一例金毛猎犬肝脏组织细胞肉瘤的多模态诊疗与长期生存分析

Multimodal Diagnosis, Treatment and Long-Term Survival Analysis of a Primary Hepatic Histiocytic Sarcoma in a Golden Retriever

摘要: 目的(Objective)：探讨多模态诊疗策略对犬原发性肝脏组织细胞肉瘤(HHS)的诊疗价值及生存获益。方法(Methods)：报告一例14岁雄性绝育金毛猎犬病例。通过体格检查、实验室检查(血常规、生化、CRP)、多模态影像学(X线、超声、超声造影CEUS、磁共振MRI)、细胞学及组织病理学确诊为原发性HHS。先行肿瘤细胞减灭术(减瘤率 > 85%)，术后14天启动口服酪氨酸激酶抑制剂帕唑帕尼(3 mg/kg, Q24H)以抑制血管生成，术后第14天加用多柔比星化疗(30 mg/m²，Q3W，共5周期)。不良反应监测方案：化疗前/后48小时全血细胞计数(骨髓抑制)；血压测量(Q2W)；尿蛋白肌酐比(UPCR, Q4W)；肝功能(ALT/ALKP, Q4W)；心脏超声(每2周期)。结果(Results)：患犬呈现食欲废绝、咳嗽、脓血性鼻涕及腹部肿块。实验室检查提示贫血、肝损伤及炎症。CEUS显示肝脏占位动脉期环状高增强，门脉期快速廓清(>40%/min，“快进快出”模式)。MRI显示T1WI稍低信号、T2WI/STIR中高信号、DWI高信号(弥散受限)，动态增强呈“快进快出”。细胞学及组织病理学确诊为恶性组织细胞肉瘤。术后联合治疗耐受性良好，未出现严重高血压(收缩压 < 160 mmHg)、蛋白尿(UPCR < 0.5)或肝毒性。确诊后总生存期(OS)达456天。确诊后15个月并发鼻腔鳞状上皮癌，最终实施安乐死。结论(Conclusion)：本例表明，手术减瘤联合多柔比星化疗及帕唑帕尼靶向治疗的多模式方案，可能显著延长犬HHS生存期(较文献报道多柔比星单药方案中位生存期(169天)提升268%)。多模态影像(CEUS, MRI)对HHS的术前诊断和评估具有重要价值。老年犬肿瘤管理中需警惕化疗相关继发癌变风险。

Abstract: Objective: To evaluate the diagnostic value and survival benefits of a multimodal strategy for canine primary hepatic histiocytic sarcoma (HHS). Methods: A 14-year-old castrated male Golden Retriever was diagnosed with primary HHS via physical examination, laboratory tests (CBC, serum biochemistry, CRP), multimodal imaging (radiography, ultrasonography, contrast-enhanced ultrasonography [CEUS], magnetic resonance imaging [MRI]), cytology, and histopathology. The treatment protocol was designed based on cytoreductive enhancement theory: Cytoreductive surgery (>85% cytoreduction rate) was performed first, followed by oral pazopanib (tyrosine kinase inhibitor; 3 mg/kg, Q24H) initiated on postoperative day 14 to inhibit angiogenesis. Doxorubicin chemotherapy (30 mg/m², Q3W, 5 cycles) commenced on postoperative day 14. Adverse event monitoring included: CBC 48 h pre/post-chemotherapy (myelosuppression); blood pressure Q2W; UPCR (urine protein-to-creatinine ratio) Q4W; hepatic enzymes (ALT/ALKP) Q4W; echocardiography every 2 cycles. Results: The dog presented with anorexia, cough, purulent/bloody nasal discharge, and an abdominal mass. Laboratory findings revealed anemia, hepatic injury, and inflammation. CEUS showed ring-like hyperenhancement in the arterial phase and rapid washout (>40%/min, “wash-in/wash-out” pattern) in the portal phase. MRI demonstrated: hypointense T1WI, hyperintense T2WI/STIR, restricted diffusion on DWI, and dynamic “wash-in/wash-out” enhancement. Cytology/histopathology confirmed malignant HS. The combined therapy was well-tolerated without significant hypertension (SBP < 160 mmHg), proteinuria (UPCR < 0.5), or hepatotoxicity. Overall survival (OS) was 456 days. Nasal squamous cell carcinoma developed at 15 months post-diagnosis, leading to euthanasia. Conclusion: Cytoreductive surgery combined with doxorubicin and pazopanib significantly prolonged survival in canine HHS (268% increase versus literature-reported median survival of 169 days with doxorubicin monotherapy). Multimodal imaging (CEUS, MRI) provides critical preoperative diagnostic and staging information. Vigilance for chemotherapy-associated secondary carcinogenesis is essential in geriatric canine oncology.