The Lymph Drainage of the Mammary Glands in the Bitch: a Lymphographic Study. Part I: The 1st, 2nd, 4th and 5th Mammary Glands

The objective of this paper was to study the lymph drainage of the 1st, 2nd, 4th and 5th mammary glands in the bitch using indirect lymphography. The main conclusions drawn after the study of 67 normal lactating mongrel bitches were as follows: lymph drains from the first gland, usually to the axillary nodes, and, in few cases, to the axillary and superficial cervical nodes simultaneously. The second gland drains to the axillary nodes. The fourth gland usually drains to the superficial inguinal nodes, but it may, rarely, drain to the superficial inguinal and medial iliac nodes simultaneously. The fifth gland drains to the superficial inguinal nodes. Lymphatic connection between the mammary glands could not be demonstrated. Furthermore, it was confirmed that lymph can pass from one gland to another, through their common regional lymph nodes, by retrograde flow. It was demonstrated that there is a connection between the superficial inguinal lymph nodes from either side. It is suggested that lymphatic connection between the axillary and sternal nodes and between the axillary and bronchial nodes should be possible in some cases. Lymphatics of the mammary glands that cross the midline were not demonstrated.     

99mTc-labeled dextran for mammary lymphoscintigraphy in dogs

Lymphoscintigraphy is the technique of choice for sentinel lymph node detection in women with early breast cancer, but there is limited information evaluating the value of this technique in animals. We investigated mammary lymphatic drainage in 25 young female mongrel dogs by intramammary injection of 18.5 MBq of 99mTc-dextran (70,000 Da). Lymph node anatomical referencing was obtained using an external marker, bone scintigraphy, or scintiscanning the body contour. Cranial and caudal thoracic mammary glands drained into the cranial sternal lymph node and axillary lymph center. The cranial thoracic mammary gland also drained into the superficial cervical lymph node in two of five animals. The cranial abdominal gland was drained by the axillary lymph center. The caudal abdominal mammary gland was drained by the superficial inguinal lymph node in all animals and simultaneously by medial iliac lymph nodes in four of five animals. In one dog, this mammary gland was also drained by the mediastinal and the superficial cervical lymph nodes. The inguinal mammary gland was drained by superficial inguinal lymph nodes and simultaneously via the medial iliac lymph node in one animal. Lymphatic communications between lymph nodes were identified in 11 of 25 (44%) animals. 99mTc-dextran mammary lymphoscintigraphy was easy and rapid to perform and may provide valuable information for further studies.     

The lymph drainage of the neoplastic mammary glands in the bitch: a lymphographic study

The purpose of this investigation was to study the lymph drainage of the neoplastic mammary glands in the bitch using indirect lymphography. The main conclusions drawn from the study of 41 natural cases were as follows: the first or cranial thoracic and second or caudal thoracic neoplastic mammary glands usually drain into the ipsilateral axillary lymph nodes and rarely into the ipsilateral axillary and sternal lymph nodes, simultaneously. The third or cranial abdominal neoplastic mammary gland usually drains into the ipsilateral axillary and superficial inguinal lymph nodes simultaneously, but sometimes only cranially into the ipsilateral axillary lymph nodes. Rarely, it drains only caudally into the ipsilateral superficial inguinal and medial iliac lymph nodes, simultaneously. The fourth or caudal abdominal neoplastic mammary gland usually drains only caudally into the ipsilateral superficial inguinal lymph nodes. Rarely, it drains into the ipsilateral axillary and superficial inguinal lymph nodes simultaneously. The fifth or inguinal neoplastic mammary gland usually drains into the ipsilateral superficial inguinal lymph nodes but rarely, does it also drain into the ipsilateral popliteal lymph node and into a lymphatic plexus at the medial aspect of the ipsilateral thigh. Lymphatic connections between the neoplastic and adjacent normal mammary glands were demonstrated in only one case. The lymph drainage pattern of the neoplastic mammary glands is slightly different to that described in normal glands using the same radiographic method.     

