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1.
Acta sci. vet. (Impr.) ; 51(supl.1): Pub. 874, 2023. ilus
Artigo em Inglês | VETINDEX | ID: biblio-1434865

Resumo

Background: Osteosarcoma is the most observed primary bone tumor in dogs, and may affect the appendicular and axial skeletons. In addition, it may be present in extraskeletal form, accounting for only 1% of cases. As shown by few reports in the literature, the involvement of the intestinal region by is rare. The objective of this study was to report the case of a 13-year-old Yorkshire dog, submitted to an exploratory laparotomy for suspected partial intestinal obstruction, diagnosed with extraskeletal osteosarcoma. Case: A 13-year-old dog, Yorkshire Terrier, male, presented clinical signs of gastrointestinal abnormalities. An ultrasound examination was performed and was found a mass in small intestine region with wall and lumen invasion. Then, was realized exploratory laparotomy and detected intestinal obstruction due to a mass with approximately 5.0 x 6.0 x 4.4 cm localized in duodenum. Surgical removal was performed and the sample sent to the veterinary diagnostic laboratory for histopathological examination. The sample had an irregular surface and firm consistency. In addition, when cut, the mass enveloped the intestinal layers and sometimes obstructed the lumen. Then, the sample were processed routinely for histopathology. After that, in microscopy evaluation was detected cell proliferation, affecting all layers of intestine. In detail, cells were elongated with pleomorphism marked and atypical mitosis. In addition, there was production of cartilage and bone matrix. So, due the absence of others sites, the neoplasm was considered primary of intestine. After that, to evaluate the expression of KI-67 and COX-2 was performed, and the cell proliferation index was 54.0% and the COX-2 expression was moderate in less than 10% of neoplastic cells. After the surgery, the patient was hospitalized for a week and continue the treatment in home. Afterwards, the tutor received the diagnosis, but even though he was instructed on the severity of the case, he chose not to undergo chemotherapy. After three months, the patient presented abdominal fluid and nodules in your liver, suggesting metastasis, but without diagnosis confirmation. The patient died five months after the diagnosis of extraskeletal osteosarcoma. However, no necropsy was realized, impossibility the diagnosis confirm. Discussion: The frequency of extraskeletal osteosarcoma in dogs remains unknown, with the mammary glands being the most affected site. In the present study, osteosarcoma affects the duodenal region and no reports of this neoplasm in the duodenum of dogs have been found in the literature. The clinical sign of dyschezia was important for the tutor to refer the animal to the veterinarian and perform the ultrasound in an attempt to elucidate the case, as the tumor mass is not always palpable. Histopathological examination and immunohistochemistry were necessary for the differential diagnosis and to establish the prognosis, although after the surgery the tutor chose not to perform chemotherapy. Extraskeletal osteosarcoma are usually highly metastatic, mainly affecting the lymph nodes and liver. In this case, the patient presented a liver nodule three months after the tumor removal surgery, but unfortunately, there was no diagnostic confirmation. Such neoplastic type is rarer and more aggressive than appendicular and axial osteosarcoma, with an average survival of 1 to 3 months. In this case, as a necropsy was not obtained, we cannot attribute the survival time to the disease. The survival rates of osteosarcomas in dogs are few months, but in the present case, although the patient died five months after surgery, the failure to perform a necropsy compromises the attribution of survival time to extraskeletal osteosarcoma.


Assuntos
Animais , Masculino , Cães , Neoplasias Ósseas/veterinária , Osteossarcoma/veterinária , Duodeno/patologia , Imuno-Histoquímica/veterinária
2.
Vet. Not. (Online) ; 27(3): 24-33, 1 out. 2021. ilus, tab
Artigo em Inglês | VETINDEX | ID: biblio-1502544

Resumo

Osteosarcoma is the most common bone cancer in dogs. It has a high invasion capacity and commonly metastasizes. This neoplasia ensues mainly in the medullary canal of long bones of the appendicular and axial skeleton, rarely affecting primarily extra-skeletal sites. Primary meningeal osteosarcomas are extremely rare both in human and veterinary medicine. A male, mixed breed dog was admitted at the Veterinary Hospital with a history of over excitement, decreased neurological reflexes, and seizures. The worsening of its clinical condition led to its euthanasia and anatomopathological examination at the Veterinary Pathology Service. This report describes a primary extra-skeletal osteosarcoma of a dog’s meninges. Its clinical signs were indicative of a central nervous system disease later diagnosed by histopathological and immunohistochemical analysis.


O osteossarcoma é considerado a neoplasia óssea mais frequente em cães. Tem elevada capacidade invasiva e comumente gera metástase. Essa neoplasia é mais frequentemente observada no canal medular de ossos longos do esqueleto apendicular e axial. É raro que acometa primariamente sítios extraesqueléticos. O osteossarcoma primário meningeal é considerado extremamente raro em medicinas humana e veterinária. Um cão macho e sem raça definida foi atendido no Hospital Veterinário com histórico de excitação, diminuição dos reflexos neurológicos e desenvolvimento de quadro convulsivo. O agravamento do quadro clínico levou à eutanásia do animal e a um exame anatomopatológico pelo Serviço de Patologia Veterinária. O objetivo deste relato é descrever um caso de osteossarcoma extra-esquelético primário de meninge em um cão que apresentou quadro clínico compatível com doença originária do sistema nervoso central e que foi diagnosticado por meio das análises histopatológica e imunohistoquímica.


Assuntos
Masculino , Animais , Cães , Encéfalo/patologia , Meninges/patologia , Osteossarcoma/diagnóstico , Osteossarcoma/veterinária , Imuno-Histoquímica/veterinária , Neoplasias Meníngeas/veterinária , Neoplasias Ósseas/veterinária
3.
Vet. Not. ; 27(3): 24-33, 1 out. 2021. ilus, tab
Artigo em Inglês | VETINDEX | ID: vti-32244

Resumo

Osteosarcoma is the most common bone cancer in dogs. It has a high invasion capacity and commonly metastasizes. This neoplasia ensues mainly in the medullary canal of long bones of the appendicular and axial skeleton, rarely affecting primarily extra-skeletal sites. Primary meningeal osteosarcomas are extremely rare both in human and veterinary medicine. A male, mixed breed dog was admitted at the Veterinary Hospital with a history of over excitement, decreased neurological reflexes, and seizures. The worsening of its clinical condition led to its euthanasia and anatomopathological examination at the Veterinary Pathology Service. This report describes a primary extra-skeletal osteosarcoma of a dogs meninges. Its clinical signs were indicative of a central nervous system disease later diagnosed by histopathological and immunohistochemical analysis.(AU)


