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An unusual cause of multiple bilateral pulmonary metastases Part 1

An autopsy, performed 3 days after death, revealed an obese African woman who weighed 91 kg with no external features of note. Systemic examination revealed multiple firm white subpleural nodules in both lungs (Fig. 1). The nodules varied in size from 1.5 to 3 cm in diameter. There were bilateral blood-stained pleural effusions that measured 1.5L each. Despite a thorough examination of the internal organs, no primary neoplasm was identified. The only other pathology noted was left ventricular hypertrophy and benign nephrosclerosis consistent with a history of systemic hypertension. The presence of multiple pulmonary nodules, which was consistent with metastatic tumour, and the absence of an obvious primary led us to perform a frozen section of a pulmonary nodule (Fig. 5). A post mortem radiological skeletal survey showed pathology of the proximal right femur (Fig. 2). No other bone abnormalities were identified. Subsequent dissection of the right thigh showed a large mass involving the greater trochanter and upper two-thirds of the femur with soft tissue extension (Fig. 3). Representative sections of the femoral head (Fig. 4), distal femur and tumour (Fig. 5) were processed for light microscopy. Received 1 November 2001, revised 16 April 2002, accepted 22 April 2002