COMMON BONE MARROW REPORT TEMPLATES
Andy Nguyen, M.D. / UT-Medical School at Houston,
Pathology
Last Revision on: 9/29/2022
27. HLH
15. Neg for HLH
14. Neg for B cell
Lymphoma-Hypocellular BM
68. Negative for HL
64. Benign Lymphoid Aggregates
25. Neutropenia with
Arrest of Granulocyte Maturation
30. Neutropenia due to
arrest of granulocytic maturation
74. Chronic neutropenia with arrest
of granulocytic maturation
33. Hypocellular bone marrow with
cytopenia
45. Acute ITP
12. CML-Acc phase with
Thrombocytopenia-Dry Tap
61. Chronic myeloid leukemia, in hematologic remission, hypercellular
42. Myelofibrosis
62. P Vera
21. MPN, NOS
23. Myeloproliferative neoplasm, NOS in accelerated phase
(12% myeloblasts)
78. CMML-0
with Reticulin MyelofibrosisB78
31. CMML-2
40. Pancytopenia with increased
erythropoiesis and dyserythropoiesis
36. Myelodysplastic syndrome with
multi- lineage dysplasia
46. MDS-Multilineage Dysplasia
19. MDS EB-1
50. MDS with del 5q
58. Megakaryocytic Dysplasia,
possible MDS with del 5q
65. Addendum for MDS-SLD with abnormal cytogenetics
70. Rule out MDS with Cytopenia
43. AML
49. AML
75. AML, NOS-Dry tap with DX made on
BX and IHCs
44. AML (transformed from MPN/MDS)
53. AML transformed from MDS-EB2
4. AML s/p Chemotherapy-No MRD- Hypocellular BM
5. AML s/p Chemotherapy-No MRD-Normocellular BM
6. AML Relapse
67. AML with 40% residual leukemia
79. Acute Promyelocytic Leukemia
66. Residual leukemic promyelocytes
(5%) by immunophenotyping
22. AML with myelodysplasia-related
changes
48. B ALL
54. B ALL
3. Adult B ALL
17. Pediatric B ALL
1.
B ALL with 1% Residual Lymphoblasts
9. B ALL s/p Chemotherapy-No MRD-Hypocellular BM
80. T lymphoblastic leukemia/lymphoma (T cell ALL/LBL)
11. CLL
51. CLL
35. Lymphoplasmacytic lymphoma
47. Lymphoplasmacytic Lymphoma
39. CD5-positive low grade B-cell
proliferative disorder
73. Monoclonal B cell lymphocytosis
vs. metastasis of small lymphocytic lymphoma
76. A small number of monoclonal B
cell lymphocytes (1.3% of bone marrow cells)
52. Follicullar
Lymphoma in BM
55. FL/DLBCL in BM
69. Low-grade B cell
lymphoma in bone marrow of patient with high-grade B cell lymphoma
13. MGUS
32. Non IgM MGUS vs. Plasma cell
myeloma, Negative Congo Red for Amyloid
37. Non IgM MGUS with no monoclonal
plasma cells in bone marrow
34. IgM monoclonal gammopathy of
undetermined significance (MGUS), no BM involvement
41. IgM monoclonal gammopathy of undetermined
significance (MGUS) with BM Involvement
57. Plasma cell myeloma with immature
plasma cells
18. Smoldering myeloma-25% monoclonal
plasma cells
72. Plasma cell myeloma, s/p chemo
with residual disease
71. Plasma cell myeloma, s/p chemo
with no residual disease
77. T cell large granular lymphocytic
leukemia (T cell LGL)
2. Polyclonal plasma cells (3%)
++++++++++++++++++++++++++++++++++++++
1. B ALL with 1% Residual
Lymphoblasts
Diagnosis
Peripheral
blood:
Hypochromic normocytic anemia
Leukocytosis with left shift
Thrombocytosis
Bone
marrow:
Hypercellular for age
Increased granulopoiesis and megakaryopoiesis
Presence of 1% residual B
lymphoblastic leukemia (see comment)
Adequate iron stores
NDN 01/04/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-
Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-
- Bone
marrow aspirate was sent for chromosome
analysis, ALL FISH panel, and quantitative PCR for Bcr/abl1
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: B lymphoblastic leukemia
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry:
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
69 year old
male with a history of B-cell ALL with t (9;22), S/P one cycle of
chemotherapy. Baseline bone marrow on
11/15/17 showed t(9;22) and 11q-, 5q-, 7q-, monosomy 13 and monosomy 20. The most recent bone marrow on 12/7/17 showed
3% residual lymphoblasts.