O osteossarcoma é considerado a neoplasia óssea mais frequente em cães. Tem elevada capacidade invasiva e comumente gera metástase. Essa neoplasia é mais frequentemente observada no canal medular de ossos longos do esqueleto apendicular e axial. É raro que acometa primariamente sítios extraesqueléticos. O osteossarcoma primário meningeal é considerado extremamente raro em medicinas humana e veterinária. Um cão macho e sem raça definida foi atendido no Hospital Veterinário com histórico de excitação, diminuição dos reflexos neurológicos e desenvolvimento de quadro convulsivo. O agravamento do quadro clínico levou à eutanásia do animal e a um exame anatomopatológico pelo Serviço de Patologia Veterinária. O objetivo deste relato é descrever um caso de osteossarcoma extra-esquelético primário de meninge em um cão que apresentou quadro clínico compatível com doença originária do sistema nervoso central e que foi diagnosticado por meio das análises histopatológica e imunohistoquímica.(AU)


Assuntos
Animais , Masculino , Cães , Osteossarcoma/diagnóstico , Osteossarcoma/veterinária , Meninges/patologia , Encéfalo/patologia , Neoplasias Ósseas/veterinária , Imuno-Histoquímica/veterinária , Neoplasias Meníngeas/veterinária
4.
Acta sci. vet. (Impr.) ; 49(suppl.1): Pub.626-Jan 4, 2021. ilus
Artigo em Inglês | VETINDEX | ID: biblio-1458489

Resumo

Background: Extraskeletal osteosarcoma (EOS), a rare variant of osteosarcoma (OS), is a malignant neoplasm that develops insoft tissues without primary bone involvement. This study aims to describe a case of EOS with a mediastinal location in a canine.Case: A 10-year-old male Uruguayan Cimarron dog, was presented to the Laboratório Regional de Diagnóstico, Faculdadede Veterinária, Universidade Federal de Pelotas (LRD/FV/UFPel) for necropsy. The dog had a history of submandibularswelling, progressive hind limb paralysis, muscle atrophy, and breathing difficulties. During necropsy, in the thoracic cavity,approximately 900 mL of serosanguinous exudate and a reddish-brown, bossed mediastinal mass measuring 15.0 cm in thelongest axis were also noted. The lung exhibited multifocal to coalescent, white, firm nodules extending from the pleurato the parenchyma and measuring up to 4.5 cm in diameter. In the parietal and occipital region of the brain, a matte winemass measuring 2.3 cm in the longest axis was observed. Fragments of the neoplastic mass, organs of the abdominal andthoracic cavities, and the brain were harvested and fixed in 10% buffered formalin. After 48 h, the samples were routinelyprocessed, incorporated in paraffin, cut into 3 µm-thick sections, and stained using Hematoxylin and Eosin (HE). Selectedsections of the neoplasm, the lung, and the brain were subjected to Von Kossa staining and immunohistochemical (IHC)analysis. For IHC, primary anti-cytokeratin monoclonal antibodies (clone AE1 / AE3, BioCare Medical) at a 1:100 dilution, vimentin (clone V9, BioCare Medical) at a 1:100 dilution, S100 Protein (clone 15E2E2, BioCare Medical) at a 1:100dilution, and Ki67 (SP6 clone, BioCare Medical) at a 1:50 dilution were used. Immunostaining ...


Assuntos
Masculino , Animais , Cães , Cães , Metástase Neoplásica , Neoplasias do Mediastino/veterinária , Osteossarcoma/veterinária , Neoplasias Encefálicas/veterinária , Neoplasias Pulmonares/veterinária
5.
Acta sci. vet. (Online) ; 49(suppl.1): Pub. 626, Apr. 9, 2021. ilus
Artigo em Inglês | VETINDEX | ID: vti-763434

Resumo

Background: Extraskeletal osteosarcoma (EOS), a rare variant of osteosarcoma (OS), is a malignant neoplasm that develops insoft tissues without primary bone involvement. This study aims to describe a case of EOS with a mediastinal location in a canine.Case: A 10-year-old male Uruguayan Cimarron dog, was presented to the Laboratório Regional de Diagnóstico, Faculdadede Veterinária, Universidade Federal de Pelotas (LRD/FV/UFPel) for necropsy. The dog had a history of submandibularswelling, progressive hind limb paralysis, muscle atrophy, and breathing difficulties. During necropsy, in the thoracic cavity,approximately 900 mL of serosanguinous exudate and a reddish-brown, bossed mediastinal mass measuring 15.0 cm in thelongest axis were also noted. The lung exhibited multifocal to coalescent, white, firm nodules extending from the pleurato the parenchyma and measuring up to 4.5 cm in diameter. In the parietal and occipital region of the brain, a matte winemass measuring 2.3 cm in the longest axis was observed. Fragments of the neoplastic mass, organs of the abdominal andthoracic cavities, and the brain were harvested and fixed in 10% buffered formalin. After 48 h, the samples were routinelyprocessed, incorporated in paraffin, cut into 3 µm-thick sections, and stained using Hematoxylin and Eosin (HE). Selectedsections of the neoplasm, the lung, and the brain were subjected to Von Kossa staining and immunohistochemical (IHC)analysis. For IHC, primary anti-cytokeratin monoclonal antibodies (clone AE1 / AE3, BioCare Medical) at a 1:100 dilution, vimentin (clone V9, BioCare Medical) at a 1:100 dilution, S100 Protein (clone 15E2E2, BioCare Medical) at a 1:100dilution, and Ki67 (SP6 clone, BioCare Medical) at a 1:50 dilution were used. Immunostaining ...(AU)


Assuntos
Animais , Masculino , Cães , Neoplasias do Mediastino/veterinária , Osteossarcoma/veterinária , Cães , Metástase Neoplásica , Neoplasias Pulmonares/veterinária , Neoplasias Encefálicas/veterinária
6.
Acta sci. vet. (Impr.) ; 48(suppl.1): Pub.530-4 jan. 2020. ilus
Artigo em Português | VETINDEX | ID: biblio-1458357

