healing vines for Beta-injection site sarcoma (thoracic area) in my diabetic cat

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Beta kitty

Beta kitty

Member Since 2016
My diabetic kitty Beta (10.5 yrs) has a suspected injection site sarcoma on her mid back (thoracic area). It's small but she's going to need surgery and likely other treatments for it. I'm so sad for her. She's the most lovable kitty ever! She comes to have her ear pricked whenever I sit down on the couch, just to get petted, no treats needed for her. She has many other health issues but is such a fighter and healthy overall so I hope she has many years left with me.

My vet sent her records to the University of MN Veterinary Hospital and I'll be making a surgery/oncology consult appointment tomorrow. It's about a 4 hour drive there, which I hate-city traffic on the beltway. Unfortunately I just ordered insulin from Marks in Canada and want to wait until it gets here before going there. I am expecting it will be here by Monday but of course with customs I can't be sure.

I've copied the test results here. I'm wondering if anyone has experienced this with their cat and if so about their experiences. Please send healing vines, good thoughts, and prayers for her if you can. Thank you, Tracy

from CT scan:
Musculoskeletal: There is very mild thickening of the skin and adjacent fat of the dorsum from the level of the scapular spine dorsally to the level of the dorsal aspect of the scapula. This is creating an ill-defined area of thickening that measures 32.3 mm in length by 2.3 mm in width on the right and 33.9 mm in length by 1.6 mm on the left. No mass is seen. However with in the fat of the mid thorax there is an oval strongly contrast medium enhancing nodule that is present within the fat along the dorsal aspect of the latissimus dorsi and epaxial musculature and measures 22.4 mm x 4.3 mm. This is seen entirely to the right of midline and is present at the level of T8 and T9. The margin between this enhancing nodule and the latissimus dorsi muscle is ill-defined. This mass is seen caudal to the trapezius muscle.

Conclusions 1. Strongly enhancing nodule at the level of T8 and T9 is concerning for a neoplastic mass such as an injection site sarcoma. The mild nodular thickening of the fat dorsal to the scapula is unusual, and more consistent with steatitis than a soft tissue sarcoma. 2. There is no evidence of pulmonary metastasis.

From fluid aspirate:
Pathology Cytologic examinations have been completed on a slide prepared from a rapidly growing hard mass in the interscapular region of a 10-year 5-month old spayed female Domestic Shorthair cat, "Beta". CYTOLOGY The slide contains a mixture of many neutrophils and a population of cells often exhibiting eccentric nuclear placement within sometimes spindloid/streaming cytoplasm. Cytoplasm of other cells is finely vacuolated. Moderate anisokaryosis, anisocytosis and instances of hyperchromasia are also noted. Some lipid droplets and rare adipocytes are also present. CYTOLOGIC IMPRESSION Soft tissue sarcoma suspected, suppurative inflammation also noted
 
Sorry to hear Beta is having this problem. Glad you are getting a consult at university. Hoping things go well for your sweet girl. Hugs and healing thoughts to you and Beta:bighug::bighug::bighug:

I am copying @Marje and Gracie in hopes she can recommend someone that can look at test results.
 
Thank you so much Julie. I'm hoping I didn't cause this by giving her injections of insulin and adequan in the scruff area. But I know she needs both of these meds so I really had no choice. Luckily I caught it early.
 
Beta kitty said:
Thank you so much Julie. I'm hoping I didn't cause this by giving her injections of insulin and adequan in the scruff area. But I know she needs both of these meds so I really had no choice. Luckily I caught it early.
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Who knows, that is where vets usually inject also, you can’t blame yourself. It is something we don’t even think about, but maybe we should. Maybe need to look at new injection site after this, there are others. I started with the side, but have moved to behind shoulders, sounds like the area Beta is having trouble. There are so many things we have to think about with diabetic cats, injection spots are usually not high on the list.
 
I had a cat with a vaccination site sarcoma which are now often called feline injection site sarcomas. Unfortunately, it was when the veterinary community first started figuring out what was going on and a treatment protocol was not available. Because it was small, they didn’t remove it and the cancer metastasized and I lost him to liver cancer.

