CHART® - Genoptix.com · - Macrocytic anemia with mild anisopoikilocytosis. Flow Cytometry Bone marrow with a clonal population of kappa light-chain restricted plasma cells. Bone

PPaatient Nametient Name Sample, JaneSeSexx FDaDatte of Birthe of Birth 0/00/0000 (00 yrs)PPaatient IDtient ID 00000AAccccesession #sion # 000000000

OrOrdering Phdering Phyysiciansician Dr. Smith, JohnAAccccount #ount # 00000-000ClientClient XYZ Cancer Center

City Name, CA 00000Client AClient Addrddresesss 123 Main Street , 2nd flr

TTelephone #elephone # (000) 000-0000

SpecimenSpecimen Bone MarrowCCollectollecteded 00/00/0000 0:00:00 PMRRececeiveiveded 00/00/0000 00:00:00 AMRReporteporteded

CHART®CHART®Clinical HisClinical HisttoryHistory of multiple myeloma. Treatment includes Velcade, Revlimid, and Decadron. Previous Compass Report shows mildly hypercellular marrow with findings consistent with persistent plasma cell myeloma with high risk genetic abnormality (collected 00/00/00, 000000000). Accompanying report, dated 00/00/00, indicates WBC 4.3 K/uL, RBC 2.36 M/uL, Hgb .9 0 g/dL, HCT 25.8%, MCV 109 fL, MCH 38.3 pg, MCHC5 3. 0 g/dL, RDW 16.1%, platelets 170 K/iL with a differential count of granulocytes 72.1%, lymphocytes 18.5%, monocytes 9.4%.

FINAL DIAFINAL DIAGNOGNOSIS:SIS:BONE MARROBONE MARROW WITH RESIDUW WITH RESIDUAL/PERSISAL/PERSISTENT PLATENT PLASMA CELL MYELSMA CELL MYELOMA (~50%), HIGH-RISK GENETIC ABNORMALITIES, AND COMA (~50%), HIGH-RISK GENETIC ABNORMALITIES, AND CONGO RED+ONGO RED+AMYLAMYLOID DEPOOID DEPOSITION. PLEASITION. PLEASE SEE ASE SEE ASSSESSESSMENTSMENT..

CCompromprehensivehensive Ase AssessessmentsmentPer note, the patient has a history of multiple myeloma and MDS, and the previous bone marrow Compass assessment revealed persistent plasma cell myeloma with high-risk genetic abnormality (collected 00/00/00, 000000000). The patient is post treatment and the provided current CBC data reveals leukopenia and macrocytic anemia. The blood smear shows mild non-diagnostic morphologic changes without overt left-shift, blasts or plasma cells. The bone marrow core biopsy shows marked hypercellularity with a neoplastic plasmacytic infiltrate forming large sheets, comprising ~50% of total cellularity. Many of the plasma cells show prominent nucleoli resembling plasmablasts. By immunohistochemical stains and flow cytometry, they are positive for CD138, kappa light chain, and partial CD20, consistent with residual/persistent plasma cell myeloma. Congo red+ amyloid deposition is observed in this sample. Moderate reticulin fibrosis is also present. Cytogenetic studies detect complex abnormalities by intelligent FISH studies indicating a high-risk disease. Clinical correlation and follow up studies are recommended.

99/11/0000 12/22/0000

Diagnosis

MILDLY HYPERCELLULAR MARROW WITH FINDINGSCONSISTENT WITH PERSISTENT PLASMA CELL MYELOMAWITH HIGH RISK GENETIC ABNORMALITY.

BONE MARROW WITH RESIDUAL/PERSISTENT PLASMA CELLMYELOMA (~50%), HIGH-RISK GENETIC ABNORMALITIES, ANDCONGO RED+ AMYLOID DEPOSITION.

CBC

WBC 4.2 K/uL, RBC 3.45 M/uL, Hgb 11.3 g/dL, HCT 32.1%,MCV 93 fL, MCH 32.8 pg, MCHC 35.1 g/dL, RDW 16.5%,platelets 154 K/uL; granulocytes 73.8%, lymphocytes 19.5%,monocytes 6.7%.

WBC 4.3 K/uL, RBC 2.36 M/uL, Hgb 9.0 g/dL, HCT 25.8%, MCV109 fL, MCH 38.3 pg, MCHC 35.0 g/dL, RDW 16.1%, platelets 170 K/uL; granulocytes 72.1%, lymphocytes 18.5%, monocytes 9.4%.

Morphology

- Peripheral blood: Mild normocytic anemia- Mildly hypercellular marrow with morphologic andimmunophenotypic findings consistent with persistentplasma cell myeloma (20-50%)- Increased iron stores

Bone marrow, core biopsy, aspirate clot, touch preparation, andaspirate smears:- Hypercellular marrow for age with morphologic andimmunohistochemical findings consistent with residual plasma cellmyeloma, comprising ~50% of the cellularity, and presence ofCongo red+ amyloid material- Presence of trilineage hematopoiesis observed with no overtdyspoiesis or increase in blasts- Moderate reticulin fibrosis is observed- Presence of storage iron; no ring sideroblasts observedPeripheral blood smears:- Leukopenia with presence of hypersegmented neutrophils butno overt left-shift, blasts, or plasma cells observed.- Macrocytic anemia with mild anisopoikilocytosis.

Flow Cytometry

Bone marrow with a clonal population of kappa light-chainrestricted plasma cells.

Bone marrow aspirate sample with a kappa-monotypic plasma cellpopulation detected, consistent with residual/persistent plasmacell myeloma.

Cytogenetics

NORMAL female karyotype without apparent clonalaberrations.Intelligent FISH for Myeloma: POSITIVE for 17p-.

NORMAL female karyotype without apparent clonal aberrations. Intelligent FISH for Myeloma: POSITIVE for -13, diminished IGH,16q- and 17p-.

2110 Rutherford RdCarlsbad, CA 92008

Client Services: 800 755 1605Fax: 888 755 1604

Derek Lyle, MDMedical Director

CLIA ID #05D1018666CAP #7186462

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City Name, CA 00000

http://www.beyondthereport.com/?ReportID=1831275



CHART®CHART®

Specimen

Bone Marrow Bone Marrow

99/11/20/11/201515 12/22/2012/22/201616

Flow Cytometry

Flow cytometry gating scheme, ckappa vs clambda Flow cytometry shows kappa+ plasma cells

Morphology

CD138 shows plasma cells CD138+ plasma cells form large sheets

Cytogenetics/FISH

Abnormal I-FISH for Myeloma: Chromosome 17 Abnorma l I-FISH for Myeloma: 17p -

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CLIA ID #05D1018666CAP #7186462

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CHART®CHART®

99/11/20/11/201515 12/22/2012/22/201616

Morphology

Congo red+ amyloid material within blood vessels

1/5/2017

Electronically Signed ByXXun Li, M.Dun Li, M.D..Senior Hematopathologist

Date

For detailed information on any of the tests performed, please refer to the individual test reports.

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CLIA ID #05D1018666CAP #7186462

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CHART® - Genoptix.com · - Macrocytic anemia with mild anisopoikilocytosis. Flow Cytometry Bone marrow with a clonal population of kappa light-chain restricted plasma cells. Bone