Vet Pathol 44:403–407 (2007)

Primary Cardiac Fibrosarcoma with Pulmonary Metastasis in a Labrador Retriever

M. C. SPELTZ, J. C. MANIVEL, A. H. TOBIAS, AND D. W. HAYDEN

Veterinary Diagnostic Laboratory, University of Minnesota, Saint Paul, Minnesota (MCS, DWH);
Veterinary Clinical Sciences, University of Minnesota, Saint Paul, Minnesota (AHT); Laboratory
Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota (JCM)

Abstract. A 6-year-old, neutered male Labrador Retriever was diagnosed with congestive heart
failure, and an echocardiogram revealed a large mass inside the pericardial sac associated with the left
ventricle. At necropsy, the dog had marked ascites, mild hydrothorax, marked hydropericardium, and
an 11.0 3 7.0 3 6.0 cm, tan and red, firm, well-demarcated mass attached to the left ventricular free
wall. The mass was diagnosed as a fibrosarcoma based on the morphologic appearance and supportive
immunohistochemical staining. To our knowledge, this is the first case report of a primary fibrosarcoma
involving the left ventricular free wall myocardium, epicardium, and pericardium with a pulmonary
metastasis in a dog.

Key words: Dog; fibrosarcoma; heart; immunohistochemistry; metastasis.

