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Smithwick Keen Acc # 139621

Smithwick Keen Acc # 139621. Trisha J Oura , DVM 9/27/2010. Smithwick. 10 month old MC Scottish Terrier Chronic hematuria Normal stream initially then dribbles of blood-tinged urine Otherwise normal. Smithwick. rDVM positive contrast cystogram : Filling defect near trigone

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Smithwick Keen Acc # 139621

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  1. Smithwick KeenAcc # 139621 Trisha J Oura, DVM 9/27/2010

  2. Smithwick • 10 month old MC Scottish Terrier • Chronic hematuria • Normal stream initially then dribbles of blood-tinged urine • Otherwise normal

  3. Smithwick • rDVM positive contrast cystogram: • Filling defect near trigone • Rule out: hematoma vs. mass • UA: brown, cloudy, USG = 1.036 • 3+ protein, 3+ blood • Cystospin from UA: suppurative inflammation with mild epithelial dysplasia

  4. Hyperechoic, broad-based, mass arising from left caudoventral bladder wall • Cystic structures along cranial margin of the mass

  5. DDX: • TCC (too young?) • LSA (too irregular?) • Leiomyosarcoma/-oma (too irregular?) • Fibrosarcoma, SCC (too weird?) • OR….. BOTRYOID RHABDOMYOSARCOMA

  6. BotryoidRhabdomyosarcoma • Bladder tumors in uncommon in dogs, most = epithelial origin and malignant • Rhabdomyosarcoma= tumor of striated muscle, can occur elsewhere (bladder, repro, skull) • Embryonal and alveolar forms occur in juveniles • Pleomorphic form occurs in adults • Arising from mucous membrane often = botryoid Botryoid= having the form of a bunch of grapes

  7. BotryoidRhabdomyosarcoma • But why is skeletal muscle in the bladder? • Embryo: UB formed when mesoderm folds medially to divide cloaca (endoderm) into rectum (dorsal) and bladder (ventral) • This division = urorectal septum = made of mesoderm • Urinary bladder: ventral portion = endoderm, but the dorsal wall = mesoderm • Tumors may arise from pleuripotentmesodermal cells

  8. BotryoidRhabdomyosarcoma • More common in larger breed, females, up to 2 yo • Embryonalrhabdomyosarcoma = most common soft tissue neoplasia in children <15yo • Clinical signs related to lower urinary tract • Metastases are possible • Uncommon, later in course of disease • Peritoneal metsreported post surgical resection • Also associated with hypertrophic osteopathy (even without pulmonary mets)

  9. Urinary Rhabdomyosarcomain the Literature • 1973 = largest case series of 7 dogs • Case reports: • Bassett, St. Bernard*, Doberman, LabX, Irish Setter, Newfoundland • Females > males • Mass in caudal UB (usually dorsal wall), +/- ureteral obstruction w/ possible hydroureter/hydronephrosis, prostatic invasion, 1 primary urethral mass • Recurrence with surgical resection • Multiple mets: liver, lung, lymph node, musculature, peritoneum if history of surgery!

  10. Prognosis? • Guarded • Most are euthanized soon after diagnosis • Tumors recur unless very aggressive surgery • Only 1 case in literature with post-op chemotherapy • Metasasis seems to occur later in disease • Humans: treatment of choice = cystectomy with re-routing of ureters into colon, chemotherapy and radiation therapy!

  11. Not Just for Young Big Dogs….or Bladders… • 11 mo F Rottweiler – gingival AND UB • 1.5 yo F Bassett – oropharynx • 2yo FI Golden - retroperitoneal • 10 yoFS mixed breed – vagina • 2 yo MC cat - liver • Yearling QH – uterus • Yearling Appaloosa - vagina

  12. What About Smithwick? • Surgical resection of the tumor following initial abdominal ultrasound • Histopathology = consistent with botryoidrhabdomyoscaroma with incomplete margins • Surgical revision 09/24/10

  13. To Be Continued….

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