Resumo

Background: The mammary neoplasms are highly frequent in female dogs. It is characterized by the proliferation of epithelial or mesenchymal cells. The mammary osteosarcoma is a example of the proliferation of the last group and its main feature is production of osteoid matrix and areas of mature bone tissue formation. Metastases to the lungs and regional lymph nodes are frequent, however some other metastasis sites have been reported. The aim of this study is to report a mammary osteosarcoma in a 12-year-old mixed-breed female dog with multiple metastases and neoplastic emboli to the central nervous system. Case: The animal was brought to the Veterinary Hospital of the Uberlândia Federal University (HV/UFU) with the complaint of increase in the volume of the mammary glands. The cytopathological exams was performed in the mass that measured 15 cm of diameter and covering a large region of the mammary gland, from the right cranial thoracic to the right cranial abdominal mammary gland. The cytological diagnostic was inconclusive because of the lack of material for diagnosis. Therefore, total unilateral mastectomy was performed for histopathology analysis. The material was then sent to the Animal Pathology Laboratory of the HV/UFU where routine processing was performed. The microscopy showed proliferation of mesenchymal cells arranged in bundles with intense pleomorfism and producing osteoid matrix, leading to the diagnosis of mammary osteosarcoma. Around 15 days after the diagnostic the animal died and was sent the Animal Pathology Laboratory of the HV/UFU for necropsy. During the external exam there was a mass at the same site of the primary mass previously extracted. Besides it, there were masses affecting lungs, intestine and kidneys. The histopathological exam showed sites of metastasis of osteosarcoma in the organs described, as well as neoplastic...


Assuntos
Feminino , Animais , Cães , Metástase Neoplásica , Neoplasias Mamárias Animais , Neoplasias do Sistema Nervoso Central/secundário , Neoplasias do Sistema Nervoso Central/veterinária , Osteossarcoma/veterinária
7.
Acta sci. vet. (Online) ; 48(suppl.1): Pub. 530, 5 set. 2020. ilus
Artigo em Português | VETINDEX | ID: vti-765356

Resumo

Background: The mammary neoplasms are highly frequent in female dogs. It is characterized by the proliferation of epithelial or mesenchymal cells. The mammary osteosarcoma is a example of the proliferation of the last group and its main feature is production of osteoid matrix and areas of mature bone tissue formation. Metastases to the lungs and regional lymph nodes are frequent, however some other metastasis sites have been reported. The aim of this study is to report a mammary osteosarcoma in a 12-year-old mixed-breed female dog with multiple metastases and neoplastic emboli to the central nervous system. Case: The animal was brought to the Veterinary Hospital of the Uberlândia Federal University (HV/UFU) with the complaint of increase in the volume of the mammary glands. The cytopathological exams was performed in the mass that measured 15 cm of diameter and covering a large region of the mammary gland, from the right cranial thoracic to the right cranial abdominal mammary gland. The cytological diagnostic was inconclusive because of the lack of material for diagnosis. Therefore, total unilateral mastectomy was performed for histopathology analysis. The material was then sent to the Animal Pathology Laboratory of the HV/UFU where routine processing was performed. The microscopy showed proliferation of mesenchymal cells arranged in bundles with intense pleomorfism and producing osteoid matrix, leading to the diagnosis of mammary osteosarcoma. Around 15 days after the diagnostic the animal died and was sent the Animal Pathology Laboratory of the HV/UFU for necropsy. During the external exam there was a mass at the same site of the primary mass previously extracted. Besides it, there were masses affecting lungs, intestine and kidneys. The histopathological exam showed sites of metastasis of osteosarcoma in the organs described, as well as neoplastic...(AU)


Assuntos
Animais , Feminino , Cães , Osteossarcoma/veterinária , Neoplasias Mamárias Animais , Metástase Neoplásica , Neoplasias do Sistema Nervoso Central/secundário , Neoplasias do Sistema Nervoso Central/veterinária
8.
Semina ciênc. agrar ; 40(6,supl.2): 3089-3098, 2019. tab, ilus
Artigo em Inglês | VETINDEX | ID: biblio-1501580

Resumo

Extra-skeletal osteosarcoma is a malignant mesenchymal neoplasm that originates from soft tissue. This tumor occurs spontaneously in dogs, but there are few cases described in the literature. The objective of this study was to describe the epidemiological and pathologic features of extra-skeletal osteosarcoma in 36 dogs. Cases diagnosed as osteosarcoma affecting dogs (n=216), during 2006 to 2016 were reviewed. Of these, 36 cases were diagnosed as extra-skeletal osteosarcoma. The mean age of affected dogs was 10.4 years, and the mean weight was 19.5kg. No breed predisposition was observed. The most frequently affected sites were the mammary glands (80.6%; 29/36), subcutaneous tissue (5.6%; 2/36), liver (5.6%; 2/36), spleen (2.8%; 1/36), omentum (2.8%; 1/36), and kidney (2.8%; 1/36). Histological examination revealed that 61.1% (22/36) of the tumors were osteoblastic, 33.3% (12/36) chondroblastic, 2.8% (1/36) fibroblastic, and 2.8% (1/36) were giant cell-rich osteosarcomas. Histological grade II and III were the most frequent. Lymph node metastases were observed in 21.4% (3/14) of the cases of mammary gland osteosarcoma. Distant metastases were observed in 23.1% (3/13) of cases by diagnostic imaging and in 71.4% (5/7) during autopsy. Metastases were observed in the lungs (57.1%; 4/7), liver (14.3%; 1/7), spleen (14.3%; 1/7), and in multiple sites (14.3%; 1/7). Pulmonary metastases were more frequently observed in cases of mammary gland osteosarcoma.


Osteossarcoma extraesquelético é uma neoplasma mesenquimal maligno que se origina de tecidos moles. O neoplasma ocorre espontaneamente em cães, mas há poucos casos descritos na literatura. Este trabalho teve como objetivo descrever os aspectos epidemiológicos e patológicos do osteossarcoma extraesquelético em 36 cães. Casos diagnosticados de osteossarcoma afetando cães (n=216), durante 2006 a 2016 foram revisados. Deste total, 36 casos tiveram diagnóstico de osteossarcoma extraesquelético. A média de idade foi de 10,4 anos, não houve predisposição racial e o peso médio foi de 19,5kg. Os locais acometidos foram glândula mamária (80,6%; 29/36), tecido subcutâneo (5,6%; 2/36), fígado (5,6%; 2/36), baço (2,8%; 1/36), omento (2,8%; 1/36) e rim (2,8%; 1/36). Na histologia, 61,1% (22/36) eram osteoblásticos, 33,3% (12/36) eram condroblásticos, 2,8% (1/36) eram fibroblásticos e 2,8% (1/36) eram ricos em células gigantes. Os graus histológicos II e III foram os mais frequentes. Metástases nodais estavam presentes em 21,4% (3/14) dos casos que ocorreram na mama. Metástases distantes foram constatadas em 23,1% (3/13) dos casos por exames de imagem e em 71,4% (5/7) dos casos pela autópsia. Os locais de metástases foram pulmões (57,1%; 4/7), fígado (14,3%; 1/7), baço (14,3%; 1/7) e em múltiplos sítios (14,3%; 1/7). Metástases pulmonares foram mais frequentes em cadelas com osteossarcoma de glândula mamária.