Cardiac tumors are rare in both humans and
domestic animals.9,12,21 The prevalence of primary heart
tumors reported in dogs was 0.69% in a study of 1,383
dogs diagnosed with neoplasia.21 Similarly, the overall
prevalence of primary cardiac neoplasia in humans is
reported as 0.1–0.5% of all autopsies.12 In dogs, primary
cardiac tumors are much more common than metastatic
tumors to the heart at 84% and 16%, respectively.21 In
humans, the reverse is true—metastatic tumors to the
heart are reported to be 20–40 times more common than
primary heart tumors.21 Over 80% of the canine primary
heart tumors are malignant, of which 80% are heman-
giosarcoma.21 Approximately 90% of the human prima-
ry cardiac tumors are benign, and 40–70% of these
tumors are atrial myxomas.12,19,21 In both humans and
domestic animals, primary cardiac fibrosarcomas are
rare among primary cardiac malignant neoplasia.9,21
This case report describes a primary cardiac fibrosarco-
ma of the left ventricular free wall in a dog.
A 6-year-old, neutered male Labrador Retriever was
referred to the Cardiology Service, University of
Minnesota Veterinary Medical Center, with ascites due
to suspected right-sided congestive heart failure. The
dog had been treated with furosemide and abdomino-
centesis; 4.7 liters of fluid had been drained during the
week prior to referral but the ascites had recurred. On
physical examination, the dog was 8% dehydrated, had
mild dyspnea manifested by increased abdominal effort,
distended jugular veins, mild tachycardia (140 bpm),
marked abdominal distension with a fluid wave, bi-
lateral muffled lung sounds ventrally, and muffled heart
sounds. Echocardiography demonstrated marked peri-
cardial effusion and a large intrapericardial mass
associated with the left ventricle and pericardium
(Fig. 1). Because of the poor prognosis, the dog was
403
euthanized and submitted to the University of Minne-
sota Veterinary Diagnostic Laboratory for necropsy.
At necropsy, the abdominal cavity contained 3.8 liters
of serosanguineous fluid; the thoracic cavity, 0.6 liters;
and the pericardium, 0.5 liters. The pericardium was
markedly and diffusely thickened (3 mm thick). At-
tached to the left ventricular free wall myocardium and
expanding into the pericardial space was an 11.0 3 7.0
3 6.0 cm, multilobulated, soft, tan, well-demarcated
mass. The pericardium had fibrous adhesions to the
mass along 50% of the surface of the mass. Over the
remaining epicardial surface of the heart, there was
a fibrovascular sheet obscuring all normal architecture
(Fig. 2). On cut surface, the majority of the mass was
mottled tan to red and multilobulated (Fig. 3). The right
ventricular free wall was markedly thickened (10 mm
wide), and the left ventricular free wall was mildly
thickened (20 mm wide); normal heart wall measure-
ments for a dog of this body weight are considered to be
5 mm for the right ventricular free wall and 15 mm for
the left ventricular free wall. There was a single, 1-cm-in-
diameter, light-tan mass, similar in consistency to the
heart mass, in the parenchyma of the right cranial lung
lobe (Fig. 4). Tissues collected at necropsy and immer-
sion-fixed in 10% neutral-buffered formalin included
heart, pericardium, lung, liver, spleen, intestine, pancre-
as, kidney, urinary bladder, thyroid gland, adrenal
gland, lymph nodes, and brain. Tissues were processed
routinely, embedded in paraffin, and 5-mm-thick sec-
tions were stained with HE.
Histologically, the cardiac mass was a well-demar-
cated, highly cellular, unencapsulated neoplasm involv-
ing the subepicardial myocardium of the left ventricular
free wall, epicardium, and adjacent pericardium. A
compressed layer of collagen separated the neoplastic
404 Brief Communications and Case Reports
Fig. 1. Echocardiogram; canine. Marked pericardi-
al effusion (PE) forms an echolucent zone around the
heart. The tumor (arrow) arises from the wall of the left
ventricle (LV). LA 5 Left atrium.
cells from the cardiac myocytes (Fig. 5). These cells were
loosely arranged in sheets and interlacing bands with
a scant amount of fine fibrovascular stroma and
occasional, thick stromal trabeculae. The neoplastic
cells were spindle-shaped with indistinct cell borders and
small amounts of eosinophilic, finely fibrillary cyto-
plasm. The nuclei were ovoid to elongated and centrally
located with finely stippled chromatin and single-to-
multiple, basophilic nucleoli. The mitotic rate was 1–3
per 4003 field (Fig. 6). There were occasional, variably
sized, well-demarcated foci of necrosis scattered
throughout the mass with slight palisading of the
neoplastic cells admixed with infrequent neutrophils at
the periphery of the necrosis. There were multifocal
hemorrhages within the mass. The pericardium was
markedly thickened with collagen, adhered to the mass
and contained a small number of infiltrating neoplastic
cells and hemosiderin-laden macrophages. Small clus-
ters of neoplastic cells rarely infiltrated the coronary
adipose tissue and coronary blood vessels. The entire
remaining epicardium was covered by a thick layer of
granulation tissue containing numerous hemosiderin-
laden macrophages admixed with occasional neutro-
phils, plasma cells, and lymphocytes. The mass in the
lung was unencapsulated and composed of spindle-
shaped neoplastic cells similar to those described in the
heart. The liver showed signs of chronic congestion with
hepatic cord atrophy, mild centrilobular fibrosis, and
slight, random hepatocellular necrosis.
The tumor was histochemically stained with Masson
trichrome, periodic acid–Schiff (PAS), and Alcian blue.
The following immunohistochemical stains were pre-
pared using the Dako EnVision/horse radish peroxidase
(Dako, Carpinteria, CA) method at dilutions appropri-
ate to the antibody: vimentin (Dako), S-100 protein
(Dako), neuron-specific enolase (Dako), glial fibrillary
acidic protein (Dako), myoglobin (Dako), pan-cytoker-
Vet Pathol 44:3, 2007
atin (LabVision Corp., Fremont, CA), a-smooth muscle
actin (Dako), chromogranin (Dako), melan-A (Dako),
Factor VIII-related antigen (Dako), neurofilament pro-
tein (Dako), synaptophysin (Dako), and desmin (Dako).
Additional immunohistochemical stains using the avi-
din-biotin-complex detection system at appropriate
dilutions included the following: tyrosinase (BioCare
Medical, Walnut Creek, CA), MART-1 (Ventana,
Tucson, AZ), CD68 (Dako), smooth muscle myosin
(Ventana), muscle-specific actin (Ventana), CD117
(Dako), mast cell tryptase (Dako), lysozyme (Ventana),
and collagen IV (Dako).
On the basis of the spindle cell morphology, the
arrangement of tumor cells, positive staining of the
neoplastic cells for vimentin (Fig. 7), and exclusion of
other spindle cell tumors by negative results with special
stains and a broad spectrum of immunohistochemical
stains, a diagnosis of high-grade primary cardiac
fibrosarcoma with pulmonary metastasis was made.
Differential diagnoses for malignant cardiac spindle cell
tumors include malignant peripheral nerve sheath
tumor, leiomyosarcoma, rhabdomyosarcoma, malig-
nant fibrous histiocytoma, hemangiosarcoma, myxosar-
coma, granular cell tumor, mast cell tumor, malignant
melanoma, perivascular epithelioid cell tumor (PE-
Coma), and metastatic sarcomatoid carcinoma.
The origin of the tumor cells in this case was con-
firmed as mesenchymal by strong cytoplasmic staining
with vimentin and no staining for pan-cytokeratin; this
also minimized the possibility of a metastatic sarcoma-
toid carcinoma. Masson trichrome did not highlight
significant collagen within the mass, which is typically
associated with well-differentiated fibrosarcomas. Ma-
lignant peripheral nerve sheath tumors are consistently
vimentin-positive,5,7,8,15–17 but stain variably for S-100.
In one study, 73% of canine tumors diagnosed as
malignant peripheral nerve sheath tumors on HE were
positive for S-100.8 Collagen IV staining can be
supportive of a diagnosis of a nerve sheath tumor since
all tumor cells should have a basement membrane
composed of collagen IV. Neither S-100 staining of the
neoplastic cells nor collagen IV staining around the
neoplastic cells was seen in this case. With the
immunohistochemical results for this case and the
neoplastic cell arrangement not classic for a nerve
sheath tumor, this diagnosis was rejected. Muscle
tumors were ruled out by negative immuno-
histochemistry for myoglobin, a-smooth muscle actin,
smooth muscle myosin, muscle-specific actin, and
desmin. Macrophage and histiocytic cell origin was
evaluated using CD68 and lysozyme, which were
negative. An unusual hemangiosarcoma was deemed
unlikely since none of the neoplastic cells showed
staining with Factor VIII–related antigen. No mucopo-
lysaccharides were seen on an Alcian blue–stained
section, which would indicate a myxosarcoma; and no
PAS-positive granules were seen, which would be
expected in a granular cell tumor. A neural origin of
the tumor cells was considered and found improbable by
the lack of staining of the neoplastic cells with glial
Vet Pathol 44:3, 2007 Brief Communications and Case Reports 405

