10445              MEDIASTINAL LYMPHOMA

The patient was a man aged 27 who was admitted with a 2 week history of swelling of the face.  On examination there was cyanosis and oedema of the head, neck and arms, with prominent veins.  The neck was grossly enlarged by swollen matted lymph nodes and similar nodes were present in the axillae and groins.  Chest X-ray showed marked enlargement of mediastinal nodes.  A biopsy was reported as “lympho-reticular medullary reticulosis” according to the then fashionable classification.  The haemoglobin was 8.6 gms%.  He was treated by radiotherapy with little relief, became progressively anaemic and weaker and died after 5 weeks.  At postmortem there was extensive lymphoma involving mediastinal, axillary, cervical and abdominal nodes.

The specimen consists of the heart, mediastinum and right lung.  A large mass of lymphoma tissue surrounds the superior vena cava and aorta and extends for a little distance into the hilum of the lung.  The superior vena cava shows marked lateral compression and there is antemortem thrombus in the upper end of the vena cava extending into the innominate veins.  Histology shows diffuse Hodgkin’s disease with lymphocyte predominance and occasional Reed-Sternberg cells.  There are large areas of necrosis.