Assuntos
Animais , Cães , Neoplasias Ósseas/veterinária , Osteossarcoma/epidemiologia , Osteossarcoma/patologia , Osteossarcoma/veterinária , Estudos Retrospectivos
9.
Semina Ci. agr. ; 40(6,supl.2): 3089-3098, 2019. tab, ilus
Artigo em Inglês | VETINDEX | ID: vti-25820

Resumo

Extra-skeletal osteosarcoma is a malignant mesenchymal neoplasm that originates from soft tissue. This tumor occurs spontaneously in dogs, but there are few cases described in the literature. The objective of this study was to describe the epidemiological and pathologic features of extra-skeletal osteosarcoma in 36 dogs. Cases diagnosed as osteosarcoma affecting dogs (n=216), during 2006 to 2016 were reviewed. Of these, 36 cases were diagnosed as extra-skeletal osteosarcoma. The mean age of affected dogs was 10.4 years, and the mean weight was 19.5kg. No breed predisposition was observed. The most frequently affected sites were the mammary glands (80.6%; 29/36), subcutaneous tissue (5.6%; 2/36), liver (5.6%; 2/36), spleen (2.8%; 1/36), omentum (2.8%; 1/36), and kidney (2.8%; 1/36). Histological examination revealed that 61.1% (22/36) of the tumors were osteoblastic, 33.3% (12/36) chondroblastic, 2.8% (1/36) fibroblastic, and 2.8% (1/36) were giant cell-rich osteosarcomas. Histological grade II and III were the most frequent. Lymph node metastases were observed in 21.4% (3/14) of the cases of mammary gland osteosarcoma. Distant metastases were observed in 23.1% (3/13) of cases by diagnostic imaging and in 71.4% (5/7) during autopsy. Metastases were observed in the lungs (57.1%; 4/7), liver (14.3%; 1/7), spleen (14.3%; 1/7), and in multiple sites (14.3%; 1/7). Pulmonary metastases were more frequently observed in cases of mammary gland osteosarcoma.(AU)


Osteossarcoma extraesquelético é uma neoplasma mesenquimal maligno que se origina de tecidos moles. O neoplasma ocorre espontaneamente em cães, mas há poucos casos descritos na literatura. Este trabalho teve como objetivo descrever os aspectos epidemiológicos e patológicos do osteossarcoma extraesquelético em 36 cães. Casos diagnosticados de osteossarcoma afetando cães (n=216), durante 2006 a 2016 foram revisados. Deste total, 36 casos tiveram diagnóstico de osteossarcoma extraesquelético. A média de idade foi de 10,4 anos, não houve predisposição racial e o peso médio foi de 19,5kg. Os locais acometidos foram glândula mamária (80,6%; 29/36), tecido subcutâneo (5,6%; 2/36), fígado (5,6%; 2/36), baço (2,8%; 1/36), omento (2,8%; 1/36) e rim (2,8%; 1/36). Na histologia, 61,1% (22/36) eram osteoblásticos, 33,3% (12/36) eram condroblásticos, 2,8% (1/36) eram fibroblásticos e 2,8% (1/36) eram ricos em células gigantes. Os graus histológicos II e III foram os mais frequentes. Metástases nodais estavam presentes em 21,4% (3/14) dos casos que ocorreram na mama. Metástases distantes foram constatadas em 23,1% (3/13) dos casos por exames de imagem e em 71,4% (5/7) dos casos pela autópsia. Os locais de metástases foram pulmões (57,1%; 4/7), fígado (14,3%; 1/7), baço (14,3%; 1/7) e em múltiplos sítios (14,3%; 1/7). Metástases pulmonares foram mais frequentes em cadelas com osteossarcoma de glândula mamária.(AU)


Assuntos
Animais , Cães , Osteossarcoma/epidemiologia , Osteossarcoma/patologia , Osteossarcoma/veterinária , Neoplasias Ósseas/veterinária , Estudos Retrospectivos
10.
Acta sci. vet. (Impr.) ; 45(suppl.1): 1-4, 2017. ilus
Artigo em Português | VETINDEX | ID: biblio-1457766

Resumo

Background: hypertrophic osteopathy is a periosteum disturb characterized by diffuse new bone formation which leads tosignificant thickening and deformity of members. Secondary in nature, it usually follows large pulmonary lesions such asabscesses and neoplasms. Extraskeletal osteosarcomas are rare and extremely malignant mesenchymal neoplasms. Theycomprise approximately 1% of all domestic animals’ osteosarcomas and develop in the absence of a primary bone lesion.The aim of this paper was to describe a case of hypertrophic osteopathy, involving joints and upper limbs bones includingilium, secondary to a mediastinal chondroblastic osteosarcoma with pulmonary metastasis.Case: A 10-year-old spayed female mixed breed dog, weighing 9 kg, was presented with painful limbs, lameness, hind limbsswelling and a four-month history of weight loss. Radiographic examination revealed bilateral and asymmetric periostealreactions on diaphyseal and/or epiphyseal areas of all proximal phalanges; metacarpal, metatarsal, carpal and tarsal bones;radius; ulna; tibia; fibula; humerus; femur and right ilium. An increased soft tissue radiopacity was noted on the lateral sideof the right knee joint. Thoracic radiographies and ultrasonography suggested the presence of a 5-cm neoplasm or abscessin the left caudal lung lobe. At necropsy, the lobe showed a firm and solid, oval white mass measuring 5.2 x 2.9 cm. Anothermass was found in the caudal mediastinum, near the diaphragm, with same color and more irregular aspect, measuring 3.3cm of diameter. Intense periosteal new-bone formation was seen in the entire length of the four limbs bones, characterizedby thickening of the bone surface and formation of irregular trabeculae perpendicular to the cortex. Significant swelling andthickening of the joint capsule was noted in the right knee. There was no microbial growth on aerobic or anaerobic culturesfrom the masses samples sent to culture. [...]