When it’s from a vaccine, it is typically caused by the adjuvant they add to vaccinations. The primary culprit used to be the feline leukemia vaccine and that’s what my kitty got it from but any vaccine with an adjuvant can cause it.

The protocol for giving vaccines changed from giving in the scruff to giving in the hind leg below the elbow so if a sarcoma occurred, the limb could always be amputated, worst case scenario. They can occur years after a vaccine is given.

Do you vaccinate? While these can occur from other injections (meloxicam, cisplatin which is a chemo drug), it’s rare even from vaccinations much less non vaccination injections. While I couldn’t find anything that indicated adequan or insulin could cause it, it seems to me it would be really, really rare.

There has been some research which indicates there might be a genetic component.

Many prayers for Beta. Please keep us posted.
 
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@Beta kitty - I wrote a section of one of my college papers (for my vet tech course) on feline VAS/FISS so I did a lot of research on current/new treatment options and what's being researched. I'll just copy and paste the relevant parts here - it may just give you some additional information to discuss with the oncologist, but if you want more clarification of anything as it was written as a technical paper, please just shout out. It looks as though you've already got part way with things as you've got a CT scan already done, but I've included the "gold standard" diagnostic techniques for completeness.

Because vaccine-related fibrosarcomas are a very aggressive form of tumor, the treatment for them must also necessarily be aggressive. As a result, when this type of tumor is suspected, it is important to follow the optimal route for diagnosis and (if necessary) removal. The first step with these tumors is to take an incisional biopsy of the tumor rather than to remove it completely. These tumors create tendrils that extend into the normal tissue around the original tumor, so using the more common diagnostic technique of excising the mass completely and sending it for biopsy runs the risk of leaving these tendrils behind and allowing the cancer to spread. “when one is presented with a lump on a cat's body, especially one that seems readily moveable, the tendency is to perform an excision biopsy, which is an attempt to remove the tumor, a decent margin around it, and send the tissue out for analysis. This will determine if the tumor was completely excised or not and will identify the tumor as an injection-site sarcoma. This sounds well and good but it does not work for this type of tumor. Margins are invariably dirty (meaning tumor extends to the edge of the sample) and with the body of the growth no longer there, it is difficult to plan the margins of the second surgery.” (Brooks, 2017). Unfortunately, in cases where conservative removal of what appears to be the entire mass are done, these tumors recur around 70 per cent of the time, and usually very quickly due to the malignant cells left behind.

Once fibrosarcoma is confirmed, treatment can begin. “Thoracic radiographs are recommended to look for evidence of pulmonary metastatic disease. Additionally, advanced imaging (most commonly computed tomography scan, but occasionally magnetic resonance imaging) is encouraged for radiation and/or surgical planning” (Saba, 2017). Radical excision remains the primary treatment of choice for this type of tumor. The tumor must be excised with a 5 cm margin on all sides, and 2 fascial planes deep. In cases where the vaccines have been given according to current guidelines, in the distal legs or the tail, amputation may achieve this aim. However, even radical surgery often fails to affect a full cure and the tumors recur, often in clusters along the line of the surgical scar. Adding radiation therapy to the treatment plan, either pre- or post-operatively extends the time between removal and recurrence of the tumor. Computer-based radiation plans are often used to minimize the damage to healthy tissue and organs.

Chemotherapy is also used in some cases; however the benefits of chemotherapy are not clear in cases where a combination of surgery and radiation therapy can be used. “Several chemotherapy agents have been used in cats with vaccine-associated sarcomas including carboplatin, doxorubicin, liposome encapsulated doxorubicin, mitoxantrone, and cyclophosphamide to name a few. One study failed to show a survival advantage when comparing cats treated with surgery, radiation and chemotherapy to cats treated with surgery and radiation and no chemotherapy. Other studies have suggested a benefit for chemotherapy when partial responses were observed in patient with nonresectable disease. Chemotherapy as a sole modality is not adequate for definitive therapy, but may be valuable for palliation of large, unresectable tumors.” (Animal Cancer and Imaging Center)