The Lymph Drainage Pattern of the Mammary Glands in the Cat: A Lymphographic and Computerized Tomography Lymphographic Study

Seventy-three clinically normal, lactating cats were used to investigate the lymph drainage of 73 mammary glands. In 50 cats of the first group, the number of lymphatic vessels emerging from the examined mammary gland, their course and the lymph nodes into which they are drained were studied by indirect lymphography (IL) after intramammary injection of an oily contrast medium. In 23 cats of the second group, the lymph drainage of the mammary glands was studied by computerized tomography indirect lymphography (CT-IL) after intramammary injection of a water soluble contrast medium. The following day, the lymph drainage of the mammary gland examined by CT-IL was studied by IL, as it was described in the first group, for comparison purposes. The main conclusions drawn after this study were as follows: lymph drains from the first and second mammary glands with one or rarely two or three lymphatic vessels to the accessory axillary lymph nodes. Lymph drains from the third mammary gland with one or two and rarely three lymphatic vessels usually to the accessory inguinal lymph nodes or to the accessory axillary lymph nodes. In some cases, it drains to both lymph nodes simultaneously or it may rarely drain only to the medial iliac lymph nodes. The fourth mammary gland with one or two and rarely three lymphatic vessels usually drains to the accessory inguinal lymph nodes. It may rarely drain only to the medial iliac lymph nodes. Mammary lymphatic vessels that cross the midline and lymphatic connection between the mammary glands were not demonstrated. No differences in the mammary lymph drainage pattern between IL and CT-IL were found.     

The Lymph Drainage of the Mammary Glands in the Bitch: a Lymphographic Study. Part II: the 3rd Mammary Gland

The objective of this investigation was to study the lymph drainage of the 3rd mammary gland in the bitch using indirect lymphography. The main conclusions drawn after the study of 62 normal lactating mongrel bitches were as follows: lymph usually drains from the third gland to the axillary and superficial inguinal nodes simultaneously, but in some cases it drains only cranially to the axillary nodes. It may, rarely, drain only caudally to the superficial inguinal nodes. A lymphatic connection between the mammary glands could not be demonstrated. It was demonstrated that there is a connection between the superficial inguinal lymph nodes on either side. It is suggested that lymphatic connection between the axillary and sternal nodes and the axillary nodes of both sides should be possible in some cases. Lymphatics of the mammary glands that cross the midline were not demonstrated. No relationship between the number of lymph nodes and the body size of the dog could be demonstrated.     

SONOGRAPHIC CHARACTERISTICS OF PRESUMPTIVELY NORMAL CANINE MEDIAL ILIAC AND SUPERFICIAL INGUINAL LYMPH NODES

The medial iliac and superficial inguinal lymph nodes are not routinely palpable in the dog, and ultrasound imaging provides an alternate noninvasive technique to assess these lymph nodes, as well as to guide needle aspiration. Herein we describe the ultrasound characteristics of the medial iliac and superficial inguinal lymph nodes in 50 healthy dogs, as well as frequency and ease of node detection. The relationship between the size of the lymph nodes and the following variables was assessed: age, gender, body weight, body condition score, body length, and thoracic height and width. Right and left medial iliac lymph nodes were detected in 50 (100%) dogs, right superficial inguinal lymph node(s) in 49 (98%) dogs, and left superficial inguinal lymph node(s) in 47 (96%) dogs. In >90% of both sets of lymph nodes, the echogenicity was hypoechoic or isoechoic to surrounding tissues, with a corticomedullary or homogenous echotexture, smooth, clearly defined margins, and a fusiform shape. Increasing weight, distance from the sternal manubrium to the ischium, and thoracic height and width were associated with increased lymph node size (P‐values<0.05). Average lymph node sizes and range of sizes provide preliminary reference values for the medial iliac and superficial inguinal lymph nodes in normal dogs.     

