23859              MEDIASTINAL LYMPHOMA

The patient was a woman aged 59 with a history of anorexia, weight loss and cachexia.  Reticulum cell sarcoma had been diagnosed 4 months previously at laparotomy for an abdominal mass.  Subsequent radiotherapy was given.  On examination at her last admission she was markedly wasted, the JVP was elevated and did not move on respiration.  There was atrial fibrillation but no cardiac failure.  A clinical diagnosis was made of superior vena cava obstruction secondary to mediastinal reticulum cell sarcoma.  There was evidence of fibrinolysis with a low fibrinogen and an increased thrombin time.  She died on the day after admission.  At postmortem massive lymphomatous deposits were present in the abdominal cavity, particularly in retroperitoneal nodes, mesentery and omentum.  Where was also massive deposition in the mediastinum.

The specimen consists of the right lung mediastinum and heart sectioned to show massive firm fleshy lymphomatous tissue in the superior mediastinum, surrounding and compressing the inferior vena cava and displacing the arch of the aorta and the great vessels arising from it.  On the reverse of the specimen the lymphomatous mass can be seen to surround the lower trachea and the origins of the major bronchi.  Histology shows pleomorphic reticulum cell sarcoma poor in lymphocytes and with quite numerous irregular giant cells.