Excerpts from Conversations with Pathologists

David Levison


PROFESSOR OF PATHOLOGY AT DUNDEE UNIVERSITY (RETIRED 2009)

[I performed] a postmortem on another [...] patients who'd died -- he'd come in to be investigated and they couldn't find anything, and the patient just got sicker and sicker and sicker and died. I was supervising the postmortem and presenting it, and I didn't know what the cause of death was – the organs were just a little bit swollen: the kidneys were swollen; the heart was a bit swollen; the brain was, but nothing definite to find. I said, "To be perfectly honest, I don't know what the cause of death was here." And he just stood there and said, "That's no help at all, David. That's absolutely useless; I don't know why we bothered to get a postmortem." And I said, "Now wait a minute Michael, we've still got to do the histology. You never know what you might find when we do the histology." Usually in these circumstances you don't find anything conclusive, because I've been in that position before. But anyway, I put the tissues through quickly... every single capillary stuffed with tumour cells. [...] every single blood vessel was stuffed with tumour cells. Then I put the lung section under the microscope, and every single capillary stuffed with tumour cells. There was no tumour, just tumour cells in the blood vessels. I put the kidney under… every single capillary stuffed with tumour cells. 



What this is is a very rare form of lymphoma called angiotropic lymphoma. Well that's what it's called now, it wasn't known what it was then. It wasn't known whether it was a tumour of the blood vessel endothelial cells or not – but we were able to do immunohistochemistry. I'd been sensible enough to keep some of the tissue from that case frozen so we could do molecular studies on it as well, and we were able to prove that these were lymphoid cells, and B-lymphocytes. This patient… All his capillaries had been blocked up by these damned tumour cells, so it was very easy to see why he had died! We got a very good paper out of it, with Michael Besser as a co-author as well. 

        Then three years later I was doing a sabbatical in Johns Hopkins in Baltimore. It was in gastroenterology, and one day there was a bit of a commotion. People came in and said, "You're Prof Levison, aren't you? You know about angiotropic lymphoma. What's this?" They shoved a slide under my microscope – it was a renal biopsy from one of their patients -- and I said, "Yup, that's what I think it is. I think it's angiotropic lymphoma." So that was my reputation made in Johns Hopkins! They'd done a literature search and found this paper, and thought, "There's someone here who knows about it. We'll get him to see if we're right about the diagnosis." So that was a nice story too!