16595              MULTIFOCAL PRIMARY CARCINOMA

The patient was a woman aged 69 who had been in good health until 12 months previously when mild hypertension was found.  She then complained of breathlessness and loss of weight.  For the last 6 months the breathlessness had increased until she was unable to walk more than a few yards without respiratory distress.  There was no ankle oedema and no orthopnoea.  On X-ray there were multiple opacities throughout both lung fields.  Biochemical investigations showed no abnormality.  The Mantoux test was negative.  She died suddenly after a few weeks in hospital.  At postmortem both lungs were studded with small rounded tumour nodules.  Hilar glands were involved but there were no other metastases.

The specimen is of the right lung sectioned to show multiple small neoplastic nodules varying in size from a few mms up to about 1 cm in diameter throughout the lung fields.  The margins of the masses are slightly indefinite and the intervening lung is congested.

The overlying pleura is somewhat nodular.  Histology shows an alveolar carcinoma composed of cuboidal and columnar cells growing on the inner walls of the alveoli and forming tubules in many places.