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!) Ultimately, my diagnosis was malignant lymphoma, high grade B cell, not otherwise specified
To illustrate the difference in color quality between different types of lighting, I shot the same frame under tungsten light (above) and window light (below). My copy stand is up against a large, bright window, so all I had to do was turn off the Photofloods, raise the miniblinds, and remove the 80B blue compensation filter normally used with daylight film under tungsten illumination. Nature accommodated me with a uniform bright overcast sky (a clear sky gives too blue a picture, and direct sunlight is too harsh and shadow-producing).
Photograph by Ed Uthman, MD. Public domain. Posted 19 May 00
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