Assuntos
Animais , Cães , Osteoartropatia Hipertrófica Secundária/veterinária , Osteossarcoma/veterinária , Síndromes Paraneoplásicas/veterinária , Neoplasias Ósseas/veterinária
11.
Acta sci. vet. (Online) ; 45(suppl.1): 1-4, 2017. ilus
Artigo em Português | VETINDEX | ID: vti-16847

Resumo

Background: hypertrophic osteopathy is a periosteum disturb characterized by diffuse new bone formation which leads tosignificant thickening and deformity of members. Secondary in nature, it usually follows large pulmonary lesions such asabscesses and neoplasms. Extraskeletal osteosarcomas are rare and extremely malignant mesenchymal neoplasms. Theycomprise approximately 1% of all domestic animals osteosarcomas and develop in the absence of a primary bone lesion.The aim of this paper was to describe a case of hypertrophic osteopathy, involving joints and upper limbs bones includingilium, secondary to a mediastinal chondroblastic osteosarcoma with pulmonary metastasis.Case: A 10-year-old spayed female mixed breed dog, weighing 9 kg, was presented with painful limbs, lameness, hind limbsswelling and a four-month history of weight loss. Radiographic examination revealed bilateral and asymmetric periostealreactions on diaphyseal and/or epiphyseal areas of all proximal phalanges; metacarpal, metatarsal, carpal and tarsal bones;radius; ulna; tibia; fibula; humerus; femur and right ilium. An increased soft tissue radiopacity was noted on the lateral sideof the right knee joint. Thoracic radiographies and ultrasonography suggested the presence of a 5-cm neoplasm or abscessin the left caudal lung lobe. At necropsy, the lobe showed a firm and solid, oval white mass measuring 5.2 x 2.9 cm. Anothermass was found in the caudal mediastinum, near the diaphragm, with same color and more irregular aspect, measuring 3.3cm of diameter. Intense periosteal new-bone formation was seen in the entire length of the four limbs bones, characterizedby thickening of the bone surface and formation of irregular trabeculae perpendicular to the cortex. Significant swelling andthickening of the joint capsule was noted in the right knee. There was no microbial growth on aerobic or anaerobic culturesfrom the masses samples sent to culture. [...](AU)


Assuntos
Animais , Cães , /complicações , Osteossarcoma/veterinária , Osteoartropatia Hipertrófica Secundária/veterinária , Síndromes Paraneoplásicas/veterinária , Neoplasias Ósseas/veterinária
12.
Tese em Português | VETTESES | ID: vtt-212990

Resumo

Neoplasias em animais domésticos são afecções crescentes em medicina veterinária, especialmente devido ao aumento da longevidade destes animais e aos melhores métodos de diagnóstico. Em cães, os tumores ósseos são relativamente comuns e o osteossarcoma, representa 85% das neoplasias ósseas diagnosticadas nesta espécie. Este trabalho teve como objetivo descrever os aspectos epidemiológicos, clínicos e patológicos do osteossarcoma canino de 2006 a 2018 e avaliar fatores prognósticos associados ao neoplasma. Os materiais e métodos aplicados e resultados obtidos foram apresentados em dois artigos científicos. O primeiro artigo descreve os aspectos epidemiológicos e patológicos de 36 casos de osteossarcoma extraesquelético em cães. No período analisado, 2006 a 2016, o osteossarcoma acometeu os tecidos moles em 16,7% dos casos. As fêmeas, com média de 10,4 anos de idade e peso médio de 19,5 kg foram mais acometidas. Não houve predisposição racial. Os principais locais foram: glândula mamária (80,6%), tecido subcutâneo (5,6%) e fígado (5,6%). Na histologia, os osteossarcomas osteoblásticos (61,1%) de grau II e III foram os mais frequentes. Metástases nodais ocorreram em 21,4% dos casos na mama. Metástases distantes ocorreram nos pulmões (57,1%), fígado (14,3%), baço (14,3%) e em múltiplos sítios (14,3%). Metástases pulmonares foram mais frequentes em cadelas com osteossarcoma de glândula mamária. O segundo artigo descreve os aspectos clínico-patológicos de 153 casos de ostessarcoma apendicular em cães, dos quais os dados de sobrevida de 22 caninos submetidos a intervenções cirúrgicas e à quimioterapia foram confrontados estatisticamente com os dados clínicos, histopatológicos e imunohistoquímicos para correlação prognóstica. No período analisado, 2008 a 2018, o osteossarcoma acometeu o tecido ósseo em 83% dos casos e deste, 82% envolviam o esqueleto apendicular. A média de idade foi de nove anos e o peso médio de 33,4 kg. Não houve predileção sexual. A raça pura mais acometida foi o Rottweiler (42%). Os principais locais acometidos foram: úmero proximal (95%), fêmur distal (70%), rádio distal (96%) e tíbia proximal (56%). Na histologia, o subtipo osteoblástico foi o mais frequente (57%). Metástases nodais ocorreram em 14% dos casos. Metástases distantes ocorreram em 75% dos casos, nos quais o pulmão (43%) foi o principal órgão acometido. Quanto à análise de fatores prognósticos, o peso, idade, sexo, membro e osso afetado, classificação histológica, contagem mitótica e grau histológico não influenciaram na sobrevida (p > 0,05). Neoplasmas na extremidade proximal dos membros tiverem uma tendência a um pior prognóstico (p=0,06). Para estes casos, a taxa de sobrevida em um ano foi de 14,3%, enquanto que na extremidade distal a taxa foi de 46,7%. Não houve diferença significativa em relação à sobrevida quando utilizadas as técnicas de amputação ou preservação do membro, desde que associadas à quimioterapia (p=0,20). A sobrevida para estes casos variou de 73 a 1185 dias e a média foi de 394 dias. Todos os casos apresentaram marcação citoplasmática para osteopontina, porém a intensidade e o percentual de células neoplásicas marcadas não influenciaram na sobrevida (p > 0,05). Em 80% dos casos com metástases deste estudo houve marcação acentuada para osteopontina.


