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Thursday, September 5, 2013

Resolved Fibrosarcoma in a horse!

Several months ago I presented a case involving a gelding that presented for lameness and soft tissue swelling along the outside of the right knee (carpus). The gelding was lame at the walk and hesitant to flex the limb at the carpus. Ultrasound exam revealed a well demarcated soft tissue mass (dark tissue inside blue circle) that was centered over the carpus (Figures 1-3). The histopathology report was consistent with a fibrosarcoma.

Figure 1
Because the tumor was located immediately adjacent to the joint capsule of the carpus, surgical removal was considered high risk. As such, the tumor was injected with a chemotherapy agent called Cisplatin via ultrasound guidance. The tumor was injected twice, approximately 30 days apart. There was a moderate reduction in the size of the tumor just 3 weeks after the first injection and the gelding was no longer lame at the walk and was more willing to flex the limb at the carpus.

Figure 2

Figure 3
 The gelding's limb was evaluated 4 weeks after the second Cisplatin treatment. There was no evidence of the fibrosarcoma on the outside of the carpus AND under the skin (Figure 5). The ultrasound exam only noted normal subcutaneous tissue and joint capsule between the ultrasound probe and the carpus. The gelding was sound at the walk, trot, canter and has returned to full work!! The case is a good example of the benefits of intra-lesional injection of tumors that are non-operable with chemotherapy agents. There are several chemotherapy agents available and the procedure can be performed at the barn with ultrasound guidance.

Figure 4

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