Abordagem terapêutica ao hemoabdómen devido a hemangiossarcoma esplénico : descrição de 3 casos clínicos
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2026
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O hemoabdómen constitui uma emergência médica frequente na medicina de animais de companhia, particularmente em cães, podendo ter origem traumática ou não traumática. Entre as causas não traumáticas, destaca-se o hemangiossarcoma (HSA) esplénico, neoplasia maligna com etiologia controversa na literatura, estando descrita uma possível origem endotelial e, mais recentemente, origem em células progenitoras pluripotentes da medula óssea. O HSA esplénico representa uma das neoplasias mais comuns do baço em cães, com maior incidência em raças de grande porte, como Pastor Alemão, Golden Retriever e Labrador Retriever. É caracterizado por ser um tumor localmente invasivo e com elevada capacidade de metastização. Os órgãos que mais frequentemente são afetados por metastização são o fígado, o omento e os pulmões. Apresenta-se tipicamente como uma massa não encapsulada, sem margens delimitadas e elevada friabilidade, condição que predispõe à rutura espontânea e consequente hemorragia. O diagnóstico definitivo é realizado por exame histopatológico, visto que os exames complementares como ecografia ou tomografia computorizada permitem apenas identificar massas esplénicas, mas não distinguem entre lesões benignas e malignas. A esplenectomia continua a ser o tratamento de eleição para estabilização e resolução da hemorragia, contudo, mesmo quando associada a protocolos quimioterápicos adjuvantes, o prognóstico permanece reservado. Entre os protocolos adjuvantes, destaca-se a doxorrubicina como o mais utilizado, demonstrando um aumento do tempo de sobrevida, enquanto a cirurgia isolada proporciona medianas de 66 dias, a associação com doxorrubicina pode prolongar a sobrevivência para 274 dias, e raramente ultrapassa os 365dias. O carácter maligno do HSA, o prognóstico desfavorável e os custos associados ao diagnóstico e tratamento condicionam fortemente a decisão terapêutica, sendo frequente a opção dos tutores pela eutanásia. No presente relatório, o diagnóstico histopatológico pós-operatório confirmou o HSA esplénico como causa de hemoabdómen nos três casos clínicos descritos. Em todos os animais foram realizados exames de imagem, incluindo ecografia abdominal e tomografia computorizada, que evidenciaram massas esplénicas compatíveis com HSA. A abordagem terapêutica consistiu em estabilização médica inicial, seguida de esplenectomia para resolução da hemorragia, permitindo a confirmação diagnóstica e o registo da evolução clínica subsequente. O tratamento médico de estabilização aliado à esplenectomia mostrou-se eficaz na resolução do hemoabdómen nos casos descritos, ainda que o prognóstico a longo prazo continue limitado pela natureza agressiva do HSA.
Hemoabdomen is a common clinical emergency in companion animal medicine, especially in dogs, and can have traumatic or non-traumatic causes. Among the non traumatic causes, splenic hemangiosarcoma (HSA) is notable as a malignant tumor with a debated origin in the literature. While it was historically believed to originate from endothelial cells, more recent reports suggest that it may develop from pluripotent bone marrow progenitor cells. Splenic HSA is one of the most common splenic neoplasms in dogs, with a higher incidence in large breeds such as the German Shepherd, Golden Retriever, and Labrador Retriever. It is characterized as a locally invasive tumor with a high metastatic potential. Metastatic spread most commonly involves the liver, omentum, and lungs. The tumor typically presents as a friable, non-encapsulated splenic mass with indistinct margins. This presentation predisposes the tumor to spontaneous rupture and acute intra-abdominal hemorrhage. A definitive diagnosis of splenic masses is established through histopathological examination because complementary diagnostic tests, such as ultrasonography or computed tomography, can only identify lesions. These techniques are unable to reliably differentiate between benign and malignant processes. Splenectomy is the preferred treatment for stabilizing and controlling hemorrhage. However, even when combined with adjuvant chemotherapy protocols, the prognosis is generally poor. Of the available adjuvant protocols, doxorubicin is the most frequently used because it has been shown to increase survival time. Splenectomy alone provides a median survival of approximately 66 days, whereas the combination of splenectomy and doxorubicin may extend survival to around 274 days, though rarely beyond 365 days. The malignant nature of splenic HSA, together with the poor prognosis and the financial costs associated with diagnosis and treatment, strongly influences therapeutic decision-making, often leading owners to elect euthanasia. In the present report, postoperative histopathological analysis confirmed splenic HSA as the cause of hemoabdomen in the three clinical cases described. All animals underwent imaging examinations, including abdominal ultrasonography and computed tomography, which revealed splenic masses consistent with HSA. The therapeutic approach consisted of initial medical stabilization, followed by splenectomy to control hemorrhage, which permitted both diagnostic confirmation and clinical follow-up. The combined approach of medical stabilization and splenectomy was effective in resolving hemoabdomen in the presented cases. However,, the long-term prognosis remains poor due to the highly aggressive nature of splenic HSA.
