Hodgkin's Lymphoma

 This elderly woman had carried a diagnosis of low-grade lymphoma since 1989. She had responded well to therapy and had been free of clinical evidence of lymphoma until spring, 2000, when she presented with this inguinal mass. Because she had developed a second cancer (breast) in the interim, the question arose as to which (if either) cancer had recurred. The clinicians opted for an excisional biopsy of the mass. The specimen was 6 cm in greatest diameter, soft and fleshy. A quick touch prep showed that it was a lymphoma, and fresh tissue was sent for surface marker characterization by flow cytometry. The tumor cells (which were gated in the "medium" and "large" areas of the cytogram) marked as B cells with light chain restriction. The cytologic features indicated a high-grade proliferation with a high mitotic rate, although there was some debate as to whether it was a large or small-cell follicular cell lymphoma (it surprises those outside the field that such a basic question as cell size can be so controversial!)

Courtesy: Ed Uthman, MD

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