25269              BRONCHIAL CARCINOMA

The patient was a man aged 62 who had a lump beneath the jaw for one month.  It grew steadily until the day of admission when he became feverish, with a headache and pain in the neck together with marked ataxia.  On examination there was gross dysarthria, bilateral nystagmus to the right and left and a lump in the jaw, measuring 3 x 4 cms, not attached to the skin.  It moved with deglutition but not when the tongue was protruded.  Chest X-ray showed a lesion in the left lower lobe.  Biopsy of the lump in the neck showed metastatic carcinoma and brain scan revealed secondaries in the right parietal lobe.  He became unconscious and died 2 weeks after admission.  At postmortem there was carcinoma in the left lower lobe with metastases in the cerebral hemisphere, the cerebellum, abdominal lymph nodes, small bowel and adrenal.

The specimen consists of the left lung sectioned to show a lobulated neoplasm in the lower lobe.  At its greatest extent it measures 10 cms in diameter and on the cut surface there are visible fibrous septa and areas of haemorrhage and necrosis.  There is a tiny calcified subpleural nodule on the medial surface of the apical segment of the lower lobe 7 cms below its tip.  This may represent an old primary tuberculous focus.  Histology shows a pleomorphic large celled carcinoma with some giant cells.