Invasive pleural malignant mesothelioma with rib destruction and concurrent osteosarcoma in a dog
© Di Tommaso et al. 2015
Received: 17 October 2015
Accepted: 21 November 2015
Published: 2 December 2015
A 7-year-old Dachshund was clinically examined because of a 10-day history of lameness in the left hind limb. On the basis of radiological and cytological findings, an osteosarcoma of the left acetabular region was suspected. The dog underwent a hemipelvectomy and osteosarcoma was diagnosed by subsequent histopathological examination. An immovable subcutaneous mass was noted on the left chest wall during the physical examination and non-septic neutrophilic inflammation was diagnosed by cytology. Forty days later, the dog showed signs of respiratory distress with an in-diameter increase of the subcutaneous mass up to 4 cm. Thoracic radiography and ultrasonography revealed pleural effusion and a lytic process in the fourth left rib. Furthermore, ultrasound examination revealed a mixed echogenic mobile structure with a diameter of around 2 cm floating within the pleural fluid of the left hemithorax close to the pericardium. The dog underwent surgery for an en bloc resection of the subcutaneous mass together with the fourth rib and the parietal pleura. Moreover, the left altered lung lobe, corresponding to the mobile structure detected by ultrasound, was removed. Based on cytological, histopathological, and immunohistochemical examinations, an invasive epithelioid pleural malignant mesothelioma was diagnosed.
KeywordsChest wall Bone lysis Mesothelioma Osteosarcoma
Malignant mesothelioma is an uncommon tumor arising mostly from the serosal surface of the pleural or peritoneal cavity . In most human patients, pleural mesothelioma is a locally advanced tumor and the invasion of the thoracic wall with rib involvement has been reported [2, 3]. A locally invasive nature of malignant mesotheliomas has rarely been reported in dogs, while involvement of ribs has not been reported at all. Only one report describing tumor infiltration of the submesothelial muscle layer in a dog has been published .
The simultaneous occurrence of a mesothelioma along with other primary malignancies has been reported repeatedly in humans, whereas no such cases have been reported in dogs . Pleural mesotheliomas have been described mainly in association with carcinomas , but a mesothelioma associated with a synchronous osteosarcoma has never been described in neither humans nor dogs.
The present case represents the first report of a diffuse pleural mesothelioma directly invading the thoracic wall in a dog having a concurrent osteosarcoma.
A 7-year-old male Dachshund weighing 7.6 kg was admitted to the Veterinary Teaching Hospital, University of Teramo, Italy, with a 10-day history of lameness in the left hind limb. During physical examination, the dog showed a grade 4 lameness on a 1–4 scale and strong pain upon palpation of the proximal portion of the left hind limb. Furthermore, an immovable subcutaneous mass measuring around 1.5 cm in diameter was noted on the left chest wall. The complete blood count, serum chemistry profile, urinalysis, and hemostatic profile were unremarkable.
A radiographic examination of the pelvis and hind limbs showed osteolytic lesions in the left ischiatic bone of the acetabular region and subtle thickening of the cortices of the caudal acetabular rim.
A fine needle aspirate (FNA) cytology of the acetabular lesions was done and showed moderate cellularity with a mixture of individual and multinucleated cells. The individual cells were round to oval and had variably shaped nuclei, prominent and multiple nucleoli, and dark blue vacuolated cytoplasma containing fine pink granules. The multinucleated cells were regarded as being osteoclasts. Furthermore, a pink intercellular matrix was found. Based on these findings, an osteosarcoma was diagnosed. A FNA cytology of the subcutaneous mass on the thoracic wall showed several neutrophils in a debris but without visible microorganisms consistent with a non-septic neutrophilic inflammation. A bacteriological examination was done but bacteria were not cultured. Thoracic radiography and abdominal ultrasound were unremarkable for metastatic lesions.
The dog underwent a hemipelvectomy and a histopathological examination of the excised tissue was performed. Microscopically, a neoplastic lesion consisting primarily of polyhedral cells with moderate nuclear pleomorphism was observed. The mitotic index, expressed as the mean value of mitoses/10 high power fields (total magnification, ×400), was 1.1. The neoplasm was infiltrative and gave rise to a small amount of osteoid matrix. The findings were consistent with a productive osteoblastic osteosarcoma. The owner declined any further treatment.