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin
and labeled with the patient's name and "bone
marrow clot" on the requisition is a red-brown, gelatinous portion of
clotted blood measuring 1.4 x 1.4 x 0.6 cm.
The clot is serially cross sectioned to reveal red-brown,
gelatinous cut surfaces. The clot is
submitted in its entirety in cassette 1A.
2. Received in
formalin in a container labeled with the patient's
name and "bone marrow biopsy" on the requisition are two red-brown, cylindrical cores of bone
measuring 0.5 and 1.1 cm in length and 0.2 cm in diameter. The specimen is submitted in toto in cassette
2A after a brief decalcification.
PY/dcr 01/03/
Peripheral Smear
CBC
Results:
WBC 24.5 K/CMM HI
RBC 2.29
M/CMM LOW
Hgb 6.6 g/dL CRIT
Hct 20.0 % CRIT
MCV 87.3 fL Normal
MCH 28.7 pg Normal
MCHC 32.9 g/dL Normal
RDW 17.9 % HI
Platelet 513 K/CMM HI
MPV 8.4 fL Normal
Segs 55.0 % Normal
Bands 14.0 % HI
Lymphocytes 6.0 % LOW
Atypical Lymphs 0.0
% Normal
Monocytes 12.0 %
Normal
Metamyelocytes 5.0 %
HI
Myelocytes 5.0 % HI
Promyelocytes 3.0 % HI
Segs-Bands
# 16.9 K/CMM HI
Lymphocytes
# 1.5 K/CMM Normal
Monocytes
# 2.9 K/CMM HI
NRBC 1 /100WB NA
Tot Cell
Ct 100 NA
Polychrom Slight
Plt
Morph Normal
Retic
Auto 2.3 % HI
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Hypochromic
normocytic anemia with mild polychromasia, rare NRBCs
White cells: Leukocytosis
Granulocytes: Left
shift with myelocytes, metamyelocytes, and bands
Lymphocytes: Normal
number and morphology
Monocytes: Increased with
normal morphology
Platelets: Increased
with normal morphology
Bone marrow
Differential (%)
Blasts: 3
Promyelocytes: 3
Myelocytes: 19
Metas: 10
Bands & PMN's: 50
Eos: 1
Baso: 0
Monos: 1
Lymphs: 3
Plasma cells: 0
Erythroids: 10
Other: M:E
ratio 8.6
Cellularity: Hypercellular
for age
Megakaryopoiesis: Increased with
normal maturation
Erythropoiesis: Decreased
with normal maturation
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis: Increased with normal maturation
Lymphocytes: Decreased
with normal morphology
Biopsy and clot section: No
clusters of blasts seen
Iron content (biopsy and clot section): Adequate iron
stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally
reviewed all specimen preparations and concur with the resident's
interpretation."
++++++++
2. Polyclonal
plasma cells (3%)
Diagnosis
Peripheral
Blood:
- Mild
macrocytic hypochromic anemia
Bone
Marrow:
-
Trilineage hematopoiesis
-
Normocellular marrow for age
- Presence
of 3% polyclonal plasma cells, see comment
- Adequate
iron stores
NDN 02/13/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-
Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-
-
Immunohistochemical stains, with adequate controls, are performed on biopsy for
CD138, kappa, and lambda. The stains show 3% of plasma cells in bone marrow
(positive for CD138) with polyclonal distribution of cytoplasmic kappa and
lambda light chains. There is a focal aggregate of plasma cells in biopsy,
however the plasma cells in this aggregate also show polyclonal light-chain distribution.
- Bone
marrow aspirate was sent for cytogenetics, and FISH panel for myeloma
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
67 year old male with
monoclonal gammopathy. IFE shows IgG/kappa monoclonal gammopathy
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin
and in a container labeled with the patient's name
and "bone marrow clot" on the requisition is a red-brown portion of
clotted blood measuring 1.0 x 1.0 x 0.2 cm.