There is also currently a trial ongoing at Washington State University to find out whether Yttrium-90 RadioGel can be used to successfully shrink these tumors pre-operatively. The aim of doing so would be to reduce the tumor size so that it can be removed effectively, hopefully extending the lifespan of affected cats. “Yttrium-90 RadioGel is a type of brachytherapy. Brachytherapy is a procedure that involves placing radioactive material directly into the tumor and allows doctors to give higher doses of radiation to more specific areas of the body, in a shorter amount of time with fewer side effects.” (WSU Veterinary Clinical Sciences).

There is also some promising research into the use of locally-administered immunotherapy in conjunction with surgical excision and iridium brachytherapy. In these cases, a virus vector containing interleukin-2 is injected into the area around the excised tumor. “With this approach, the vector virus enters the cat’s cells in the vicinity of injection; these cells then produce IL-2, inciting a local antitumor immune response. Local delivery of IL-2 reduces the patient risk of systemic toxicity seen with systemic IL-2 administration.” (Saba, 2017).
 
Thanks for the replies and info Marje and April . Marje sorry your kitty suffered with this too. Beta has had vaccines and was found as a stray so may have had scruff vaccines before. My vet uses the leg.

I've been researching treatment and would love to be able to do brachytherapy and immunotherapy verses standard radiation, but not sure if they're available in my area. We'll see.

Beta has her appt at the Univ of Mn Vet School this Tuesday. So will find out recommended treatment then. Hope the trip goes ok. It's a four hour drive.

Today am was a fur shot unfortunately. I tried to shoot the flank for first time and failed totally. I was hoping absorption would be better there since she has thickening on the scruff according to CT scan which I heard could affect absorption of insulin.

Thanks again and will keep you posted on Beta's progress.
 
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I think I would persevere with the flank shots too - I'm not at all sure I'd want to stick any more needles in a suspect area even if the insulin was absorbing OK there. I did do flank shots on Rosa sometimes and I found they were easier if she was lying down a little curled up on her side - that seemed to give me more skin to play with to get a decent tent for the shot. Most cases of fibrosarcoma are associated with vaccines, but in theory there is a very small risk from any injection because of the inflammation that the needle itself causes. Probably safest to continue to avoid the scruff/shoulder area altogether with needles for her just in case. And please do keep us updated when you know more.
 
Beta kitty said:
@Noah & me (GA) @Marje and Gracie @manxcat419 Updates : Beta is having a insicisional biopsy tomorrow for the suspected injections site sarcoma. They seem to think this could be inflammatory reaction to adequan or insulin verses sarcoma. They recommend stop adequan and give insulin injections elsewhere, recommended the leg. Thanks for the support
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Paws crossed. You can give insulin in the side of the chest and the flank.

If you scroll down on this post, you’ll see a diagram showing where you can inject.

Good luck and please let us know.:bighug:
 
Marje and Gracie said:
Paws crossed. You can give insulin in the side of the chest and the flank.

If you scroll down on this post, you’ll see a diagram showing where you can inject.

Good luck and please let us know.:bighug:
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Thanks! I've been giving it in side of chest and side of belly last few days. Flank is harder for me. I just started trying the lift and roll (or whatever it's called) because her fur is thick and kind of long. This works better for me.
 
