Vet. Pathol.

18: 224-227 (1981)

Canine Angiosarcoma (Lymphangiosarcoma): A Case Report

W. R. KELLY,G. T. WILKINSON
and P. W. ALLEN

Departments of Veterinary Pathology and Public Health, and Veterinary Medicine,

University of Queensland, St. Lucia, Queensland; and the Institute of Medical and
Veterinary Science, Adelaide, South Australia, Australia

Abstract. After injury to the left foreleg, a 2S-year-old Great Dane bitch developed severe
oedema of the limb, which did not respond to pressure bandaging or a proteolytic agent. Skin
breakdown occurred over the metacarpal region and lymph could be expressed from this
lesion. The oedema spread, anaemia and dyspnoea developed and the animal died of
respiratory insufficiency 55 days after the initial injury. Autopsy showed widespread infiltration
of subcutis, fascia1 planes and some muscles of the leg by invasive cords and sheets of small
endothelial-type cells which formed channels sometimes filled with blood. There was wide-
spread diffuse metastatic neoplasm throughout the lung but no cavernous blood sinus
formation. There were small metastases in local lymph nodes, kidney, bone marrow and
spleen. It was concluded that the injury made obvious an oedema caused by preexisting
angiosarcoma.

There is understandable reluctance to make a diagnosis of lymphangiosarcoma

when studying vascular neoplasms, since it is difficult to distinguish cytologically
between normal endothelial cells of blood vessel and lymphatic origin. This case,
however, had several distinctive clinical and anatomical features that distinguished
it from the more commonly encountered haemangiosarcoma. We found no reports
of lymphangiosarcoma in animals.

Case History
A 2S-year-old Great Dane bitch with gross oedema of the left foreleg, which arose after a
blow to the leg, was treated unsuccessfully with a diuretic, and pressure bandaging. Twelve
months previously, on the anterior aspect of the left shoulder, the bitch had developed a large
fluid swelling from which lymph-like fluid was aspirated. After aspiration the swelling
recurred, but then resolved spontaneously over the following week.
On presentation, the animal was alert but slightly febrile, mildly dehydrated and panting-
signs attributed to the diuretic treatment and hot weather.
The left foreleg was swollen with painless, pitting oedema from the shoulder to the paw.
The skin from the left axilla along the ventral surface of the thorax was oedematous. There
was hair loss, purplish discolouration, focal softening and exudation of a serosanguineous fluid
in a circular area, approximately 3 cm in diameter, on the anterior metacarpus. The biceps
brachii muscle was hard just below the shoulder joint. The joints of the affected limb were
painless, the bitch was not lame and there was no noticeable pulsation in the leg. Radiography
224
 Canine Angiosarcoma 225

of the limb was unrewarding but the lungs showed increased radiodensity. Serum proteins
were normal and there was a moderate lymphopaenia. Aspirated fluid from the leg contained
many erythrocytes and mononuclear cells and had a protein content of 15 g/l. Bacterial
culture yielded Staphylococcus aureus.
A tentative diagnosis was lymphatic rupture or obstruction after trauma. The bitch’s
condition deteriorated despite treatment with antibiotics, corticosteroids, proteolytic enzymes
and pressure bandaging. Anaemia and dyspnoea worsened and collapse and death occurred
55 days after the initial trauma.