The specimen is submitted in toto in cassette 1A.
2. Received in formalin
in a container labeled with the patient's name and
"bone marrow biopsy" on the requisition are two red-brown cylindrical
cores of bone measuring 1.6 and 0.3 cm in length and 0.2 cm in diameter. The specimen is submitted in toto in cassette
2A after a brief decalcification.
PY/dcr 02/09/
Peripheral Smear
CBC 2/9/18
WBC 10.1
RBC 3.85
Hgb 12.5
MCV 97.5
Plt
209
Differential
(%)
Seg 77.9
Lymph 4.1
Mono 5.8
Eos 11.9
Baso
0.3
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Mild
macrocytic hypochromic anemia, slight polychromasia
White cells: Adequate
in number
Granulocytes: Normal
number and morphology
Lymphocytes: Decreased
with normal morphology
Monocytes: Normal
number and morphology
Platelets: Adequate
number with a few large forms
Bone marrow
Differential (%)
Myeloblasts: 0%
Promyelocytes: 9%
Myelocytes: 14%
Metas: 8%
Bands & PMN's: 22%
Eos: 12%
Baso: 1%
Monos: 1%
Lymphs: 7%
Plasma cells: 3%
Erythroids: 23%
M:E ratio: 2.9:1
Cellularity: 40%
Megakaryopoiesis: Adequate with normal
maturation
Erythropoiesis: Adequate
with normal maturation
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis: Adequate
with normal maturation, increased in eosinophils
Lymphocytes: Normal
number and morphology
Plasma cells: Slight
increase (3%) with unremarkable morphology
Biopsy and clot section: A
focal area in biopsy with increase in plasma cells is seen
Iron content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060, 88342, 88341 x2
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Some of
the immunohistochemical tests in this panel were developed and their
performance characteristics determined by Memorial Hermann Southwest Hospital
Laboratory. They have not been cleared or approved by the U. S. Food
and Drug Administration. The FDA has determined that such clearance
or approval is not necessary. These tests are used for clinical
purposes. They should not be regarded as investigational or for research. This
laboratory is regulated under the Clinical Laboratory Improvement Amendments of
the 1988 (CLIA) as qualified to perform high complexity clinical testing.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen preparations
and have personally issued this report."
+++++
Diagnosis
Peripheral Blood:
- B lymphoblastic leukemia
Bone Marrow:
- B lymphoblastic
leukemia, see comment
NDN/NDN 01/29/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-
-Dr. Rios was notified
of the findings on 1/29/2018.
-Bone marrow aspirate
was sent for cytogenetics, ALL FISH panel, PCR testing for bcr/abl1,
and AFB/fungal stains/cultures.
-Biopsy and clot
section are pending processing. Findings will be reported in Addendum
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: B lymphoblastic leukemia
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry:
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
34 y/o male with severe
anemia, thrombocytopenia, leukocytosis with numerous blasts
Gross Description
Will be reported in
Addendum by Surgical Pathology
Peripheral Smear
CBC Results
Date/time:1/29/2018
WBC 169.6
RBC 2.2
Hgb 7.0
Hct 20.3
Plt 8
Differentials:
Seg 2%
Bands 1%
Lymph 8%
Mono 1%
Metamyelocytes
1%
Promyelo 1%
Blasts 86%
Microscopic Description
PERIPHERAL
BLOOD:
Erythrocytes:
Normochromic hypochromic anemia with anisopoikilocytosis,
mild polychromasia
White
cells: mark increase in number
Granulocytes: Decreased with normal
morphology
Lymphocytes: Decreased with normal
morphology
Monocytes: Decreased with normal morphology
Others: numerous blasts (86%)
Platelets: Decreased with normal morphology
Bone marrow
Differential
(%)
Lymphoblasts:
90
Promyelocytes:
0
Myelocytes:
0
Metas:
0
Bands
& PMN's: 5
Eos:
0
Baso: 0
Monos: 0
Lymphs: 0
Plasma
cells: 0
Erythroids: 5
Megakaryopoiesis: Markedly decreased
Erythropoiesis:
Markedly decreased
Granulopoiesis:
Markedly decreased
Lymphocytes:
Markedly decreased
Others:
numerous lymphoblasts (90%)
Biopsy
and clot section: pending processing. Findings will be reported in Addendum
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
+++++++
4. AML s/p
Chemotherapy-No MRD- Hypocellular BM
Diagnosis
Peripheral
Blood:
- Pancytopenia
Bone Marrow:
- Hypocellular for age (s/p chemotherapy)
- No morphologic or immunophenotypic evidence
of residual leukemia,
see comment
- Increased iron stores
NDN/LZ 02/01/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-18- 60) in gate #1 shows a T
cell population (about 90% of the cells analyzed) with high CD4/CD8 ratio
(8:1), otherwise no aberrant loss or aberrant expression of T cell markers, a
small B cell population (about 6% of the cells analyzed) with no evidence of
surface-light chain restriction. Analysis of cells in gate #2 (blast area)
shows a small number of normal myeloblasts (<1%) with expression of CD33 and
CD13. These results indicate no residual leukemic population with flow
cytometry in this patient with history of AML, s/p chemotherapy.