The FNA cytology of the subcutaneous mass was repeated. The cytological pattern was similar to the previous FNA cytology, whereas cytology of the bone aspirate of the fourth rib was non-diagnostic.
The dog underwent surgery for an en bloc resection of the subcutaneous mass together with the fourth rib and the parietal pleura. Furthermore, the left altered lung lobe was removed.
The dog died from complications arising after surgery. The owner declined a necropsy.
Though mesothelioma is the most common primary tumor of serosal membranes, it is a rare neoplasm both in humans and dogs [1, 5]. Most cases of pleural mesothelioma occur as diffuse tumors covering the surfaces of the body cavity, whereas the localized forms are rare [6, 7].
Mesotheliomas are considered malignant due to their ability to spread by implantation, but they rarely metastasize in dogs [1, 8]. Malignant pleural mesothelioma rarely metastasizes to distant sites in humans, whereas a locally advanced disease appears in most patients; the invasion of the chest wall with rib destruction has also reported [2, 3]. Indeed, according to the International Mesothelioma Interest Group Staging System of pleural mesothelioma, this condition, with or without rib destruction is described in stages III and IV . A review of the veterinary literature revealed only two canine cases with the chest wall being invaded with a mesothelioma. Reggetti et al.  described a case of a diffuse mesothelioma that infiltrated the muscle layer underlying the pleura but, unlike what we found, both ribs and subcutaneous tissue were not involved. Liptak and Brebner  reported two subcutaneous masses in the thoracic wall as metastases of a solitary mesothelioma of the diaphragm in a dog without involvement of ribs.
Metastases are rare and generally spread via the lymphatic system . Nevertheless, cases with a suspected hematogenous dissemination of mesothelioma have been reported in dogs and cats [8, 12, 13]. In the case reported here, the involvement of subcutaneous tissue and ribs was a direct extension of the primary tumor to the chest wall rather than due to metastatic dissemination. Direct invasion was supported by the involvement of all structures of the chest wall, such as muscle layer, ribs and subcutaneous tissue. On the contrary, the multifocal pattern and the presence of intravascular emboli in the lung suggest a metastatic hematogenous spread rather than a direct invasion.
Bone destruction, in particular rib erosion, has not been reported in dogs with diffuse or solitary mesotheliomas. The differential diagnosis of lytic rib lesions includes primary or metastatic neoplasia, inflammatory and metabolic disease, and trauma. Primary tumors of the ribs mainly consist of osteosarcomas, chondrosarcomas, hemangiosarcomas, and fibrosarcomas, but osteosarcomas and hemangiosarcomas have been reported to develop bone metastasis as well . In the present report, rib lesions could be attributed to a metastasis of the pelvic osteosarcoma or due to primary tumor.
The co-existence of mesothelioma and other malignancies appears relatively frequent in humans, and most of these tumors are carcinomas and adenocarcinomas [5, 15]. Exposure to asbestos has been closely related to the development of pleural mesotheliomas . Risk factors for synchronous neoplasms such as male sex, older age, a positive smoking history, and a history of significant exposure to asbestos are risk factors for development of both types of neoplasms—either as a single and a concurrent neoplasm .
The simultaneous occurrence of mesothelioma and other primary tumors has not been described in dogs previously. The contribution of asbestos to canine mesothelioma remains unknown, although it is considered a risk factor [18, 19]. Other carcinogens may play an important role in the pathogenesis of these tumors, but a cause–effect relationship has not been identified.
This case represents the first report of a diffuse pleural mesothelioma directly invading the thoracic wall in a dog with a concurrent osteosarcoma. Malignant mesotheliomas need to be considered a potentially locally invasive tumor in dogs and, therefore, should be included in the differential diagnosis when investigating a subcutaneous mass in the thoracic wall, especially in dogs with pleural effusion. Malignant mesotheliomas should be considered in the diagnostic workup of patients with lytic rib lesions.
MDT and FR performed the clinical workup of the patient and drafted the manuscript. GM and ARDA performed the histopathological examinations. DS and CC performed the diagnostic imaging. SM and AL were involved in the clinical workup. AB was involved in drafting the manuscript. All authors read and approved the final manuscript.
The authors declare they have no competing interest.