Beta kitty said:
@Noah & me (GA) @Marje and Gracie @manxcat419 Updates : Beta is having a insicisional biopsy tomorrow for the suspected injections site sarcoma. They seem to think this could be inflammatory reaction to adequan or insulin verses sarcoma. They recommend stop adequan and give insulin injections elsewhere, recommended the leg. Thanks for the support
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I'm really glad they're doing an incisional biopsy rather than attempting an excisional one. That gives you a much, much better chance of effective treatment later on. I have to say, I agree that there's a possibility that this is a rare, non-vaccine injection site issue. It can happen, and especially now they've found that the non-adjuvanted vaccines are still implicated even though they cause much less localized inflammation than the adjuvanted ones, all shots are considered to be a small risk. Clearly with things like insulin and sub-q fluids, the benefits outweigh the risk for most cats - I wouldn't want anyone to stop giving life-saving treatment based on the small chance that the treatment itself might cause an issue. You can give sub-q shots in the leg, but if they're having you follow vaccine protocol for them, then you're really meant to give them much further down the leg than is easy for most people to achieve, simply due to lack of sufficient skin and tissue for an easy injection site. Another option can be to give them in the tail - again, as far down as possible - that might be something to ask about if you find he objects to you using a leg, or you simply can't get enough skin to shoot accurately there.
 
One more thing you might need to consider is whether or not absorption of insulin would be as good from the peripheral sites such as lower leg or tail. You may find you need to adjust the dose if she doesn't seem to absorb the insulin as well that way as I'm not sure there's a whole lot of data on giving shots in peripheral areas. I do understand your vet's concern with flank or chest shots though - if this is simply something she's prone to, you need to keep all shots out of her main body area as far as possible.
 
I will ask about tail injections - she's a very tolerant kitty. They did say i could give the injections /adequan anywhere subq, but that regardless of where injected it could cause the inflammatory cells to react in the area of the original reaction.
 
It could. And using a peripheral site, sad to say, is essentially done so that if necessary the tail or limb can be amputated to effect a cure of a sarcoma.
 
I take it as a compliment you tagged me but this is way beyond my knowledge of feline cancer. That the injection sight could even play a role in this is shocking to me. I was taught the scruff shot with Nigel but moved to the flank on my own and did the same with Noah. Nigel had a cancer I can't recall the specifics of and Noah just got old. Both had a form of untreatable cardiomyopathy.
It goes without saying that you've done your homework and that comes from love. I wish you the best.
Please drive carefully, I've driven with tears in my eyes and it's very hard.
Some other people who's opinions I deeply respect; Wendy&Neko, Jeff, Larry&kitties, Jill&Alex. I'm sorry I couldn't be of more help.
 
@Marje and Gracie @manxcat419 Updates
Beta is home after two days in hotel and at vet. Doing well, used litter box right away and then ate. She didn't like the hotel much and neither did I! They used such a strong smelling cleaner that gave me a headache and burning eyes. I had to switch rooms. Only good thing was the new room was lots cheaper.

They did wedge biopsy and took five samples. Said the tissue looked different (darker color). The results will be back in a week or two.
They did mention giving the adequan in the leg if that seems to be the cause of the abnormal tissue/lump. I didn't get to talk to the vet who did the surgery cause he was on on rounds.

They were rushed and it was 6am so I was tired after Beta waking me up by exploring the hotel room. She managed to wedge herself under the tiny space beneath the fridge cabinet twice. I had to lift it up to get her her out! Her back end was stuck under it.

Beta has diarrhea (like pudding) now which started the day after surgery. Not sure if they gave antibiotics but if so I'm sure that's the cause of it. She always used to get diarrhea from antibiotics but hasn't been on them for many years. I might try to call the vet but not sure it's necessary since she's eating fine and seems ok otherwise.
 
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As long as she's eating OK, the diarrhea likely is either a stress reaction or from antibiotics given for the biopsy. Even if you're not given antibiotics to bring home, most surgical cases are given injectable penicillin at the time the surgery is done as a preventative measure. Thankfully, it's one more step of the process done - now it's just the wait for results, which I know can feel awfully long when you know there's nothing more you can do until you have them.
 
Biopsy Results back NO sarcoma, just inflammation and fat necrosis likely from adequan injections. Thanks for the support and prayers.
 
Beta kitty said:
Biopsy Results back NO sarcoma, just inflammation and fat necrosis likely from adequan injections. Thanks for the support and prayers.
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That is just the best news I've heard in a long time. Absolutely wonderful outcome for both of you. And now it's time for you to relax just a little and just love your girl. :bighug::bighug::bighug:
 
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