The patient was a 47 year old woman who presented with a history of weight loss, progressive breathlessness and one episode of haemoptysis. She had been a heavy smoker (40 cigarettes/day). Physical examination was consistent with consolidation of the right upper lobe and a massive pleural effusion, and these findings were confirmed on x-ray examination. Bronchoscopy revealed an obstruction of the right main bronchus and a biopsy was taken which showed squamous cell carcinoma. She died fairly soon thereafter and postmortem findings showed carcinoma of the right main bronchus and right upper lobe with metastatic spread to hilar and mediastinal nodes, the left adrenal gland and kidney.
The mounted specimens are a transected lymph node (above) and an adrenal gland (below), both of which have been infiltrated by metastatic carcinoma. The lymph node contains a small white subcapsular nodule 5 mm. in diameter. The adrenal gland has been expanded and largely replaced by a mass of similar pale tissue. There is a very attenuated layer of residual adrenal cortex around the tumour. These lesions are metastatic deposits of poorly differentiated squamous cell carcinoma of the bronchus. NOTE: The adrenal glands are a very common site of metastatic carcinoma.