-Reticulin and
trichrome stains are pending on biopsy. Results will be reported in Addendum.
-Additional aspirate
has been sent to Genoptix to perform cytogenetic
analysis, AML molecular profile, and FLT3 mutation studies. Results will be
issued separately in Addendum.
Tumor Summary
N/A
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone
marrow procedure was performed by IR
Clinical Information
83 y/o female with AML,
diagnosed on 11/6/17 with positive FLT3, IDH2, NPM1, and NRAS; negative for
bcr-abl1, AML-FISH panel, cytogenetics. The most recent bone marrow on 12/26/17
showed 40% residual blasts
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin in a container and labeled
with the patient's name and "bone marrow
clot" on the requisition is a red-brown gelatinous portion of clotted
blood measuring 4 x 1.0 x 0.9 cm. The
clot is serially cross sectioned to reveal red-brown gelatinous cut
surfaces. Tissue is serially cross
sectioned to reveal red-brown gelatinous cut surface. The specimen is submitted in its entirety in
cassette 1A.
2. Received in formalin in a container and
labeled with the patient's name and "bone marrow
biopsy" on the requisition is a red-brown cylindrical core of bone with
adherent clotted blood measuring 1.0 cm in length and up to 0.2 cm in diameter.
The specimen is submitted in toto in cassette 2A after brief decalcification. PY/dg
01/31/
Peripheral Smear
CBC result
(1/31/
WBC 0.4 K/CMM CRIT
RBC 2.79 M/CMM LOW
Hgb 8.0 g/dL LOW
Hct 22.6 % LOW
MCV 81.1 fL Normal
MCH 28.5 pg Normal
MCHC 35.2 g/dL Normal
RDW 14.6 % HI
Platelet 3 K/CMM CRIT
MPV 12.0 fL HI
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Hypochromic
normocytic anemia, mild polychromasia,
White cells: Leukopenia
Granulocytes: Decreased
with normal morphology
Lymphocytes: Decreased
with normal morphology
Monocytes: Decreased
with normal morphology
Platelets: Thrombocytopenia
with normal morphology
Bone marrow
Differential (%): Unable to perform due
to hypocellular aspirate
Cellularity: 10%
Megakaryopoiesis: focally
increased
Erythropoiesis: decreased
Granulopoiesis: decreased
Lymphocytes: decreased
Biopsy: hypocellular with no blasts seen; focal increase in
megakaryocytes
Iron content (biopsy): Increased iron stores
Intradepartmental Consultation
N/A
Non Clinical Documentation
CPT:88305x2, 88313,
88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally reviewed the resident's preliminary
interpretation and all specimen preparations and have personally issued this
report".
++++
5. AML s/p
Chemotherapy-No MRD-Normocellular BM
Diagnosis
Peripheral
Blood:
- Macrocytic
hypochromic anemia
- No blasts
seen
Bone
Marrow:
- Normocellular for age (s/p chemotherapy)
- No morphologic or immunophenotypic evidence
of residual leukemia,
see comment
- Increased iron stores
Comment
-
Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-18- )
shows
- Bone
marrow aspirate was sent for cytogenetics, FLT3/NPM1 mutations. Results will be
reported in
Addendum
Tumor
Summary
_
Specimen
Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical
Information
77 y/o male
with AML (diagnosed in 12/17), positive for FLT3, NPM1, TET2, negative
cytogenetics. The most recent BM in 1/2018 showed no residual blasts with
morphology and flow cytometry, but positive for FLT3 and NPM1 mutations.
