CASE HISTORY

Patient was first admitted complaining of a cough following a chill a month before. On admission she had a pleural effusion on the left side. This was aspirated and she was discharged with the diagnosis of idiopathic pleural effusion. She was readmitted a month later when a bronchoscopy was performed by Dr Scadding. A nodular mass was found in the lower left bronchus and a portion removed for biopsy. On section this showed a spheroidal cell carcinoma of similar type to the oat-cell tumour. A course of deep x-ray therapy was started, but had to be stopped on account of a severe fall in the white cell count. Her clinical condition improved. She gained weight and was discharged. She was readmitted for further deep Xray therapy; at this time the physical signs showed collapse of the lower lobe of the left lung. A further course of Xray therapy was given. Patient developed a secondary nodule in the right axillary line. This was removed under local anaesthesia and proved to be a spheroidal cell carcinoma. She was finally admitted for the last time 14.12.36 complaining of cough and pain on coughing. The bouts of coughing were frequent and severe and unproductive. The whole of the left side of the chest was completely dull on percussion, being most marked at the base. Right lung was resonant. Heart showed no lesion. After the last admission patient's condition gradually got worse. CXR showed that the heart and mediastinum were markedly displaced to the left and the left lobe of the diaphragm was elevated. Left lung showed marked opacity indicative of collapse. Patient died relatively suddenly.

PATHOLOGY

Lung 180mmx155mmx55mm. The specimen comprised the lower part of the trachea and the adjacent portions of both bronchi together with about half of the left lung. In the proximal part of the main left bronchus there is a circumscribed mass of tumour. This completely occluded the bronchus. It has also surrounded and invaded several root glands. The tumour is pale and translucent but shows more opaque patches denoting necrosis. The lung shows severe collapse, apparently due to the blocking of the bronchus. In the upper part the bronchi are dilated. In the lower part there is a patchy invasion by tumour. The pleura shows some fibrous thickening.