This 45 year old man first presented six months before his final admission with a lump in the left supraclavicular region. He was otherwise well. Excision biopsy was performed and resulted in a diagnosis of malignant lymphoma. He remained well for several months, but was then re-admitted with a six week history of pain in the left shoulder and upper arm, and intermittent swelling of the whole arm. On examination, there was generalised lymphadenopathy with marked left supraclavicular and left axillary node enlargement. There was swelling of the left arm, and weakness of the arm and hand. He was treated with deep X-ray therapy and intravenous Thio-tepa (N.B. current drug therapy is multi-drug combination cytotoxic chemotherapy). Two weeks after admission he developed vomiting. Barium meal showed a duodenal obstruction thought to be due to extrinsic pressure from enlarged lymph nodes. His condition deteriorated rapidly and he died.
There are three specimens in the container. They are the tracheal bifurcation with adjacent para-tracheal and peri-bronchial lymph nodes, a group of mediastinal lymph nodes and a section of lung. 1. The trachea has been opened longitudinally and is viewed from behind. The para-tracheal lymph nodes are pale and matted together. Similar abnormal tissue is seen as a confluent pale mass on the left side of the trachea, above the aortic arch, which is seen cut in cross-section. The peri-bronchial lymph nodes are also enlarged, and contain carbon pigment. The circumscribed small paler areas in the lymph nodes and extra-nodal tumour are foci of necrosis. Note: the atheroma in the wall of the aorta. 2.The mediastinal nodes are greatly enlarged, and pale fleshy homogeneous cut surface. The ill-defined brown areas are due to haemorrhage. These nodes surround and have compressed a large vein. 3.The lung has been sliced to show the cut surface. There is focal consolidation and a number of small pale abscesses, some of which have become confluent. This is an example of Hodgkin's Disease with terminal pulmonary infection and abscess formation.