See also L123b
Specimen A consists of two slices of left lung. The smaller piece contains the left main bronchus
taken immediately adjacent to the trachea. The tracheobronchial nodes are markedly enlarged and
infiltrated by pale tumour. There is peripheral anthracosis in several of the nodes. The tumour has
extended into the substance of the lung and has invaded the majority of the left upper lobe; here the
tumour has a nodular consistency with focal areas of necrosis and pinpoint haemorrhages.
Immediately distal to the tumour in the vicinity of the apex, there is a pronounced lipoid pneumonia.
The tumour has crossed the oblique fissure and extends into the left lower lobe. There is plugging
of the distal left lower lobe bronchi and further foci of lipoid pneumonia are seen in the vicinity of
the tumour in the lower lobe. Scattered vessels contain recent thrombi.
The patient, a 60-year-old man, had a past history of hypertension. He was a known
smoker who consumed 25 cigarettes a day. He was admitted with a four week history of anorexia,
weakness and weight loss, associated with intermittent dyspnoea. Chest x-ray showed an opacity
of the left hemithorax with elevation of the left diaphragm and the suggestion of a mass above and
behind the left hilum. He gradually deteriorated and died 19 days following admission. Histologic
examination of tissue taken from the primary site and from each of the metastases showed small
cell undifferentiated carcinoma.