HEART & MEDIASTINAL CONTENTS - Mediastinal tumour (small cell carcinoma from lung)

This specimen shows the heart, pericardium, great vessels, trachea and hilar area of each lung. The pericardium is thickened and roughened due to tumour infiltration. There is a mass of tumour around the arch of the aorta, extending up along-side the great vessels. This is continuous with a large mass of tumour infiltrating the lower mediastinum, visible both posteriorly and anteriorly. Mediastinal lymph nodes are infiltrated by tumour, as is the wall of the right main bronchus. Towards the base of the specimen, infiltration of the myocardium can be seen.
This woman was admitted to hospital approximately six weeks before her death with a history of persistant cough and breathlessness for 3-4 months. An undifferentiated small cell carcinoma was identified in the sputum. A brain scan suggested a metastatic deposit in the right frontal lobe. During her stay in hospital she developed symptoms of superior vena cava obstruction, tracheal obstruction and inappropriate ADH secretion. At autopsy, tumour deposits were found in the liver, diaphragm, adrenals, pericardium, pancreas, pituitary and brain. No definite primary site could be identified but the most likely origin of the tumour was lung.