Pathology

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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Granular cell tumor

 This 2-cm tumor presented as an abdominal wall mass thought to be an incisional hernia in a middle-aged woman. Hard, gritty, and with an infiltrating margin, this typical gross appearance of a granular cell tumor raises concern that one is dealing with a malignant neoplasm. Fortunately, the microscopic picture is characteristically benign, featuring cytologically bland cells with coarse, eosinophilic, granular cytoplasm. Granular cell tumors of the breast represent one of the few lesions that can impersonate an invasive breast cancer on gross examination.

Courtesy:Ed Uthman, MD.

4

Adenocarcinoma of the stomach

 This cancer presented in a 40-year-old woman complaining of abdominal pain. Endoscopically it was a "very suspicious" ulcer. Biopsy showed diffusely infiltrating signet ring cell adenocarcinoma. These are gross photos of the subtotal gastrectomy specimen. The photo above is asen face view of the ulcer. The pyloric margin is to the left. The ulcer is seen on the lesser curvature.

Courtesy: Ed Uthman.

 

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