Hemoabdomen is a common clinical emergency in companion animal medicine, especially in dogs, and can have traumatic or non-traumatic causes. Among the non traumatic causes, splenic hemangiosarcoma (HSA) is notable as a malignant tumor with a debated origin in the literature. While it was historically believed to originate from endothelial cells, more recent reports suggest that it may develop from pluripotent bone marrow progenitor cells. Splenic HSA is one of the most common splenic neoplasms in dogs, with a higher incidence in large breeds such as the German Shepherd, Golden Retriever, and Labrador Retriever. It is characterized as a locally invasive tumor with a high metastatic potential. Metastatic spread most commonly involves the liver, omentum, and lungs. The tumor typically presents as a friable, non-encapsulated splenic mass with indistinct margins. This presentation predisposes the tumor to spontaneous rupture and acute intra-abdominal hemorrhage. A definitive diagnosis of splenic masses is established through histopathological examination because complementary diagnostic tests, such as ultrasonography or computed tomography, can only identify lesions. These techniques are unable to reliably differentiate between benign and malignant processes. Splenectomy is the preferred treatment for stabilizing and controlling hemorrhage. However, even when combined with adjuvant chemotherapy protocols, the prognosis is generally poor. Of the available adjuvant protocols, doxorubicin is the most frequently used because it has been shown to increase survival time. Splenectomy alone provides a median survival of approximately 66 days, whereas the combination of splenectomy and doxorubicin may extend survival to around 274 days, though rarely beyond 365 days. The malignant nature of splenic HSA, together with the poor prognosis and the financial costs associated with diagnosis and treatment, strongly influences therapeutic decision-making, often leading owners to elect euthanasia. In the present report, postoperative histopathological analysis confirmed splenic HSA as the cause of hemoabdomen in the three clinical cases described. All animals underwent imaging examinations, including abdominal ultrasonography and computed tomography, which revealed splenic masses consistent with HSA. The therapeutic approach consisted of initial medical stabilization, followed by splenectomy to control hemorrhage, which permitted both diagnostic confirmation and clinical follow-up. The combined approach of medical stabilization and splenectomy was effective in resolving hemoabdomen in the presented cases. However,, the long-term prognosis remains poor due to the highly aggressive nature of splenic HSA.
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VETERINARY MEDICINE, HEMOPERITONEUM, SPLENECTOMY, MEDICAL TREATMENTS, NEOPLASMS, DOGS, COMPANION ANIMALS, HISTOPATHOLOGY, DIAGNOSTIC IMAGING, PROGNOSIS, ANIMAL BREEDS, MESTRADO INTEGRADO EM MEDICINA VETERINÁRIA, VETERINÁRIA, MEDICINA VETERINÁRIA, HEMOABDÓMEN, ESPLENECTOMIA, TRATAMENTOS MÉDICOS, NEOPLASIAS, CÃES, ANIMAIS DE COMPANHIA, HISTOPATOLOGIA, DIAGNÓSTICO POR IMAGEM, PROGNÓSTICOS, RAÇAS DE ANIMAIS