Fig. 2. Heart and lungs, pericardium partially removed; canine. A large, multilobulated mass (M) is attached to the left ventricular
free wall. The pericardium (arrows) is diffusely thickened. A thick fibrovascular layer (asterisk) covers the entire epicardium, obscuring
the cardiac profile.
Fig. 3. Heart; canine. The cut surface of the mass is mottled tan and red and multilobulated. The mass involves the left ventricular
free wall with indistinct demarcation (arrows) between the mass and the myocardium. IVS 5 interventricular septum; RV 5 right ventricle.
Fig. 4. Lung; canine. There was a single, 1 cm-diameter, tan, firm, metastatic nodule within the lung parenchyma.
Fig. 5. Heart; canine. A compressed layer of collagen (arrows) separates the neoplastic cells from the cardiac myocytes. HE.
Fig. 6. Heart tumor; canine. The tumor consists of spindle cells with indistinct cell borders, ovoid nuclei, and finely fibrillary
eosinophilic cytoplasm. Multiple mitotic figures are present (arrows). HE.
Fig. 7. Heart tumor; canine. The cytoplasm of the neoplastic cells stain strongly for vimentin. EnVision/horseradish peroxidase
method; Mayer’s hematoxylin counterstain.
406 Brief Communications and Case Reports
fibrillary acidic protein, neuron-specific enolase, and
neurofilament protein. The tumor was not of neuroen-
docrine origin since chromogranin and synaptophysin
were negative. Mast cell markers were negative (mast
cell tryptase) or showed only minimal, nonspecific,
cytoplasmic staining (CD117). Malignant melanoma
can have spindle-shaped cells but the neoplastic cells
were negative for S-100, tyrosinase, and melan-A/
MART-1, and no melanin granules were seen on HE
slides. A PEComa has not been reported in domestic
animals, but in humans, this tumor stains positively for
smooth muscle actin and the previously listed melano-
cytic markers. Since all of these markers were negative
on the tumor, PEComa was excluded.
Primary cardiac fibrosarcomas are rare in humans
and dogs.9,21 In dogs, the prevalence is reported as less
than 1% of all primary heart tumors; in humans, the
percentage drops to 0.01–0.02%.1,12,21 The reported sites
for canine cardiac fibrosarcomas include the right
ventricular free wall,1,20 endocardium of the right
atrium,11 interatrial septum,20 and interventricular
septum.20 None of these cases had metastases.1,11,20 In
humans, the most common site of cardiac fibrosarcomas
is within the right atrium, but fibrosarcomas can be
found anywhere in the heart.2,3,9,10,12–14,19,22 These
tumors are aggressive, infiltrate the myocardium and
pericardium, and can metastasize to distant sites in-
cluding the lungs, liver, bone, brain, and skin.19 Other
animal species in which primary cardiac fibrosarcomas
have been reported include a cat, on the wall of the left
atrium;18 a sheep, in the right atrium;4 and a monkey, in
the interventricular septum.6
To the authors’ knowledge, this is the first report of
a primary cardiac fibrosarcoma with a pulmonary
metastasis in a dog. Other unique features of this case
include the location of the tumor on the left ventricle
and the large size of the mass. The mass in the dog in
this report had an average diameter of 8 cm, which is
more than twice that of other reported primary cardiac
fibrosarcomas in dogs (mean, 3 cm; range, 0.5–
4.5 cm).1,11,20 The mean diameter on human cases of
cardiac fibrosarcoma for which a size was given is
4.5 cm (range, 2–6.6 cm).2,13,14 The exact origin of the
tumor in this case cannot be determined but could be the
pericardium, epicardium, or myocardium. The diagnosis
of a fibrosarcoma is based primarily on excluding other
spindle cell tumors because immunohistochemical mar-
kers specific for fibrosarcomas in either humans or
domestic animals currently do not exist.
Acknowledgements
We thank Jan Shivers and the laboratory staff for
their efforts on the immunohistochemistry and special
stains for this case. We would also like to thank Dr. Erik
Olson for his help with figures and editing.
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Request reprints from Dr. M. C. Speltz, Minnesota
Veterinary Diagnostic Laboratory, 1333 Gortner Ave-
nue, St. Paul, MN 55108, (USA). E-mail: seco0003@
umn.edu.