Consent for publication
Written informed consent was obtained from the owner of the patient for the publication of this report and any accompanying images.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Garrett LD. Mesothelioma. In: Withrow SJ, MacEwen EG, editors. Small animal clinical oncology. 5th ed. St. Louis: Elsevier; 2013. p. 696–700.Google Scholar
- Steiner RM, Cooper MW, Brodovsky H. Rib destruction: a neglected finding in malignant mesothelioma. Clin Radiol. 1982;33:61–5.View ArticlePubMedGoogle Scholar
- Stahel RA, Weder W, Lievens Y, Felip E. Malignant pleural mesothelioma: ESMO clinical practice guidelines for diagnosis, treatment and follow up. Ann Oncol. 2010;21(Suppl 5:v):126–8.View ArticleGoogle Scholar
- Reggetti F, Brisson B, Ruotsalo K, Southorn E, Bienzle D. Invasive epitelial mesothelioma in a dog. Vet Pathol. 2005;42:77–81.View ArticleGoogle Scholar
- Del Gobbo A, Fiori S, Gaudioso G, Bonaparte E, Tabano S, Palleschi A, et al. Synchronous pleural and peritoneal malignant mesothelioma: a case report and review of literature. Int J Clin Exp Pathol. 2014;7:2484–9.PubMed CentralPubMedGoogle Scholar
- Allen TG, Cagle PT, Churg AM, Colby TV, Gibbs AR, Hammar SP, et al. Localized malignant mesothelioma. Am J Surg Pathol. 2005;29:866–73.View ArticlePubMedGoogle Scholar
- Espino L, Vazquez S, Failde D, Barreiro A, Miño N, Goicoa A. Localized pleural mesothelioma causing cranial vena cava syndrome in a dog. J Vet Diagn Invest. 2010;22:309–12.View ArticlePubMedGoogle Scholar
- Smith DA, Hill FW. Metastatic malignant mesothelioma in a dog. J Comp Path. 1989;100:97–101.View ArticlePubMedGoogle Scholar
- Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. Pleural mesothelioma. In: Edge S, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010. p. 271–7.Google Scholar
- Liptak JM, Brebner NS. Hemidiaphragmatic reconstruction with a transversus abdominis muscle flap after resection of a solitary diaphragmatic mesothelioma in a dog. J Am Vet Med Assoc. 2006;228:1204–8.View ArticlePubMedGoogle Scholar
- Head KW, Cullen JM, Dubielzig RR. Tumors of serosal surfaces. In: Meuten DJ, editor. Tumors in domestic animals. 4th ed. Ames: University Press; 2002. p. 477–8.Google Scholar
- Kobayashi Y, Usuda H, Ochiai K, Itakura C. Malignant mesothelioma with metastases and mast cell leukaemia in a cat. J Comp Path. 1994;111:453–8.View ArticlePubMedGoogle Scholar
- Gumber S, Fowlkes N, Cho D. Disseminated sclerosing peritoneal mesothelioma in a dog. J Vet Diagn Invest. 2011;23:1046–50.View ArticlePubMedGoogle Scholar
- Russell RG, Walker M. Metastatic and invasive tumors of bone in dogs and cats. Vet Clin N Am Small Anim Pract. 1983;13:163–80.View ArticleGoogle Scholar
- Bianchi C, Bianchi T, Ramani L. Malignant mesothelioma of the pleura and other malignancies in the same patient. Tumori. 2007;93:19–22.PubMedGoogle Scholar
- Berman DW, Crump KS. Update of potency factors for asbestos-related lung cancer and mesothelioma. Crit Rev Toxicol. 2008;38:1–47.View ArticlePubMedGoogle Scholar
- Allen TC, Moran C. Synchronous pulmonary carcinoma and pleural diffuse malignant mesothelioma. Arch Pathol Lab Med. 2006;130:721–4.PubMedGoogle Scholar
- Glickman LT, Domanski LM, Maguire TG, Dubielzing RR, Churg A. Mesothelioma in pet dogs associated with exposure of their owners to asbestos. Environ Res. 1983;32:305–13.View ArticlePubMedGoogle Scholar
- Harbison ML, Godleski JJ. Malignant mesothelioma in urban dogs. Vet Path. 1983;20:531–40.View ArticleGoogle Scholar