This 47-year old woman was admitted with terminal carcinomatosis. On examination, a hard liver and a right pelvic mass were palpable. She had been ill with constitutional symptoms for months and she finally sought medical attention. She was admitted for palliative care and died shortly afterwards.
The left intact lung has multiple pale tumour nodules of varying size are scattered throughout the lung substance. Near the hilum several nodules are confluent. The hilar lymph nodes contain pale tumour tissue. Small tumour nodules from 2mm to 2cm can be seen beneath the thickened pleura on the costal, mediastinal and diaphragmatic surfaces. Histologically, these were metastatic deposits of adenocarcinoma. At post-mortem there was an adeno-carcinoma of ovary, with metastases in lungs, heart, liver and pericardium.
Pulmonary metastases are more common than primary lung cancer. Malignant diseases arising anywhere in the body may spread to the lungs due to its rich blood supply and lymphatic drainage. Sarcomas usually metastasize by the bloodstream, and carcinomas spread either via the bloodstream or the lymphatic system or both.