EXTERNAL EXAMINATION: The body is that of an adult-like male. The body has been embalmed. The head is normal cephalic, there is gray hair distributed over the scalp. The ears are without lesion, the nose is without lesion. The eyes have been capped. The mouth has been sealed. At the right base of the neck, there is a sutured embalming wound. The chest is symmetric and stable. The abdomen is rounded. There is a old healed surgical wound between the umbilicus and the pubis and the midline. The scar expands to as wide as 8 cm and is associated with a ventral hernia that measures approximately 15X12X8 cm. The upper extremities are without lesion. There is a yellow metal ring present on the 4th finger of the left hand. The lower extremities are well formed. The back is without lesion. The external genitalia are adult male. The penis is uncircumcised. The testicles are descended into the scrotum and are without masses. Along the left hip, there is a 25 cm in length recently healed surgical wound.
INTERNAL EXAMINATION: The body is opened by the usual y-shaped incision revealing approximately 5 cm of subcutaneous fat present at the level of the umbilicus. The ventral hernia sac is filled with yellow-clear low viscosity fluid. The walls of the hernia sac are shiny and trabeculated. The pleural spaces are without abnormal accumulations of fluid, fibrous adhesions are not present. Peritoneal cavity is smooth and glistening. There are no abnormal accumulations of fluid. No significant fibrous adhesions are observed.
RESPIRATORY SYSTEM: The larynx is palpated and sighted without lesion. The trachea is patent and without lesion. The major bronchi are well formed. The right and left lungs are heavy. The visceral pleura is smooth and glistening. Bilaterally, the posterior aspects of both lungs are congested. At the lateral base of the right lower lobe, there is a 3 cm in diameter white metastatic tumor mass. In the right upper lobe and in the left upper/lower lobes, there are numerous small metastatic white tumors, none exceeding 0.5 cm in diameter. The carinal lymph nodes are enlarged to approximately 3 cm in diameter and filled with gray tumor. The parenchyma of the lung reveals severe panlobular and centrilobular emphysema with extensive anthracotic pigmentation.
CARDOVASCULAR SYSTEM: The pericardium is lightly adhesed to the surface of the heart. The pericardial space is obliterated by fibrinous adhesions. These are easily broken. The heart appears slightly enlarged, with dominance of the left ventricle. The myocardium is red and meaty, no evidence of scarring or past infarction is observed. The right atrium is well formed. The tricuspid valve is well formed and without lesion. The sinus and culnis of the right ventricle are well formed. The right ventricular free wall measures up to 0.7 cm in thickness. The pulmonary valve is well formed. The pulmonary arteries fail to reveal blood clots. There are 4 pulmonary veins with which return just through the left atrium. The mitral valve is well formed. The left ventricle is well formed. The left ventricular free wall measures up to 2.1 cm in thickness. The aortic valve is without lesion. The coronary arteries are distributed over the heart in the usual fashion and there is no significant atherosclerosis observed. The aorta runs the usual course and reveals only mild atherosclerosis. The greats veins are without blood clot or other abnormality. The lymph nodes, right and left of the aorta from the pelvic floor to the diaphragm, are markedly enlarged up to 5 cm in diameter, white and filled with tumor.
GASTROINTESTINAL: System the esophagus runs the usual course and is without lesion. The stomach is well formed. The small intestine and large intestine are well formed. The appendix is present and without lesion.
LIVER: The liver is of the expected size, shape, and position. Glisson’s capsule is smooth and glistening. The hepatic parenchyma is slightly buttery in character but shows no evidence of metastatic tumor and no evidence of cirrhosis. The gall bladder is present in the usual position and contains approximately 70 ml of greenish-black viscid bile. No stones are observed. The extra hepatic billiary ducts are the expected caliber and run the usual course.
SPLEEN: The spleen is enlarged and weighs approximately 400 g. The splenic capsule is intact. The splenic parenchyma is red, meaty, and uniform. No metastatic tumor masses are observed.
PANCREAS: The pancreas is of the expected size, shape, and position with some nonspecific gross abnormality.
ADRENAL GLANDS: The adrenal glands are the expected size, shape, and position. Both the cortices and the medullae are well formed.
THYROID GLAND: The thyroid gland is palpated in situ and is without lesion.
UROGENITAL SYSTEM: The kidneys are the expected size, shape, and position. The capsules are smooth and glistening and strip with ease. The renal parenchyma is well formed. The cortex is greater than 0.5 cm in thickness. The palpices and klacices and pyramids are all well formed. The ureters run the usual course and are the usual caliber. The bladder is contracted and trabeculated. The prostate appears to be about 20 g in weight and is gray and uniform.
CENTRAL NERVOUS SYSTEM: The central nervous system is not examined in this dissection.
PROVISIONAL ANATOMIC DIAGNOSIS:
1. Bilateral bronchial pneumonia.
2. Malignant tumor of unknown primary with metastasis to
A. Periaortic lymph nodes.
B. Left and right lungs.
C. Carinal lymph nodes.
3. Past history of bladder carcinoma.
4. Myocardial hypertrophy with left ventricular thickening.
5. Splenic hypertrophy.