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2501 South State Highway 121, Suite 1210 Lewisville, TX 75067-8188

Provider No.: CL0083

Tel: 214-818-9100 Fax: 972-966-7899

Test Cancer Center Patient Name: EXAMPLE, PATIENT Accession #: PS13-37350

Med. Rec. #: Collected: 9/5/2013 DOB: Received: 9/6/2013 Gender: Billing #: 259530 Reported: 9/9/2013 11:20 Physician(s):

259530 XX/XX/1981 (Age: 32) M UNIDENTIFIED PHYSICIAN

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Diagnosis HEMATOPATHOLOGY REPORT ***Original Report Follows Addendum***

ADDENDUM COMMENT

FINAL COMPREHENSIVE DIAGNOSIS Chromosomal analysis demonstrates a complex karyotype with two related cell line. The stemline (1/20) demonstrates duplication of 6p and del(11) and sideline in addition to these features shows structural abnormalities in chromosome 1 karyotype. These findings indicate poor prognosis (see cytogenetic report for details). The diagnoses are unchanged.

***Electronically Signed Out*** Javed Gill, M.D.

asp 50x blood 50x bx 20x

ORIGINAL REPORT

DIAGNOSIS Date Reported: 9/9/2013 11:20

BLOOD: MANY CIRCULATING BLASTS (12%), RARE METAMYELOCYTES (LEFT SHIFT), MILD MICROCYTIC ANEMIA AND MILD THROMBOCYTOPENIA.

CBC (Test Cancer Center), 09/05/2013): WBC 8.17K/uL, RBC 4.60M/uL, Hgb 11.5g/dL, Hct 35.7%, MCV77.6fL, MCH 25.0pg, MCHC 32.2g/dL, RDW 14.6%, Plts 131K/uL, MPV 10.3fL . Manual diff(%): Segs+bands 29, Lymphs 52, Monos 4, Eos 2, Metamyelocytes 1, Blasts 12.

BONE MARROW: HYPERCELLULAR (CELLULARITY + 100%) WITH MARKED IMMATURITY (BLASTS = 89%). SUPPRESSED MYELOID AND ERYTHROID MATURATION. ADEQUATE NUMBER OF MEGAKARYOCYTES. CONSISTENT WITH, "T-LYMPHOBLASTIC LEUKEMIA / LYMPHOMA, T-LBL".

Sample Report

EXAMPLE, PATIENTPBM Pathology Report PS13-37350

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Aspirate diff(%), 200 cells: Blasts 89, Promyelocytes 0, Myelocytes 0, Metamyelocytes 1, Segs+bands 1, Lymphs 7, Monos 0, Eos 0, Mast cells/basos 0, Plasma cells 0. Myeloid total 3, RBC precursors 2.

COMMENT

This patient has a history of extensive lymphadenopathy including a mediastinal mass (7 cm) and hypercalcemia.

Test Ordering Physician has also reviewed this case and concurs.

Correlation with cytogenetic results will be performed in the final comprehensive diagnosis.

Results reported to Physician on 9/6 at 5:50pm.

Specimen: blood, marrow aspirate, clot, biopsy, touch prep Procedure: marrow aspiration and biopsy Aspiration site: iliac crest Biopsy site: iliac crest Immunophenotype: flow cytometry performed; see body of the report

***Electronically Signed Out***

pxb/9/9/2013 Javed Gill, M.D.

ANCILLARY STUDIES

Cytogenetic Analysis: Abnormal male bone marrow chromosome analysis with two related abnormal cell lines containing multiple structural abnormalities (complex karyotype). The stemline (seen in 1 of 20 cells examined) contained a duplication of 6p [dup(6)] and a deletion of 11q [del(11)]. The sideline (seen in 16 0f 20 cells examined) contained the abnormalities seen in the stemline as well as a structurally abnormal chromosome 1 [add(1)]. Three normal male cells were observed.

Comment: The deletion of 11q23 has been seen in both myeloid and lymphoid malignancies; while the dup(6) and add(1) are not common, recurring cytogenetic aberrations in any particular type of hematolymphoid malignancy. In general, complex karyotype and clonal evolution are associated with a poor prognosis.

