This 53 year old male presented with a 2 month history of cough, weakness, anorexia and weight loss. Examination showed signs of congestive failure with non-pulsatile jugular venous congestion. Chest film showed a large heart which increased in size following admission. The finding of malignant cells in both sputum and pericardial fluid and the development of left lower lobe consolidation with leg thrombophlebitis suggested the possibility of carcinoma of the lung. The patient died following an episode of cerebral confusion.
The specimen is of a markedly enlarged, pale heart with some subepicardial blood-staining and nodularity. The paleness and increase in size of heart is mostly due to increase in epicardial fat. Externally the region of the right ventricle is distorted and posteriorly there is narrowing of the right ventricular cavity. Again, posteriorly, the left ventricle has been sectioned and white tumour tissue may be seen invading the epicardial fat. There is associated patchy haemorrhage. Tumour tissue can also be seen in the myocardium. Although this specimen is not very satisfactory from the demonstration point of view, it shows secondary anaplastic carcinoma of the pericardium and myocardium. The origin of the carcinoma is unknown.