomes. This study discussed a case of feline CNS relapsed LSA and, as such, offers useful information regarding the clinical presentation and outcome in a cat diagnosed with this variant of LSA. The incidence of intracranial tumors is reported as high as 2.
제안 방법
In this study, after a diagnosis of secondary CNS LSA had been established, the treatment protocol included corticosteroids, cytarabine, and L-asparaginase. Steroids are easy to use and rapidly effective, but the response is transient.
The cat had been given two chemotherapy protocols including a conventional (COP) and a rescue protocols. A conventional protocol was applied to induce CR when induction and re-induction, respectively.
The patient was treated with the COP protocol (Table 1) as described for feline multicentric LSA (15) and was evaluated at each treatment. Clinical remission was assessed by physical examination and sometimes by radiography or ultrasonography, depending on the site and extent of the tumor.
The COP protocol was considered to be ineffective, and chemotherapy with cytarabine as the primary drug was started (Table 1). The rescue protocol consisted of cytarabine, L-asparaginase, and a corticosteroid. For CNS relapse, the results of a physical examination before each treatment were combined, as appropriate, with blood tests to evaluate the side-effect.
This report describes a cat with CNS relapsed multicentric T-cell LSA treated with cytarabine, dexamethasone, and L-asparaginase for 5 weeks.
대상 데이터
1%) (13). Neurological signs of the patient in this study included ataxia, blindness, and nystagmus (Table 2). In humans, a change in personality is the most common presenting symptom.
성능/효과
In conclusion, this is the first study reporting the efficacy of cytarabine in combination with a conventional chemotherapeutic protocol for the treatment of feline secondary CNS T-cell LSA with systemic nodal enlargement. The clinical results reported here show some effect of cytarabine on short-term remission and overall survival.
On 203 days after the first presentation the cat had a recurrence of LSA in the cranial mediastinal lymph nodes, and CR was reinduced using the same protocol as the one previously adopted. The second CR lasted for 95 days.
Recently, the clinical impact of secondary CNS LSA has become important as a consequence of the prolongation of survival times due to improvements in systemic chemotherapy that does not target the CNS. The results from this study suggest that feline secondary CNS T-cell LSA is an aggressive disease with a poor prognosis that is only minimally responsive to the standard LSA chemotherapy protocol. Future directions in the study of this disease may include in vitro studies to evaluate sensitivity to various chemotherapeutic agents in order to identify more effective chemotherapeutic drugs for this form of LSA.
The results of blood and serum biochemical analysis revealed increased small to large sized lymphocytes on the differential count (9676/µl, reference 1,000-5,000/µl), increased AST (62 U/L, reference 0-48 U/L) and increased GGT (5 U/L, reference 0-1 U/L).
A cytologic examination of the CSF revealed increased numbers of medium- to large-sized lymphocytes (Fig 4). The results of the diagnostic procedures indicated CNS relapsed LSA and metastases to peripheral lymph nodes.
참고문헌 (16)
Bashir RM, Bierman PJ, Vose JM, Weisenburger DD, Armitage JO. Central nervous system involvement in patients with diffuse aggressive non-Hodgkin's lymphoma. Am J Clin Oncol 1991; 14: 478-482.
Boehme V, Zeynalova S, Kloess M, Loeffler M, Kaiser U, Pfreundschuh M, Schmitz N. Incidence and risk factors of central nervous system recurrence in aggressive lymphoma-a survey of 1693 patients treated in protocols of the German High-Grade Non-Hodgkin's Lymphoma Study Group (DSHNHL). Annal Oncol 2007; 18: 149-157.
Chamberlain MC, Nolan C, Abrey LE. Leukemic and lymphomatous meningitis: incidence, prognosis and treatment. J Neurooncol 2005; 75: 71-83.
Hollender A, Kvaloy S, Nome O, Skovlund E, Lote K, Holte H. Central nervous system involvement following diagnosis of non-Hodgkin's lymphoma: a risk model. Annal Oncol 2002; 13: 1099-1107.
Miller DC, Hochberg FH, Harris NL, Gruber ML, Louis DN, Cohen H. Pathology with clinical correlations of primary central nervous system non-Hodgkin's lymphoma. The massachusetts general hospital experience 1958-1989. Cancer 1994; 74: 1383-1397.
Moore AS, Cotter SM, Frimberger AE, Wood CA, Rand WM, L'Heureux DA. A comparison of doxorubicin and COP for maintenance of remission in cats with lymphoma. J Vet Int Med 1996; 10: 372-375.
Seo KW, Choi US, Lee JB, Kim MI, Oh YI, Chung JY, Lee SK, Hwang CY, Youn HY. Central nervous system relapses in 3 dogs with B-cell lymphoma. Can Vet J 2011; 52: 778-783.
Snyder JM, Lipitz L, Skorupski KA, Shofer FS, Van Winkle TJ. Secondary intracranial neoplasia in the dog: 177 cases (1986-2003). J Vet Int Med 2008; 22: 172-177.
Troxel MT, Vite CH, Massicotte C, McLear RC, Van Winkle TJ, Glass EN, Tiches D, Dayrell-Hart B. Magnetic resonance imaging features of feline intracranial neoplasia: retrospective analysis of 46 cats. J Vet Int Med 2004; 18: 176-189.
Troxel MT, Vite CH, Winkle TJ, Newton AL, Tiches D, Dayrell-Hart B, et al. Feline intracranial neoplasia: retrospective review of 160 cases (1985-2001). J Vet Int Med 2003; 17: 850-859.
van Besien K, Ha CS, Murphy S, McLaughlin P, Rodriguez A, Amin K, Forman A, Romaguera J, Hagemeister F, Younes A, Bachier C, Sarris A, Sobocinski KS, Cox JD, Cabaillas F. Risk factors, treatment, and outcome of central nervous system recurrence in adults with intermediate-grade and immunoblastic lymphoma. Blood 1998; 91: 1178-1184.
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