Case description: A 2-year-old Thoroughbred filly was evaluated because of hemorrhage from the vulva and suspected hematuria of 5 days' duration.
Clinical findings: A primary coagulopathy was ruled out on the basis of results of hematologic testing. Vaginoscopy and cystoscopy revealed a large bleeding mass in the bladder that extended into the vagina, causing marked obliteration of normal urogenital structures and difficulty in urination. Histologic examination of endoscopic and surgical biopsy specimens revealed a poorly differentiated neoplasia likely of mesenchymal origin. Chronic suppurative cystitis caused by Streptococcus zooepidemicus was also diagnosed.
Treatment and outcome: The tumor continued to grow despite treatment with doxorubicin and, within 45 days, was causing substantial discomfort and stranguria. Given the grave prognosis, the horse was euthanized. At necropsy, the tumor was found to have caused widespread destruction of the urinary bladder and to have invaded the broad ligament of the uterus. The mass was identified as a poorly differentiated leiomyosarcoma on the basis of results of histologic examination and immunohistochemical staining for alpha-actin.
Clinical relevance: Findings suggested that leiomyosarcoma should be considered in the differential diagnosis when examining horses with urogenital bleeding.