Gross
Description
The
specimen is received in two parts each labeled with the patient's name and
medical record number.
1. Received in formalin
and labeled with the patient's name and bone marrow clot on the requisition is
a red-brown portion of clotted blood measuring 1.4 x 1.1 x 0.8 cm. The clot is serially cross sectioned to
reveal a red-brown gelatinous cut surface.
The clot is submitted in its entirety in cassette
1A.
2. Received in
formalin and labeled with the patient's name and bone
marrow core on the requisition are three red-brown cylindrical cores of bone,
two measuring 0.4 x 0.2 x 0.2 cm and one measuring 1.0 x 0.2 x 0.2 cm. The specimen is
submitted in toto in cassette 2A after a brief decalcification. PY/myf 03/02/
Peripheral
Smear
CBC Results:
WBC 5.3
K/CMM Normal
RBC 2.68
M/CMM LOW
Hgb 9.1 g/dL LOW
Hct 26.8 % LOW
MCV 99.8 fL HI
MCH 34.1 pg HI
MCHC 34.2
g/dL Normal
RDW 24.9
% HI
Platelet 208
K/CMM Normal
MPV 7.7 fL Normal
Segs 28.7 % LOW
Lymphocytes 46.7
% HI
Monocytes 23.8
% HI
Eosinophils 0.0
% Normal
Basophils 0.6 % Normal
Segs-Bands # 1.5 K/CMM
Normal
Lymphocytes # 2.5 K/CMM Normal
Monocytes # 1.3
K/CMM HI
Anisocyte 1+
Macrocyte 1+
Retic Auto 2.4
% HI
Microscopic
Description
PERIPHERAL BLOOD:
Erythrocytes: Macrocytic
hypochromic anemia with anisocytosis and mild polychromasia
White cells: Normal
in number
Granulocytes: Unremarkable
morphology; no blasts seen
Lymphocytes: Unremarkable
morphology
Monocytes: Mild monocytosis with unremarkable morphology
Platelets: Adequate
number with normal morphology
Bone marrow
Differential (%)
on
aspirate
Myeloblasts: 2%
Promyelocytes: 3%
Myelocytes: 4%
Metas: 1%
Bands & PMN's: 15%
Eos: 1%
Baso: 0%
Monos: 3%
Lymphs: 13%
Plasma cells: 1%
Erythroids: 57%
M:E ratio: 0.5
Cellularity: 30%
Megakaryopoiesis: Adequate with normal
maturation
Erythropoiesis: Increased with
mild dyserythropoiesis
Iron
Content (aspirate): Increased iron
stores
Granulopoiesis: Adequate with
normal maturation
Lymphocytes: Normal
number and morphology
Plasma cells: Normal
number and morphology
Biopsy and clot
section: No clusters
of blasts seen
Iron content (biopsy
and clot section): Increased iron stores
Intradepartmental
Consultation
_
Non
Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching
Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and have
personally issued this report".
+++++
Diagnosis
Peripheral
Blood:
-
Hypochromic normocytic anemia and thrombocytopenia
- Numerous
circulating blasts
Bone
Marrow:
- Acute
myeloid leukemia relapse, see comment
- Increased
iron stores
02/13/
NDN 02/13/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-18- 78) shows an
abnormal population in the same position (CD45/SSC scattergram) as the leukemic
cells in original bone marrow sample in July 2017. The leukemic cells retain
the same marker profile: positive for CD13, CD33, CD38, CD4, CD7, CD117, CD34,
HLA-DR. They are negative for TdT. These findings are
consistent with acute myeloid leukemia.
