CASE HISTORY

Clinical manifestations dated back only a relatively short time though the tumour was obviously of much longer standing.  Thirteen months before death he complained of febrile illness with cough and purulent sputum, night sweats and pain around right nipple.  In hospital for the greater part of the intervening time, his condition progressed from bad to worse and he came to autopsy with the clinical diagnosis of carcinoma (established 12 months before death), collapse, bronchiectasis and abscess of right lung. 

PATHOLOGY

The right lung was very large and heavy, completely filling the pleural cavity and weighing 1510 grams.  It was quite airless and sank in water, and the greater part of the lower lobe was fluctuant.  On cutting the lung, a large amount (about a litre) of dirty thick, slimy, greyish-yellow, mucopurulent material exuded from various parts but chiefly from one very large cavity which occupied the greater part of the lower lobe. This cavity was quite thin walled and trabeculated.  Its walls were soft and relatively smooth, not noticeably indurated by fibrosis.  Into this huge cavity most of the secondary bronchi in the lower lobe opened freely. There was a firm orange sized knuckled tumour mass around the root of the lung and mostly embedded in lung tissue. The tumour erupted into and occluded the right main bronchus about an inch beyond the bifurcation.  Within the bronchial lumen there were soft red polypoid masses of heaped up tumourous mucosa partly disintegrating.  The tumour extended out into and occluded the main division of the bronchus in the hilus.  On the cut surface of the hilus region of the lung in the occluded bronchi could be easily embedded in a firm, localised tumour mass the central parts of which were softening and showing several cartilagenous rings protruding from the softened area.  The main artery as it entered the hilus of the lung was abruptly constricted to a very small calibre by the surrounding tumour.  On the cut surface, constricted branches of pulmonary artery were readily seen and in some the narrow lumen was completely plugged by firm, gelatinous tissue, evidently organised thrombus.  Those parts of the outlying lung which were not cavitated showed a patchy firm yellow consolidation as from chronic pneumonia, the yellowish mottling was suggestive of clusters of fat laden inflammatory cells.  These yellowish areas were interlarded with streaks and patches of well marked anthracotic pigmentation.  There was no definite evidence of tuberculous lesions.  The diaphragm was depressed by and firmly adherent to the base of the right lung.