Neoplasms in domestic animals are increasing in veterinary medicine, especially due to the increased longevity of these animals and the best diagnostic methods. In dogs, bone tumors are relatively common and osteosarcoma accounts for 85% of the bone neoplasms diagnosed in this species. The objective of this study was to describe the epidemiological, clinical and pathological aspects of canine osteosarcoma from 2006 to 2018 and to evaluate prognostic factors associated with neoplasm. The materials and methods applied and results obtained were presented in two scientific papers. The first article describes the epidemiological and pathological aspects of 36 cases of extra-skeletal osteosarcoma in dogs. In the analyzed period, from 2006 to 2016, osteosarcoma affected the soft tissues in 16.7% of cases. Females, with a mean age of 10.4 years, mean weight of 19.5 kg were the most affected. There was no racial predisposition. The main sites were: mammary gland (80.6%), followed by subcutaneous tissue (5.6%) and liver (5.6%). In histology, osteoblastic osteosarcomas (61.1%) of grade II and III were the most frequent. Nodal metastases were present in 21.4% of the cases that occurred in the breast. Distant metastases occurred in the lungs (57.1%), liver (14.3%), spleen (14.3%) and multiple sites (14.3%). Pulmonary metastases were more frequent in bitches with osteosarcoma of the mammary gland. The second article describes the clinical-pathological aspects of 153 cases of appendicular ostessarcoma in dogs, of which the survival data of 22 canine submitted to surgery and chemotherapy were statistically compared with the clinical, histopathological and immunohistochemical data for prognostic correlation. In the analyzed period, from 2008 to 2018, the osteosarcoma affected the bone tissue in 83% of the cases and of this, 82% involved the appendicular skeleton. The mean age was 9 years and the mean weight was 33.4 kg. There was no sexual predilection. The pure breed most affected was the Rottweiler (42%). The main sites were: proximal humerus (95%), distal femur (70%), distal radius (96%) and proximal tibia (56%). In histology, osteoblastic osteosarcomas were more frequent (57%). Nodal metastases occurred in 14% of cases. Distant metastases occurred in 75% of cases, in which the lung (43%) was the main organ affected. Regarding the analysis of prognostic factors, weight, age, sex, affected limb and bone, histological classification, mitotic count and histological grade did not influence survival (p> 0.05). Neoplasms located at the proximal extremities of the limbs tend to have a poor prognosis (p = 0.06). For these cases, the survival rate at one year was 14.3%, while at the distal end the rate was 46.7%. There was no significant difference in survival when using amputation or limb preservation techniques, since they were associated with chemotherapy (p = 0.20). The survival of these dogs ranged from 73 to 1185 days, with a mean of 394 days. All cases presented cytoplasmic marking for osteopontin, but the intensity and percentage of marked neoplastic cell did not influence the survival (p> 0.05). In 80% of the cases with metastases from this study there was marked marking for osteopontin.

13.
Acta sci. vet. (Impr.) ; 40(2): Pub. 1042, 2012. ilus
Artigo em Português | VETINDEX | ID: biblio-1373567

Resumo

Background: Chondrosarcoma is a malignant neoplasm originated from chondroid cells with production of cartilage matrix with lot of degrees of differentiation. It may be found in skeletal or extraskeletal tissue, more commonly in flat bones. It most often has an aggressive behavior with involvement of bone and adjacent soft tissues, which necessitates their rapid identification, surgical intervention and therapy. Chondrosarcoma is reported as uncommon neoplasm in the nasal cavity of dogs and should be distinguished by both other malignancies and for non-neoplastic diseases. Case: A 7-years-old dog, mixed breed, male, had a swelling in the nasal cavity for more than 30 days. The change was seen in the right frontal-nasal region with invasion of the oral cavity, with serous nasal discharge and also, inspiratory and expiratory noises. Even after cytology and biopsy of the tumor to chemotherapy instituted, there was not successful and the dog was euthanized. At necropsy, there was a large multilobulated mass, with firm consistency, interspersed with soft areas in the right nasal region. In the cut surface, the mass showed staining grayish-white interspersed with dark areas, which block most of the nasal cavity causing partial lysis of frontal, temporal and tubinates bones, as well as purulent secretion of the frontal sinuses (sinusitis). Microscopically, the mass consisted of mesenchymal neoplastic cells arranged in bundles or nodules without orientation, separated by fine bands of fibrous connective tissue poorly vascularized. The neoplastic cells showed round to oval nucleus, sparse chromatin and conspicuous nucleoli. Some areas were more solid and composed of cells with few cytoplasm, similar to chondroblastic cells. It was observed multifocal areas of chondroid matrix formation. Discussion: Based on pathological findings, the diagnosis of chondrosarcoma was confirmed. The histopathological findings confirmed the diagnosis of chondrosarcoma suggested by cytology. Despite being an uncommon neoplasm in dogs, chondrosarcoma should be considered as differential diagnosis of other nasal diseases that can lead macroscopic changes and similar clinical signs. The osteosarcoma is the most common bone tumor of the nasal cavity in dogs. The similarity of the macroscopic findings of chondrosarcoma and oesteosarcoma, as well as histological and immunohistochemical stain, may be a challenge to diagnosis for the clinician and pathologist. Other neoplasms such as squamous cell carcinoma, fibrosarcoma and hemangiosarcoma, as well as proliferative rhinitis caused by fungal agents, should also be considered in the differential diagnosis. These conditions can be differentiated by microscopic features and immunohistochemical stain. The fine needle aspiration biopsy is an important method, however to establish the definitive diagnosis is always required histopathologic evaluation. In primary chondrosarcoma of the nasal cavity in dogs, the survival with treatment is made from three to six months, however, often results in local severe invasion and serious clinical changes. In this case, the treatment was not effective because the degree of tumor differentiation and infiltration of the surrounding structures, as well as worsens of the clinical signs. The knowledge of the clinicopathological findings and biology of this tumor is essential for rapid diagnosis and more effective clinical interventions.