- The
current findings of 82% myeloblasts in this patient with AML remission in
12/2017 are consistent with AML relapse
- Bone
marrow aspirate was sent for cytogenetics, FISH panel for AML, AML molecular
profile, PCR for FLT3, PCR for bcr/abl1
- Dr Rios
and Kanaan were notified of the findings on 2/13/18
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: acute myeloid leukemia
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry:
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
Clinical
History: 71 y/o male with AML, diagnosed in 7/2017. The most recent BM in
12/2017 showed remission, normal AML-FISH panel. Now patient with numerous
blasts in PBS
Gross Description
The
specimen is received in two parts each labeled with the patient's name and
medical record number.
1. Received in formalin in a container labeled
with the patient's name and "bone marrow clot" on the requisition are
multiple red-brown portions of clotted blood measuring 2.8 x 2.0 x 0.2 cm. The specimen is submitted in toto in
cassette 1A.
2. Received in formalin in a container labeled
with the patient's name and "bone marrow biopsy" on the requisition
is a red-brown, cylindrical core of bone measuring 1.2 cm in length
and 0.2 cm in diameter. The specimen is
submitted in toto in cassette 2A after a brief decalcification. PY/jjb 02/13/
Peripheral Smear
CBC Results:
WBC 7.4 K/CMM Normal
RBC 2.67 M/CMM LOW
Hgb 7.7 g/dL LOW
Hct 23.1 % LOW
MCV 86.5 fL Normal
MCH 28.9 pg Normal
MCHC 33.4 g/dL
Normal
RDW 25.9 % HI
Platelet 50 K/CMM LOW
MPV 9.0 fL Normal
Segs 0.0 % LOW
Bands 0.0 % Normal
Lymphocytes 17.0 % LOW
Atypical Lymphs 0.0
% Normal
Monocytes 1.0 % LOW
Eosinophils 1.0 % Normal
Blasts 81.0 % HI
Segs-Bands
# 0.0 K/CMM LOW
Lymphocytes
# 1.3 K/CMM Normal
Monocytes
# 0.1 K/CMM Normal
Eosinophils
# 0.1 K/CMM Normal
NRBC 1 /100WB NA
Anisocyte 1+
Hypochrom
1+
Target
Cell Moderate
Plt
Morph Normal
Retic
Auto 0.4 % LOW
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normocytic
hypochromic anemia with mild polychromasia
White cells: Normal
in number with many blasts (81%)
Granulocytes: Decreased
with normal morphology
Lymphocytes: Normal
morphology
Monocytes: Normal morphology
Platelets: Decreased
with normal morphology
Bone marrow On aspirate
Differential (%)
Myeloblasts: 82%
Promyelocytes: 0%
Myelocytes: 0%
Metas: 0%
Bands & PMN's: 2%
Eos: 1%
Baso: 0%
Monos: 3%
Lymphs: 5%
Plasma cells: 1%
Erythroids: 6%
M:E ratio: 14.66
Cellularity: 60 %
Megakaryopoiesis: Markedly
decreased
Erythropoiesis: Markedly
decreased
Iron Content (aspirate): Increased iron
stores
Granulopoiesis: Marked
arrest of maturation beyond myeloblasts
Lymphocytes: Normal
morphology
Plasma Cells: Normal
morphology
Biopsy and clot
section: Diffuse distribution of myeloblasts
Iron content (biopsy
and clot section): Increased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have been
reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen preparations
and have personally issued this report."
++++
Diagnosis
Peripheral
Blood:
-
Normochromic normocytic anemia
-
Leukopenia
Bone
marrow:
-
Normocellular for age
- Increased
megakaryopoiesis and erythropoiesis
- No evidence
of residual leukemic promyelocytes, see comment
- Decreased
iron stores
02/14/
NDN 02/14/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-
Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-
- Bone
marrow aspirate was sent for cytogenetics, FISH testing and quantitative PCR
for PML/RARA.
- No
evidence of residual leukemic promyelocytes and no increase in myeloblasts are
seen. However, patient has been on ATRA/Arsenic Trioxide treatment. Leukemic
cells have differentiated into mature forms with normal morphology and normal
immunophenotype. Definitive assessment of residual leukemia will be based on
cytogenetics and molecular testining (results pending)
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: acute promyelocytic leukemia
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry:
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
Clinical
History: 55 y/o female with APL relapse (BM on 1/24/18) and brain myeloid
sarcoma. Pt is on ATRA/Arsenic Trioxide. Original BM was in 2010.