Abnormal Karyotype - sideline Abnormal Karyotype - stemline

9/13/2013 21:38 ***Electronically Signed Out*** Zhenjun Lou, Ph.D., DABMG and

Thomas Lohmann, M.D Technical and Professional services performed at: med fusion, 2501 South State Hwy 121, Suite 1100, Lewisville, TX 75067

Flow Cytometry - Leukemia/Lymphoma Profile: T-lymphoblastic leukemia/lymphoma. Abnormal bone marrow cells: 88% variable size T-Lymphoblasts expressing CyCD3, CD4, CD5, CD7, CD34, CD38, CD45, CD117 and TDT; negative for CD2[predominately], SurfaceCD3, CD8, CD13, CD33, CD56, CD123, CD2 and Myeloperoxidase.

Sample Report

ODOM, RODRIGUE I PBM Pathology Report PS13-37350

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asp smear 50x SS vs 45 blasts in red

9/6/2013 18:56 ***Electronically Signed Out*** Javed Gill, M.D. Technical services performed at: med fusion, 2501 South State Hwy 121, Suite 1100, Lewisville, TX 75067. Professional services performed at PBM Lewisville, 2501South State Hwy 121, Suite 1210, Lewisville, TX 75067.

MORPHOLOGY REPORT

Clinical History Suspected non-Hodgkin Lymphoma or ALL.

Microscopic Description Peripheral Smear: WBC: increased number of blasts, small sized with scanty amount of basophilic cytoplasm, few degenerated

cells, many lymphocytes and mature granulocytes / monocytes. RBC: mild anisopoikilocytosis, minimal polychromasia, occasional ovalocytes and dacryocytes. Platelets: estimate agrees with the reported count, granulation is normal, average size is not increased

Marrow aspirate smear/touch prep: Particles: cellular, well dispersed/touch prep is adequate Immature Infiltrate: most of the cellular elements are blasts with partly condensed and sometimes fine chromatin

Myeloid Cells: Erythroid precursors: Megakaryocytes: Dyspoiesis: Lymphocytes: Plasma cells:

pattern, no apparently nucleoli, no cytoplasmic granules or Auer rods occupying about 90% of cells.markedly suppressed. severely suppressed. present insignificant morphologically mature morphologically unremarkable

Marrow Core Biopsy and Aspirate Clot: Core Biopsy: 8mm with hematopoietic marrow, bone spicules well formed, periosteal soft tissue with a

dense, diffuse small cell, immature infiltrate occupying about 90%. Aspirate Clot Particles: no particles but scattered large number of immature lymphoid , small cells and suppressed

hematopoiesis. Overall cellularity: Approaches 100%. Megakaryocytes: adequate in number M/E ratio: estimate agrees with aspirate/touch prep differential count Granulomas: absent Infiltrates: most of the cellular elements are comprised of a small cell, immature, dense infiltrate.

Ancillary Stain(s): Iron Stain: performed on aspirate smear, aspirate clot and biopsy

Storage iron: markedly increased

Ring Sideroblasts: minimal erythroid activity (assessment not feasible)

Reticulin: mildly increased (Grade 1/3).

Sample Report

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Adequacy: All controls show appropriate reactivity

Specimen(s) Received 1: Bone marrow aspirate 2: Bone marrow Biopsy 3: 2 unstained peripheral,3 unstained aspirate,2 unstained touch preps 4: EDTA Tube 5: EDTA Tube 6: NaHep Tube 7: NaHep Tube

Gross Description Specimen #1, received in formalin labeled "Odom and bone marrow aspirate", consists of a 1.5 x 0.6 x 0.6 cm aggregate of clotted blood. Entirely submitted in cassette 1A.

Specimen #2, received in formalin labeled "Odom and bone marrow biopsy", consists of a 1.5 cm in length by 0.2 cm in diameter core of bony tissue. Entirely submitted in cassette 2A.

Specimen #3, received labeled "slides" and consists of two unstained peripheral slides, three unstained aspirate slides, two unstained touch preps. Also received are two green top tubes and two purple top tubes with blood.

cm/9/6/2013 Unless otherwise stated and when applicable, the quality of the H&E and other stains is satisfactory.

Technical services performed at PBM Lewisville, 2501 South State Hwy 121, Suite 1210, Lewisville, TX 75067 Professional services performed at PBM Lewisville, 2501 South State Hwy 121, Suite 1210, Lewisville, TX 75067.

Sample Report