A 62 year old man presented with lumps in the neck and a husky voice one year before this final admission. Despite treatment, he subsequently developed hepatomegaly and splenomegaly and further lymph node enlargement. Terminally, immature lymphocytes and blast cells were seen in his peripheral blood.
The specimens in three containers comprise tracheal bifurcation, caecum and colon, and spleen (only the tracheal specimen has been included in Demonstration 14). (i) The trachea and main bronchi are surrounded by para-tracheal, peri-bronchial and mediastinal lymph nodes which are grossly enlarged. Some nodes are discrete but others are matted together. The cut surface has a homogeneous pale fawn appearance, interrupted by occasional patches of carbon. (ii) The mucosa of the caecum and colon are displayed to show many nodules measuring between 0.5 cm and 2 cm in diameter. These nodules are prominent about the ileo-caecal valve. The mucosa is not ulcerated. (iii) The spleen is uniformly enlarged and slicing revealed multiple pale nodules up to 0.5 cm in diameter on the cut surface. Histologically the appearances are those of acute lymphatic leukaemia or malignant lymphoma.
Malignant lymphoma may, in some cases, progress to involve the bone marrow and peripheral blood, giving rise to a leukaemic blood picture.