Frequency of an accessory popliteal efferent lymphatic pathway in dogs

Staging and therapeutic planning for dogs with malignant disease in the popliteal lymph node are based on the expected patterns of lymphatic drainage from the lymph node. The medial iliac lymph nodes are known to receive efferent lymph from the popliteal lymph node; however, an accessory popliteal efferent pathway with direct connection to the sacral lymph nodes has also been less frequently reported. The primary objective of this prospective, anatomic study was to describe the frequency of various patterns of lymphatic drainage of the popliteal lymph node. With informed client consent, 50 adult dogs with no known disease of the lymphatic system underwent computed tomographic lymphography after ultrasound‐guided, percutaneous injection of 350 mg/ml iohexol into a popliteal lymph node. In all 50 dogs, the popliteal lymph node drained directly to the ipsilateral medial iliac lymph node through multiple lymphatic vessels that coursed along the medial thigh. In 26% (13/50) of dogs, efferent vessels also drained from the popliteal lymph node directly to the internal iliac and/or sacral lymph nodes, coursing laterally through the gluteal region and passing over the dorsal aspect of the pelvis. Lymphatic connections between the right and left medial iliac and right and left internal iliac lymph nodes were found. Based on our findings, the internal iliac and sacral lymph nodes should be considered when staging or planning therapy for dogs with malignant disease in the popliteal lymph node.     

Indirect computed tomography lymphangiography with aqueous contrast for evaluation of sentinel lymph nodes in dogs with tumors of the head

Sentinel lymph node evaluation is widely used in human medicine to evaluate the first lymph node(s) to which a tumor drains. Sentinel lymph node biopsy allows avoidance of extensive lymphadenectomies in cases where the sentinel lymph node is negative for metastasis, thereby reducing patient morbidity. It has been shown that regional lymph nodes are not always the sentinel lymph node, thus identification and sampling of sentinel lymph nodes allows for more accurate staging, which is critical for treatment and prognostication in dogs with cancer. The objective of this prospective, pilot study was to determine if indirect computed tomography (CT) lymphangiography with aqueous contrast agent would successfully allow identification of sentinel lymph nodes in dogs with masses on the head. Eighteen dogs underwent CT lymphangiography. The sentinel lymph node was successfully identified within 3 min of contrast injection in 16 dogs (89%). Compression of lymphatic vessels from endotracheal tube ties and/or the patient's own body weight delayed or prevented identification of sentinel lymph nodes in two dogs (11%). Computed tomography lymphangiography with aqueous contrast can be used successfully to rapidly identify sentinel lymph nodes in dogs with masses on the head.     

Indirect magnetic resonance lymphography of the head and neck of dogs using Gadofluorine M and a conventional gadolinium contrast agent: A pilot study

The purpose of this pilot study was to evaluate lymph node enhancement with an indirect magnetic resonance (MR) lymphography technique using 2 different contrast agents in the head and neck region of healthy dogs. Five dogs were imaged at various times after intradermal injection of gadoversetamide and Gadofluorine M (minimum of 1 week apart) in the right and left mandibular, temporal, and lateral neck regions. We observed consistent progressive enhancement with time in the mandibular, retropharyngeal, and superficial cervical lymph nodes. The node enhancement was comparable for both contrast agents. Contrast enhancement of the parotid lymph nodes was not seen. We conclude that this technique of indirect MR lymphography using either agent could be used to identify those lymph nodes at highest risk of metastatic disease in dogs with cancer, and to guide staging and treatment.     

