查看狗狗原发性心脏血管肉瘤的流行病学、临床和病理特征：51例的回顾的源代码

== 概述 ==

血管肉瘤（hemmangiosarcoma， HSA）是一种侵袭性恶性肿瘤，起源于血管内皮细胞或内皮前体细胞[20]。原发性 HSA 可发生于身体任何血管化部位，但最常见的起因部位包括脾脏、'''右心房和右心房耳廓'''、皮下组织和肝脏[4,8,14,33]。这种肿瘤很容易通过血源性途径转移到远处器官，因为它很容易进入体循环，'''肺部'''是最常受累的部位[23,29]。


根据一项数据库调查，累及心脏的肿瘤在狗中很少发生，总发病率为 0.19%[32]。HSA 是累及犬类的最常见心脏肿瘤类型，占根据组织学类型确定的所有心脏肿瘤的 69% [32]。其发病率比第二常见的心脏肿瘤主动脉体肿瘤高约 10 倍[32]。德国牧羊犬（German Shepherd Dogs， GSs）和金毛猎犬（Golden Retrievers， GRs）的心脏 HSA 发生率似乎更高[1,2,4,15,19,24,27,30]，没有明显的性别偏好[1,30]。大多数病例中，原发性 HSA 位于'''右心房（RA）'''或右心房耳廓（RAu）[1,2,13,19,24]，但偶尔肿瘤可能出现在左侧心腔[1,11,19]。


心脏 HSA 的首发体征通常与心包积液（pericardial effusion， PE）、心包填塞和右心衰竭体征有关，包括嗜睡、虚脱、腹胀、运动不耐受、呼吸困难和咳嗽[2,9,29,30,33]。体格检查的常见异常包括心音低沉、心动过速、黏膜苍白、股动脉搏动微弱、腹液波和呼吸用力增加[2,29,30,33]。常见的实验室检查结果包括中性粒细胞增多、轻度再生性贫血和大量循环有核和未成熟红细胞[2,17,22,29]。据报道，二维超声心动图可用于检测心脏肿块[12,22]。然而，证明其诊断价值的报道有限。


狗心脏 HSA 的治疗可能包括药物和手术选择，但心脏 HSA 的诊断通常提示'''预后极差'''[30]。在诊断时，'''肿瘤通常已经转移'''，这可能导致患者选择姑息治疗，例如反复心包穿刺术，联合或不联合辅助化疗[6,30]。心包穿刺术通常伴有显著的临床改善，但心包填塞的临床体征通常会在数日内复发，常导致死亡或促使安乐死[30]。更积极的心脏 HSA 治疗方法包括心包切除术、肿瘤切除术和化疗的各种组合[30,33]。如果早期发现，没有多器官转移的粗体证据，有时可以通过手术切除原发肿瘤，特别是当它局限于 RAu 时[10]。肿瘤切除后化疗，尤其是多柔比星化疗，可延长生存期，但获益似乎不大[33]。

在此介绍的研究中，我们旨在阐明 51 例原发性心脏 HSA 犬病例的流行病学、临床和病理特征，并确定接受心包切除术和肿瘤切除术治疗的右心房或耳廓 HSA 狗的生存时间联合或不联合辅助化疗。


Hemangiosarcoma (HSA) is an aggressive, malignant tumor that arises from either the vascular endothelium or endothelial precursor cells [20]. Primary HSA can develop in any vascularized site in the body, but the most frequent sites of origin include the spleen, right atrium and auricle, subcutaneous tissues and liver [4, 8, 14, 33]. This tumor metastasizes easily to distant organs via hematogenous routes, because it has ready access to the systemic circulation, the lungs being the most frequently affected site [23, 29].

Tumors involving the heart occur infrequently in dogs with an overall incidence of 0.19% according to a database survey [32]. HSA is the most common type of cardiac tumor affecting dogs, representing 69% of all cardiac tumors identified according to histologic type [32]. Its incidence is approximately 10-fold higher than the second most common cardiac tumor, aortic body tumor [32]. There appears to be a higher incidence of cardiac HSA in German Shepherd dogs (GSs) and Golden Retrievers (GRs) [1, 2, 4, 15, 19, 24, 27, 30] with no apparent sex predilection [1, 30]. In most cases, primary HSA is located in the right atrium (RA) or auricle (RAu) [1, 2, 13, 19, 24], but occasionally the tumor may arise in the left-sided cardiac chambers [1, 11, 19].

Presenting signs of cardiac HSA are usually related to pericardial effusion (PE), cardiac tamponade and signs of right-sided heart failure, including lethargy, collapse, abdominal distention, exercise intolerance and dyspnea and cough [2, 9, 29, 30, 33]. Common abnormalities on physical examination include muffled heart sounds, tachycardia, pale mucous membranes, weak femoral pulses, an abdominal fluid wave and increased respiratory effort [2, 29, 30, 33]. Common laboratory findings include neutrophilia, mild regenerative anemia and large numbers of circulating nucleated and immature red blood cells [2, 17, 22, 29]. Two-dimensional echocardiography is reportedly useful for detection of cardiac masses [12, 22]; however, reports demonstrating its diagnostic value are limited.

Treatment for cardiac HSA in dogs may include medical and surgical options, although a diagnosis of cardiac HSA generally indicates an extremely poor prognosis [30]. By the time of diagnosis, the tumor has usually metastasized, which may lead owners to opt for palliative treatment, such as repeated pericardiocentesis with or without adjuvant chemotherapy [6, 30]. Pericardiocentesis is usually associated with marked clinical improvement, but clinical signs of cardiac tamponade typically recur within a few days, often resulting in death or prompting euthanasia [30]. More aggressive approaches to the treatment of cardiac HSA include various combinations of pericardectomy, tumor resection and chemotherapy [30, 33]. If identified early without gross evidence of multiple organ metastases, the primary tumor can sometimes be removed surgically, particularly when it is localized to the RAu [10]. Chemotherapy, especially with doxorubicin, following tumor resection may prolong survival, but the benefit appears to be small [33].

In the study presented here, we aimed to clarify the epidemiological, clinical and pathological features of 51 canine cases of primary cardiac HSA and to determine the survival times of dogs with right atrial or auricular HSA treated by pericardectomy and tumor resection with or without adjuvant chemotherapy.

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