Assuntos
Animais , Masculino , Cães , Neoplasias Nasais/veterinária , Condrossarcoma/diagnóstico , Doenças do Cão/diagnóstico , Cavidade Nasal
14.
Clín. Vet. (São Paulo, Ed. Port.) ; 21(120): 52-58, 2016. ilus
Artigo em Português | VETINDEX | ID: biblio-1481034

Resumo

Osteossarcoma extraesquelético em cães é um tipo raro de câncer ósseo,com capacidade de acometer outros órgãos e tecidos epiteliais. Este estudotem como objetivo relatar o caso de um cão macho da raça rotweiller comosteossarcoma extraesquelético em glândula tireoide e evolução de três meses, desde a sua manifestação clínica. Durante a consulta , foi realizada radiografia do pescoço para avaliar a extensão do tumor. Foram feitas também radiografia do tóraxe ultrassonografia abdominal, sendo ambas negativas para metástase. O material do tumor foi colhido por citologia aspirativa, sendo sugestivo para osteossarcoma. Após 25 dias, o paciente foi submetido ao procedimento cirúrgico para tireoidectomia total; no entanto, veio a óbito após o término da cirurgia, devido a complicaçõescardio/respiratórias. Foi realizada a necropsia, sendo constatada a presença de nódulos na pleura e no pulmão compatíveis com metástase. O diagnóstico foi confirmado posteriormente por meio do exame histopatológico, o que caracterizou um quadro raro de câncer em cães.


Extraskeletal osteosarcoma is a rare type of bone cancer in dogs, and canaffect other organs and epithelial tissues. This study reports the case of a male rottweiler presenting a three-month history of extraskeletal osteosarcoma in the thyroid gland. Neck radiography was performed to assess tumor extension, as well as chest and abdominal ultrasonography, which were negative for metastasls . Aspirationcytology of tumor material was suggestive of osteosarcoma. After 25 days, the patient underwent total thyroidectomy, but passed away after surgery completion due to cardiorespiratory complications. Necropsy confirmed the presence of nodules in the pleura and lung that were consistent with metastasis. Histopatholoqical examinationlater confirmed the diagnosis of a rare case of cancer in dogs.


El osteosarcoma extraesquelético del perro es un tipo raro de cânceróseo, que puede afectar otros órganos y tejidos epiteliates. Este trabajo tiene como objetivo relatar el caso de un perro macho de raza Rottweiler que presento un osteosarcoma extraesquelético en la glándula tiroides con evolución de tres mesesdesde su manifestación clínica. Durante la consulta se realizó una radiografia delcuello a fin de evaluar la extensión del tumor. Se realizaron también radiografías de tórax y ecografía abdominal, aunque ambos exámenes fueron negativos en relacióna la presencia de metástasis. Se realizó una punción aspirativa, y el material enviado para examen fue sugestivo de osteosarcoma. Veinticinco días después el paciente entró en cirugía, en la que se realizó una tiroidectomía total. No obstante, el mismo murió después del procedimiento quirúrgico debido a complicaciones cardiorrespiratorias.En la necropsia se pudo comprobar la presenda de nódulos en la pleura y en el pulmón compatibles con metástasis. El diagnóstico se comprobó por exámenes histopatológicos, confirmando la presencia de un cuadro raro de cáncer en perros.


Assuntos
Animais , Cães , Glândula Tireoide , Osteoblastos , Osteossarcoma/diagnóstico , Osteossarcoma/veterinária , Metástase Neoplásica , Neoplasias Ósseas/veterinária , Tireoidectomia/veterinária
15.
Clín. Vet. ; 21(120): 52-58, 2016. ilus
Artigo em Português | VETINDEX | ID: vti-338166

Resumo

Osteossarcoma extraesquelético em cães é um tipo raro de câncer ósseo,com capacidade de acometer outros órgãos e tecidos epiteliais. Este estudotem como objetivo relatar o caso de um cão macho da raça rotweiller comosteossarcoma extraesquelético em glândula tireoide e evolução de três meses, desde a sua manifestação clínica. Durante a consulta , foi realizada radiografia do pescoço para avaliar a extensão do tumor. Foram feitas também radiografia do tóraxe ultrassonografia abdominal, sendo ambas negativas para metástase. O material do tumor foi colhido por citologia aspirativa, sendo sugestivo para osteossarcoma. Após 25 dias, o paciente foi submetido ao procedimento cirúrgico para tireoidectomia total; no entanto, veio a óbito após o término da cirurgia, devido a complicaçõescardio/respiratórias. Foi realizada a necropsia, sendo constatada a presença de nódulos na pleura e no pulmão compatíveis com metástase. O diagnóstico foi confirmado posteriormente por meio do exame histopatológico, o que caracterizou um quadro raro de câncer em cães.(AU)


Extraskeletal osteosarcoma is a rare type of bone cancer in dogs, and canaffect other organs and epithelial tissues. This study reports the case of a male rottweiler presenting a three-month history of extraskeletal osteosarcoma in the thyroid gland. Neck radiography was performed to assess tumor extension, as well as chest and abdominal ultrasonography, which were negative for metastasls . Aspirationcytology of tumor material was suggestive of osteosarcoma. After 25 days, the patient underwent total thyroidectomy, but passed away after surgery completion due to cardiorespiratory complications. Necropsy confirmed the presence of nodules in the pleura and lung that were consistent with metastasis. Histopatholoqical examinationlater confirmed the diagnosis of a rare case of cancer in dogs.(AU)


El osteosarcoma extraesquelético del perro es un tipo raro de cânceróseo, que puede afectar otros órganos y tejidos epiteliates. Este trabajo tiene como objetivo relatar el caso de un perro macho de raza Rottweiler que presento un osteosarcoma extraesquelético en la glándula tiroides con evolución de tres mesesdesde su manifestación clínica. Durante la consulta se realizó una radiografia delcuello a fin de evaluar la extensión del tumor. Se realizaron también radiografías de tórax y ecografía abdominal, aunque ambos exámenes fueron negativos en relacióna la presencia de metástasis. Se realizó una punción aspirativa, y el material enviado para examen fue sugestivo de osteosarcoma. Veinticinco días después el paciente entró en cirugía, en la que se realizó una tiroidectomía total. No obstante, el mismo murió después del procedimiento quirúrgico debido a complicaciones cardiorrespiratorias.En la necropsia se pudo comprobar la presenda de nódulos en la pleura y en el pulmón compatibles con metástasis. El diagnóstico se comprobó por exámenes histopatológicos, confirmando la presencia de un cuadro raro de cáncer en perros.(AU)


Assuntos
Animais , Cães , Osteossarcoma/diagnóstico , Osteossarcoma/veterinária , Osteoblastos , Glândula Tireoide , Tireoidectomia/veterinária , Metástase Neoplásica , Neoplasias Ósseas/veterinária
16.
Braz. j. vet. res. anim. sci ; 41(5): 299-305, set.-out. 2004. graf, ilus
Artigo em Inglês | VETINDEX | ID: vti-5208

