19583              APICAL BRONCHOGENIC CARCINOMA

This patient was a man aged 71.  Three years previously a squamous cell carcinoma of the right upper lobe involving the adjacent ribs and intercostal muscle was resected in Melbourne.  A little more than a year later localised pain developed over the posterior aspect of the shoulder.  The pain increased in spite of radiotherapy and became so severe that some months before his death a percutaneous cordotomy was attempted but failed.  Thereafter he was treated by potent analgesics (the Brompton cocktail) and gradually deteriorated and died.  At postmortem there were metastases in the liver and in the ribs.

The specimen consists of the right lung sectioned to show the recurrent apical carcinoma measuring 7 x 4 cms.  The tumour had penetrated the overlying thoracic wall and is covered by dense fibrous adhesions.  The remainder of the upper lobe shows moderate local emphysema with anthracosis.  The lower lobe is congested and contains quite numerous patches of bronchopneumonia.  Histology shows squamous cell carcinoma at the apex and acute bronchopheumonia at the base.