Pathological Findings in a Case of Equine T-Cell Lymphoma Associated with Ataxia

A 15-year-old Dutch Warmblood gelding suddenly developed incoordination and hindlimb stumbling. The horse had a history of eyelid lymphoma. Necropsy revealed yellow-white or dark reddish-brown masses adhering to the outer surface of the spinal dura mater from the first cervical vertebra to the seventh thoracic vertebra. The spinal cord close to the first cervical vertebra and the seventh thoracic vertebra was markedly compressed by the masses filling the epidural space. The masses were also observed in the larynx, eyelids, and adipose-rich tissues, including the joints and orbits. They appeared similar in shape. The mandibular, retropharyngeal, axillary, superficial inguinal, deep inguinal, and lateral iliac lymph nodes were solid and enlarged. Histologically, the masses were composed of small or medium-sized lymphocyte-like tumor cells, but atypical cells and mitotic figures were rare. There were moderate infiltrations of macrophages and multinucleated giant cells, which were occasionally ingesting the surrounding tumor cells. Immunohistochemically, the tumor cells were classified as T-cell-derived cells. Throughout the spinal cord, enlargement or loss of nerve axons, dilation of periaxonal spaces, and macrophage infiltration into periaxonal spaces were observed, mainly in the ventral funiculus. Spinal cord compression by the tumor mass was suggested as a cause of the locomotive dysfunction. This is the first report of equine lymphoma with ataxia located from the proximal cervical to middle thoracic dura mater and in joint cavities.     

Lymphatic Drainage on Healthy and Neoplasic Mammary Glands in Female Dogs: Can it Really be Altered?

The purpose of this research was to study the mammary lymphatic drainage under a macroscopic and mesoscopic view, comparing the vascular pattern of healthy and neoplasic mammary glands injected with drawing ink alcoholic and fluorescein solutions, in 46 mongrel female dogs. The results pointed out that the thoracic gland is drained by the axillary lymph centre, but in mammary neoplasia either superficial cervical or ventral thoracic lymph centres can be involved. Cranial and caudal abdominal glands may be drained by the axillary, inguinofemoral and popliteal lymph centres. However, the popliteal drainage is specific for the healthy caudal abdominal mammary gland. The inguinal gland can be drained by both inguinofemoral and popliteal lymph centres in both neoplasic and healthy conditions. Regarding the mammary lymphatic communications, this research demonstrated that neoplasic glands present more types of anastomosis (40.9%), than healthy glands (33.33%), and an increase in contralateral anastomosis (50%) compared with healthy ones (33%). Given the data, the mammary neoplasia can change the lymphatic drainage pattern in terms of lymph centres and vascular arborization, thus forming new drainage channels and recruiting a larger number of lymph nodes. Lastly, some comments were made about the severity of a specific neoplasic mammary gland and conditions to be considered before making a decision in terms of the most adequate operative procedure, and suggestions for further investigations.     

Assessment of the cardiovascular and lymphatic systems.

Assessment of the cardiovascular and lymphatic systems first requires a complete signalment, history, and general physical examination. Further assessment of the cardiovascular system begins with evaluation of the cardiac borders through palpation and thoracic percussion. Complete cardiac auscultation requires careful evaluation of several parameters. The location, intensity, and character of normal heart sounds are first determined. This is followed by assessment of heart rate and rhythm. Finally, special attention should be placed on identifying abnormal heart sounds and describing them based on their location, intensity, duration, sound quality, and radiation. Assessment of the arterial, venous, and capillary systems provides additional information on the status of the cardiovascular system. Assessment of the lymphatic system primarily involves evaluation of external and palpable internal lymph nodes. Commonly palpable external lymph nodes include the intermandibular, parotid, retropharyngeal, superficial cervical, subiliac, mammary, and scrotal lymph nodes. Palpable internal abdominal lymph nodes include the iliofemoral lymph nodes and the iliosacral lymph center. Other lymph nodes that may be palpable include the renal, ruminal, and mesenteric lymph nodes. Lymph nodes should be evaluated for size, consistency, and tenderness.     

Primary lymphedema of the hindlimb in the dog.

Congenital lymphedema was diagnosed clinically and confirmed radiographically in five dogs. In all dogs, hindlimbs were affected with painless pitting edema at birth or shortly thereafter. The absence of popliteal lymph nodes and lymphatic hyperplasia or lymphatic hypoplasia were detected by lymphangiography or necropsy (or both). Improvement was obtained by long-term bandaging in Robert Jones splints in one dog and by surgical excision of the affected superficial fascia and subcutaneous tissue in two dogs. The remaining two dogs were euthanatized after lymphangiographic studies and were necropsied to confirm the diagnosis.     