Resumo

Osteosarcoma is defined as a bone matrix-producing malignant mesenchymal tumor. It is relatively rare among domestic animals, but corresponds to 85% of all malignant bone tumors in dogs. To study canine osteosarcoma in animals living in Brazil and correlate the clinical-morphological findings with prognosis, forty-six cases of dogs with osteosarcoma were studied retrospectively out of a total of 56 malignant primary bone tumors on file. The animals were assessed in terms of age, sex, breed, topographic tumor distribution, and presence of metastases at diagnosis. The tumors were classified histologically by the method of Pool1. Osteosarcomas corresponded to 82% of primary malignant bone dysplasias in the sample studied. Age ranged from 6 months to 14 years (C = 8 y), sex: 32 F/18 M; breed: large dogs (86%), topographic location: appendicular skeleton (64%), axial skeleton (28.5%) and extraskeletal (7.5%); presence of metastases in 17.4%. Histopathology: osteoblastic (32.6%), chondroblastic (9.6%) and telangiectatic (5.8%) patterns; combined: 52%. Osteosarcoma mainly affects adult females. Breed is a predisposing factor, the appendicular skeleton is most often involved, and an osteoblastic histological pattern predominates. The lungs are a common site of metastasis, with pure-bred male dogs being most predisposed regardless of the morphological pattern of osteosarcoma. (AU)


O osteossarcoma é definido como um tumor maligno mesenquimatoso produtor de matriz óssea. É relativamente raro entre os animais domésticos, contudo em cães, corresponde a aproximadamente 85% das neoplasias ósseas malignas. A finalidade deste trabalho foi estudar o osteossarcoma canino, em nosso meio, correlacionando os achados clínico-morfológicos com o prognóstico. Retrospectivamente foram levantados 52 cases de cães com osteossarcoma. Foram avaliados quanto a idade, sexo, raça, peso, porte físico, distribuição topográfica e presença de metástases ao diagnóstico. Os tumores foram classificados histologicamente segundo POOL14. A idade variou de 6 meses a 14 anos (média = 8 anos); sexo: 31 F/ 19 M; cães de raça pura (67.5%) e sem raça definida (SRD) (32.5%); cães de grande porte foram os mais afetados (71,9%). Esqueleto apendicular (75,6%), axial (17.1%) e extraesquelético (7.3%); Metástase ao diagnóstico em 17.1%. Histopatologia: padrão puro (52%); osteoblastic (38.6%); condroblastic (9.4%) e telangiectásico (4%) e padrão combinado 48%. Conclusão: Afeta, em geral, fêmeas adultas e o esqueleto apendicular é o mais comprometido. A raça é fator predisponente e histologicamente predomina o padrão puro osteoblastic. Os pulmões são sede comum de metástases, sendo os cães machos e de raça pura os mais predispostos, independente do padrão morfológico do osteossarcoma. (AU)


Assuntos
Animais , Cães , Neoplasias Ósseas , Cães/anatomia & histologia
17.
Vet. Zoot. ; 18(4): 563-569, 2011.
Artigo em Português | VETINDEX | ID: vti-698974

Resumo

Osteosarcoma is a common neoplasm described predominantly in large breed dogs. Most of the cases occur in the long bones, but other anatomical locations, such as axial skeleton and extra-skeletal sites, are also described. Nasal cavity is rarely reported as being a primary site for development of osteosarcoma. Here we describe a rare case of an intranasal osteosarcoma in a dog with computed tomography, cytological and histopathological findings. Key words: cytology, histopathology, tomography, osteosarcoma.  OSTEOSSARCOMA INTRANASAL EM UM CÃO BLOOD HOUND: ACHADOS TOMOGRÁFICOS, CITOLÓGICOS E HISTOPATOLÓGICOS RESUMO Osteossarcoma é uma neoplasia comum descrita predominantemente em cães de raças grandes. A maioria dos casos ocorre em ossos longos, mas há descrição em outras localizações anatômicas, como esqueleto axial e sítios extra-esqueleto. Na cavidade nasal é raramente relatada como sítio primário para desenvolvimento de osteossarcoma. Aqui descrevemos um caso raro de osteossarcoma intranasal em um cão, com achados tomográficos, citológicos e histopatológicos. Palavras-chave: citologia, histopatologia, tomografia, osteossarcoma   OSTEOSARCOMA  INTRANASAL EN UN PERRO BLOOD HOUND: HALLAZGOS EN LA TOMOGRAFÍA COMPUTARUZADA, CITOLOGÍA E HISTOLOGÍA RESUMEN El osteosarcoma es un tumor frecuente sobre todo en perros de raza grande. La mayoría de los casos ocurren en los

18.
Vet. zootec ; 18(4): 563-569, 2011.
Artigo em Português | LILACS-Express | VETINDEX | ID: biblio-1503057

Resumo

Osteosarcoma is a common neoplasm described predominantly in large breed dogs. Most of the cases occur in the long bones, but other anatomical locations, such as axial skeleton and extra-skeletal sites, are also described. Nasal cavity is rarely reported as being a primary site for development of osteosarcoma. Here we describe a rare case of an intranasal osteosarcoma in a dog with computed tomography, cytological and histopathological findings. Key words: cytology, histopathology, tomography, osteosarcoma.  OSTEOSSARCOMA INTRANASAL EM UM CÃO BLOOD HOUND: ACHADOS TOMOGRÁFICOS, CITOLÓGICOS E HISTOPATOLÓGICOS RESUMO Osteossarcoma é uma neoplasia comum descrita predominantemente em cães de raças grandes. A maioria dos casos ocorre em ossos longos, mas há descrição em outras localizações anatômicas, como esqueleto axial e sítios extra-esqueleto. Na cavidade nasal é raramente relatada como sítio primário para desenvolvimento de osteossarcoma. Aqui descrevemos um caso raro de osteossarcoma intranasal em um cão, com achados tomográficos, citológicos e histopatológicos. Palavras-chave: citologia, histopatologia, tomografia, osteossarcoma   OSTEOSARCOMA  INTRANASAL EN UN PERRO BLOOD HOUND: HALLAZGOS EN LA TOMOGRAFÍA COMPUTARUZADA, CITOLOGÍA E HISTOLOGÍA RESUMEN El osteosarcoma es un tumor frecuente sobre todo en perros de raza grande. La mayoría de los casos ocurren en los

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