A 6-year-old Haflinger mare was presented with a history of recurrent hemoabdomen. On necropsy, a firm infiltrative multinodular yellow mass was observed in the wall of the posterior abdomen. Histopathologic examination revealed a proliferation of fibroblastic cells, which were positive for a-smooth muscle actin and vimentin.Keywords abdominal wall, desmoid fibromatosis, horse, immunohistochemistry, myofibroblastic proliferation
Case HistoryA 6-year-old, 454-kg Haflinger mare was examined at the Centre Hospitalier Universitaire Vétérinaire of the University of Montreal with a 24-hour history of lethargy and anorexia. The mare presented with dullness, muscular fasciculations, and profuse sweating. The rectal temperature was 37.9 C, heart rate was 100 beats per minute, and respiratory rate was 44 respirations per minute. A large amount of abdominal fluid was observed by ultrasonography, which on analysis was consistent with hemorrhagic effusion (PCV [Packed cell volume], 50%; total protein concentration, 5.9 g/dl). No neoplastic cells were seen on cytologic evaluation of the fluid. Four days after admission, a second abdominal ultrasonography revealed the presence of a large oval solid mass measuring 9 Â 15 cm in the right caudal abdomen. On transrectal examination, the mass was firm, lobulated, nonmobile, and adhered to the abdominal wall. The following day, the mare became lethargic and anorexic, and euthanasia was performed.At necropsy, mild subcutaneous edema was present in the ventral aspect of the posterior abdomen. The abdominal cavity contained blood-tainted ascites (approximately 2.5 liters). A protruding mass measuring 10 Â 15 Â 8 cm was present in the abdominal wall, on the right posterior area close to the umbilicus (Fig. 1a). It was firm, infiltrative, multinodular, and yellow (Fig. 1b). The variably sized nodules were separated by a moderately abundant connective tissue. Hemorrhagic foci less than 2 cm in diameter were observed in the mass. Voluminous vessels were present at its base. Soft hemorrhagic projections 3 to 4 cm in diameter were extended into the abdomen. No other gross abnormality was observed in the mare.
Differential DiagnosesThe differential diagnoses considered in view of the gross observations were fibroma, desmoid fibromatosis, rhadomyoma, mesothelioma, hemangioma, hemangiosarcoma, giant cell tumor of soft parts, and fibrosarcoma.
Microscopic FindingsHistologically, the mass was unencapsulated and had no distinct borders. It was infiltrative and composed of bundles and sheets of densely packed fusiform cells forming collagen (Fig. 2a). The fibroblastic cells had a scant basophilic cytoplasm, with an elongated pale basophilic nucleus and 1 small eosinophilic nucleolus. No anaplastic features or mitosis were observed. A progressive maturation was present, with the density of cells becoming less as the density of the collagen was higher. Strands of dense collagenous tissue divided the mass in nodules. Mononuclear inflammatory cells and siderophages were present in zones of edem...