Patterns of lymph node metastasis identified following bilateral mandibular and medial retropharyngeal lymphadenectomy in 31 dogs with malignancies of the head

Variable pathways of lymphatic drainage have been described in the dog head and neck. The aim of this study was to retrospectively assess the patterns of lymph node metastasis in dogs with malignancies of the head following bilateral mandibular and medial retropharyngeal lymphadenectomy. Thirty‐one dogs were included. Median age at surgery was 10 years (range: 5 months to 14 years) and mean bodyweight was 21.4 ± 11.9 kg. Lymph node metastasis occurred in 14 dogs (45%), with spread to mandibular lymph nodes in 14 dogs and medial retropharyngeal metastasis in 11 dogs. Eight of 13 dogs (62%) with lymphatic metastasis and a lateralised lesion showed contralateral dissemination, while 12/13 (92%) showed ipsilateral metastasis. Of 13 dogs with oral malignant melanoma, four showed metastasis to all four lymph centres. Contralateral metastasis may occur in dogs with malignancies of the head and should be considered during staging and management.     

FEASIBILITY OF CONTRAST‐ENHANCED ULTRASOUND‐GUIDED BIOPSY OF SENTINEL LYMPH NODES IN DOGS

Our goal was to develop and validate a technique to identify the sentinel lymph nodes of the mammary glands of healthy dogs with contrast‐enhanced ultrasound, and evaluate the feasibility of obtaining representative samples of a sentinel lymph node under ultrasound guidance using a new biopsy device. Three healthy intact female adult hounds were anesthetized and each received an injection of octafluoropropane‐filled lipid microspheres and a separate subcutaneous injection of methylene blue dye around a mammary gland. Ultrasound was then used to follow the contrast agent through the lymphatic channel to the sentinel lymph node. Lymph node biopsy was performed under ultrasound guidance, followed by an excisional biopsy of the lymph nodes and a regional mastectomy procedure. Excised tissues were submitted for histopathologic examination and evaluated as to whether they were representative of the node. The ultrasound contrast agent was easily visualized with ultrasound leading up to the sentinel lymph nodes. Eight normal lymph nodes (two inguinal, one axillary in two dogs; two inguinal in one dog) were identified and biopsied. Lymphoid tissue was obtained from all biopsy specimens. Samples from four of eight lymph nodes contained both cortical and medullary lymphoid tissue. Contrast‐enhanced ultrasound can be successfully used to image and guide minimally invasive biopsy of the normal sentinel lymph nodes draining the mammary glands in healthy dogs. Further work is needed to evaluate whether this technique may be applicable in patients with breast cancer or other conditions warranting evaluation of sentinel lymph nodes in animals.     

Metastatic transmissible venereal sarcoma in a dog

An adult male dog with large penile sheath and serosanguineous exudate from the preputial orifice and a cutaneous fistula in the right inguinal area was examined. Necropsy revealed tumor masses on the penis and prepuce, in superficial inguinal and external iliac lymph nodes, and in the liver. Histopathologic diagnosis of the tumor was confirmed by transplantation studies.     

Topographie des Collecteurs Lymphatiques Mammaires de la Chienne

The topography of the lymph drainage was examined by in vivo injections of india ink into the mammary parenchyma of 73 female dogs. Only one gland was injected at a time on each side. Only the cranial abdominal mammary gland had direct drainage to the axillary as well as to the superficial inguinal nodes. The principal routes of drainage differ for each gland. The glands on each side are completely independent as regards their lymph drainage. The cranial thoracic mammary glands on each side had their own collecting duct which led to the sternal lymph nodes. The results of this study suggest to develop a new model for the surgical extirpation of mammary tumors in the bitch.