24704              LYMPHOMA

The patient was a man aged 50 who had a 3 week history of abdominal swelling, vomiting and loss of weight.  Examination showed a mass in the left iliac fossa and enlargement of the spleen.  Lymph node biopsy and laparotomy with biopsy showed undifferentiated carcinoma or reticulum-cell sarcoma.  He was treated with chlorambucil.  Iliac crest bone marrow biopsy was normal.  He became markedly anaemic and was transfused but died soon afterwards.  At postmortem there was a purpuric rash on the skin and there was massive lymphomatous infiltration in the abdominal cavity.  The spleen was greatly enlarged (500 gm) and showed multiple lymphomatous infiltrates.  There was also infiltration in the thorax involving mediastinal nodes.

The specimen is a slice of liver.  The surface is slightly nodular and the cut surface shows many small lymphomatous infiltrates up to about 7 mms in diameter.  Their edges are irregular and ill-defined and many of them are haemorrhagic.  The intervening liver substance shows mild chronic passive congestion.  Histology shows a reticulum cell sarcoma forming dense argyrophilic reticulum