查看犬血管肉瘤化疗管理 – 更新的源代码

== Introduction ==

血管肉瘤是一种起源于血管内皮的恶性肿瘤。与其他兽医物种相比，它主要出现在犬科动物中。它主要发生在老年动物中，也被发现与某些品种有关：德国牧羊犬、金毛猎犬、拉布拉多猎犬、拳击师、伯尔尼山犬、德国短毛指针犬和平毛猎犬 [1]。Sabattini和Bettini [2]，（2009）报告说，'''德国牧羊犬'''品种是血管瘤和血管肉瘤'''受影响最大'''的品种。Lamerato-Kozicki[3]评估了关于犬血管肉瘤起源的两种假说，并得出结论，它们是由转化的血管母细胞干细胞引起的。这排除了血管肉瘤起源于突变导致的分化血管内皮细胞的假设。一项类似的研究报告称，血管肉瘤起源于多能祖细胞，该祖细胞具有分化为多个谱系的能力，这是适应过程的一部分[4]。Benjamin等[5]报道，通过将狗暴露于高水平的电离辐射，可以在狗身上进行实验性地发展血管肉瘤。犬血管肉瘤通常会累及脾脏。皮肤相关性血管肉瘤在犬科动物中较少见[6]。皮肤血管肉瘤根据其组织学位置分为三个阶段：真皮、皮下和深部。其中，皮肤（I期）皮肤血管肉瘤被发现不那么严重，与其他阶段相比，生存时间更长。皮下注射（II期）和深层（III期）的生存期较短。在深部（III.期）皮肤血管肉瘤中，皮肤下方的肌肉层也受累[7]。

Hemangiosarcoma is a type of malignant tumor that originates from the vascular endothelium. It is mostly seen in canines when compared to other veterinary species. It occurs mainly in older animals and is also found to be related to certain breeds German Shepherd, Golden Retriever, Labrador Retriever, Boxer, Bernese Mountain dog, German Shorthaired Pointer and Flat-Coated Retriever [1]. Sabattini & Bettini [2], (2009) reported that German shepherd dog breed was the most affected breed in case of hemangioma and hemangiosarcoma. Lamerato-Kozicki [3] evaluated two hypotheses regarding the origin of hemangiosarcoma in canine and concluded that they are arising from the transformed hemangioblastic stem cells. This ruled out the hypothesis that hemangiosarcoma are originating from the differentiated vascular endothelial cells due to mutation. A similar study reported that hemangiosarcoma arises from multipotent progenitors that has the ability to differentiate into multiple lineages as a part of adaptive process [4]. Benjamin et al. [5] reported that hemangiosarcoma can be developed experimentally in dogs by exposing them to high levels of ionizing radiations. Hemangiosarcoma in canines commonly affects the spleen. Skin associated hemangiosarcomas are less frequently seen in canines [6]. Cutaneous hemangiosarcomas are classified into three stages depending on their histological location as dermal, hypodermal, and deep. Among them dermal (Stage I) cutaneous hemangiosarcoma was found to be less severe and had higher survival times when compared to other stages. Hypodermal (Stage II) and Deep (Stage III) were having only shorter survival periods. In deep (Stage III) cutaneous hemangiosarcoma, the muscle layer below the skin are also involved [7].


对死于血管肉瘤的狗的尸检显示存在多器官转移[8]。Waters等[9]报道，与没有肺转移的狗相比，有肺转移的狗发生脑转移的风险要高8倍。因此，血管肉瘤肺转移的筛查也可作为颅内病变和相关症状的指征。完全切除是非内脏血管肉瘤的治疗方法选择。手术切除非内脏血管肉瘤可以使患者在至少一年内临床正常。在这种情况下，肿瘤切除不完全将导致复发[10]。Tsuji等[11]报道了一例犬皮肤血管肉瘤病例，其特征是从肘部到手指的左前肢多发性皮肤和皮下肿块。肿瘤边界划界不清，上覆皮肤溃疡。在骨骼和肌肉血管肉瘤的情况下，如果肢体和肌肉血管肉瘤局限于单个肢体，则可以尝试截肢。放射疗法可用于姑息治疗，以管理狗的血管肉瘤。在接受放射治疗时，在受脾血管肉瘤影响的非脾脏血管肉瘤患者中观察到肿瘤大小减小[12]。

Post-mortem examination of dogs died due to hemangiosarcoma revealed presence of multi-organ metastasis [8]. Waters et al. [9] reported that the dogs having pulmonary metastasis will have eight times greater risk of having brain metastasis when compared with the dogs without pulmonary metastasis. Hence screening for lung metastasis in hemangiosarcoma can be also used as an indication of intracranial lesion and associated symptoms. Complete excision is the choice of treatment in case of non-visceral hemangiosarcoma. Surgical removal of non-visceral hemangiosarcoma can make the patient clinically normal for at least a period of one year. Incomplete removal of tumor in such cases will result in recurrence [10]. Tsuji et al. [11] reported a case of canine cutaneous hemangiosarcoma characterized by multiple cutaneous and subcutaneous masses in the left forelimb from elbow to digits. The tumor showed poor demarcation and the overlying skin was ulcerated. Amputation of the limb can be attempted in cases of hemangiosarcomas of bones and muscles if they are localized to a single limb. Radiation therapy can be used for palliative treatment in managing hemangiosarcoma in dogs. Reduction in tumor size was observed in non-splenic hemangiosarcoma affected canine patients when treated with radiation therapy [12].

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