Results
The carcase was gaunt, with severe subcutaneous oedema. The left foreleg was
swollen, and the skin was indurated and, distally, was red and weeping watery pink
fluid.
There was severe pulmonary oedema and hydrothorax (3 to 4 1 of blood-tinged
watery fluid). The lungs were collapsed ventrally, and overall were brownish-yellow;
even the more aerated parts were heavy and leathery. Subpleural lymphatics were
focally distended, producing blister-like elevations of the visceral pleura.
The subcutis and fascial planes of the left foreleg looked brawny because of
infiltration by alternate zones of haemorrhage and grey nodular tissue which had
invaded the brachial and cephalic veins at several points, but not enough to cause
occlusion. Local lymph nodes were found with difficulty but were not grossly
involved.
The spleen contained numerous small nodules, some haemorrhagic.
Histologically, the subcutaneous and intermuscular fascial planes of the affected
leg were broadened by a profuse infiltration of small nondescript spindle-shaped
cells, uniform in size and nuclear conformation and with indistinct and scanty
cytoplasm. They more closely resembled plump endothelial cells than any other
normal cell. Mitosis was not common, but many isolated cells were undergoing
shrinkage necrosis. The cells were arranged in discontinuous sheets or tubes often
apposed to one another so that irregular spaces were formed in the tissue (fig. 1);
these spaces usually contained some red cells, occasionally nucleated. The lines of
invading cells showed a pronounced tendency to surround and isolate normal tissue
components, so that dense collagen bundles, blood vessels and fat cells were seques-
tered by a thin but continuous layer of the endothelial-type cells (fig. 1). In places,
whole bundles of skeletal muscle were infiltrated uniformly by these cells, which
surrounded each muscle fibre. Associated with the more cellular zones of the growth
were large dense accumulations of blood, apparently derived from haemorrhages,
since they were never even partly contained b j endothelial lining.
Axillary and cubital lymph nodes of the affected leg contained small cortical
metastases; medullary sinusoids contained much free blood not closely associated
with the metastases.
Most lung alveoli were consolidated by a confusing pattern of cells similar to those
described in the leg (fig. 2). As in the leg, the invading cells completely isolated lung
components such as segments of alveolar wall, vessels of all sizes and bundles of
smooth muscle from small airways. Many alveoli contained free blood and haemo-
226 Kelly, Wilkinson and Allen

Fig. 1: Section from intermuscular fascia1tissue in foreleg. Anastomosing channels lined by

endothelial-type cells which surround and isolate collagen bundles (C). HE.
Fig. 2 Section of lung. Obliteration of alveoli (A) by whorled masses of spindle-shaped
cells. Bronchiole (B) contains fluid and red cells. HE.

siderin-filled macrophages. Distended subpleural lymphatics were lined by the

malignant endothelial cells.
The nodules in the spleen consisted of dense whorled masses of sarcoma in which
the cells were more solidly arranged and more active mitotically than in lung or leg.
There were large irregular haemorrhages in these nodules and the malignant cells
again had isolated normal tissue components. In the spleen and liver there was also
much extramedullary haemopoiesis, no doubt induced by chronic haemorrhage from
 Canine Angiosarcoma 221

the neoplasm. There was marked erythroid metaplasia in a section of femoral

marrow, as well as a metastatic focus of sarcoma.
There were microscopic focal metastases in the kidney; these were not nodules but
again were characterized by the tendency of the invading cells to separate cortical
tubules.

Discussion
There are many references in the literature to lymphangiosarcoma arising in
extremities which have been chronically oedematous, usLally from 5 to 15 years.
Most cases have occurred in women’s arms which had been chronically oedematous
after radical mastectomy with or without radiation therapy. A comprehensive review
of 21 cases [3] emphasized the difficulty in distinguishing these neoplasms from
haemangiosarcomas, especially when there is considerable suffusion of blood
throughout the tumor.
The usual outcome in man is metastasis to the lungs and death [ 1, 2, 31. The lung
metastases tend to be diffuse, as in this dog.
The cytological features of blood vascular and lymphatic endothelium are similar,
which may render somewhat artificial the distinction made here between haeman-
giosarcoma and lymphangiosarcoma.Nevertheless, this case was unique in its clinical
presentation and in the pattern of growth and metastasis of the neoplasm; in
particular there was an extremely diffuse pattern of growth of primary tumor and of
the lung metastases. The tendency to form endothelium-lined blood lakes was much
less evident than in haemangiosarcomas. Moreover, severe oedema is not a feature
of tissues infiltrated by haemangiosarcoma.
It seems unlikely that the recent injury to the Ieg in this dog was related to the
development of the neoplasm; rather, it seems likely that the relatively mild trauma
caused oedema because lymphatic drainage already was compromised by the neo-
plasm.
The anaemia and hypoproteinaemia presumably developed because of chronic
leakage of protein-rich lymph and erythrocytes from the skin lesion.

References
I IRONSIDE,P.; ALLEN,P.W.: Test and Teach Number Eleven; parts 1 and 2. Pathology 9:
110 and 178-179, 1977
2 SCOTT, R.B.;NYDICK,I.; CONWAY,
H.: Lymphangiosarcoma arising in lymphoedema. Am
J Med 28: 1008-1012, 1960
A.H.; IVINS,J.C.; SOULE,
3 WOODWARD, E. H.: Lymphangiosarcoma arising in chronic
lymphoedematous extremities. Cancer 30:562-572, 1972

Request reprints from W. R. Kelly, Department of Veterinary Pathology and Public Health,
University of Queensland, St. Lucia, Queensland 4067 (Australia).