Clinico-Pathological Conference: Vii. Montreal General Hospital, April 19, 1956

Our plain-English summary of Clinico-Pathological Conference: Vii. Montreal General Hospital, April 19, 1956, by H.S. Mitchell, W.H. Mathews (1956).

The study

• Authors: H.S. Mitchell, W.H. Mathews
• Published: Canadian Medical Association Journal 75(9):757-760, November (1956)
• Type of article: Journal article
• Our copy: from Johns-Manville's own medical library, J-M no. 002660. The article is still under copyright, so we describe it here rather than post it.

In plain English

This clinico-pathological conference report from the Montreal General Hospital (April 19, 1956) described one patient. A 66-year-old white man was admitted with six weeks of cough, three weeks of shortness of breath and four days of chest pain. He had worked in and around construction jobs all his life. In the discussion he was described as an asbestos worker who had been in the industry for 30 years, and he was a heavy smoker. A large left-sided pleural effusion was found. Four taps produced bloody fluid that was negative for tumour cells, and five sputum tests were also negative for tumour cells. He died suddenly 24 days after admission. In the clinical discussion, Dr. Mitchell judged anaplastic bronchogenic carcinoma the likeliest diagnosis and related the net-like X-ray pattern in the lungs to asbestosis. The post-mortem examination found an anaplastic, "oat cell" type bronchogenic carcinoma of the left lung that had spread to lymph nodes, the pericardium, the vertebral marrow and elsewhere. It also found bilateral pulmonary asbestosis with fibrosis, emphysema and terminal bronchopneumonia. As a single case, it cannot show how often this occurs.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (clinico-pathological conference: a clinical discussion followed by the post-mortem findings)
• Who was studied: one 66-year-old white man admitted to the Montreal General Hospital with cough, shortness of breath and chest pain
• Exposure: He worked in and around construction jobs all his life, including as a time-keeper. The discussing physician called him an asbestos worker who had been in the industry for 30 years. No fiber type is named. He was also a heavy smoker.
• Main results:
  • The patient had a large left-sided pleural effusion. The fluid from four taps was bloody and negative for tumour cells and acid-fast bacilli.
  • Five sputum examinations were negative for tumour cells.
  • The patient died suddenly 24 days after admission.
  • Before the autopsy findings were given, the discussing clinician favoured anaplastic bronchogenic carcinoma as the diagnosis.
  • The discussing clinician attributed the net-like (reticular) X-ray appearance of the lungs to asbestosis rather than to tumour.
  • At post-mortem examination, the tumour was an anaplastic bronchogenic carcinoma of "oat cell" type in the left lung.
  • Metastases were found in the vertebral marrow, in a retroperitoneal lymph node and in the perivesical fat, in addition to hilar and mediastinal lymph nodes.
  • The autopsy found bilateral pulmonary asbestosis with widespread interstitial pulmonary fibrosis.
  • The heart weight was normal (360 g), although the clinician had suggested rheumatic heart disease.
• The authors' conclusion: The final pathological diagnosis was anaplastic bronchogenic carcinoma of the left lung with regional and disseminated metastases, bilateral pulmonary asbestosis with fibrosis and emphysema, terminal bronchopneumonia, and pulmonary osteoarthropathy.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Sputum, Bronchogenic Carcinoma, Autopsy, Pericardium, Bilateral, Asbestosis, Fibrosis.

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