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin in a container labeled
with the patient's name and "bone marrow clot" on the requisition are
two red-brown portions of clotted blood measuring 0.1 x 0.7 x 0.2 cm and 0.7 x
0.5 x 0.2 cm. The specimen is submitted
in toto in cassette 1A.
2. Received in formalin and labeled with
the patient's name and "bone marrow biopsy" on the requisition is a
tan-red cylindrical core of bone measuring 1.8 cm in length and 0.2 cm in
diameter. The specimen is submitted in toto in cassette 2A after a brief
decalcification. PY/dg 02/13/
Peripheral Smear
CBC
Results:
Segs 33.5 % LOW
Lymphocytes 44.4 % HI
Monocytes 21.5 % HI
Eosinophils
0.3 % Normal
Basophils 0.3 % Normal
Segs-Bands
# 0.4 K/CMM LOW
Lymphocytes
# 0.6 K/CMM LOW
Monocytes
# 0.3 K/CMM Normal
Anisocyte 1+
Plt
Morph Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic
hypochromic anemia with mild polychromasia
White cells: Decreased
in number
Granulocytes: Normal
morphology, no leukemic cells seen
Lymphocytes: Normal
morphology
Monocytes: Normal morphology
Platelets: Normal
number and morphology
Bone marrow
Differential (%)
Myeloblasts: 3%
Promyelocytes: 7%
Myelocytes: 8%
Metas: 2%
Bands & PMN's: 2%
Eos: 6%
Baso: 0%
Monos: 1%
Lymphs: 1%
Plasma cells: 0%
Erythroids: 69%
M:E ratio: 0.43:1
Cellularity: 40%
Megakaryopoiesis: Increased with
normal maturation
Erythropoiesis: Increased
with normal maturation
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis: Lack
of maturation maturation (left shift); no leukemic
promyelocytes seen; in increase in blasts
Lymphocytes: Decreased
with normal morphology
Biopsy and clot section: Normocellular
with increased megakaryopoiesis and erythropoiesis
Iron content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
+++++
Diagnosis
Peripheral
Blood:
-
Pancytopenia
Bone
Marrow:
- Aplastic
anemia, see comment
- Decreased
iron stores
02/13/
NDN 02/13/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
No evidence
of malignancy is seen in bone marrow. The findings in peripheral blood and bone
marrow are most supportive of aplastic anemia. Etiologies may include
medication, viral infection, and immune disorders. Clincal
correlation is suggested.
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
Pancytopenia
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin
and labeled with the patient's name and "bone
marrow clot" on the requisition is a red-brown portion of clotted blood
measuring _.8 x 1.3 x 0.4 cm. The clot
is serially cross sectioned to reveal a red-brown, gelatinous cut
surface. The clot is submitted in its
entirety in cassette 1A.
2. Received in formalin
in a container labeled with the patient's name and
"bone marrow biopsy" on the requisition is a red-brown cylindrical
core of bone measuring 1.9 cm in length and 0.2 cm in diameter. The specimen is submitted in toto in cassette
2A after a brief decalcification.
PY/dcr 02/13/
Peripheral Smear
CBC
Results:
WBC 3.3 K/CMM LOW
RBC 4.07 M/CMM LOW
Hgb 13.8 g/dL LOW
Hct 41.4 % LOW
MCV 101.6 fL HI
MCH 33.8 pg HI
MCHC 33.3 g/dL Normal
RDW 16.1 % HI
Platelet 42 K/CMM LOW
MPV 8.6 fL Normal
Segs 40.3 % LOW
Lymphocytes 48.7 % HI
Monocytes 9.8 % Normal
Eosinophils 0.8 % Normal
Basophils 0.4
% Normal
Segs-Bands
# 1.3 K/CMM LOW
Lymphocytes
# 1.6 K/CMM Normal
Monocytes
# 0.3 K/CMM Normal
RBC
Morph Normal
Macrocyte 1+
Plt
Morph Normal
Retic
Auto 1.5 % Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Macrocytic
hypochromic anemia with mild polychromasia
White cells: Decreased
in number, no blasts seen
Granulocytes: Decreased
with normal morphology
Lymphocytes: Normal
number and morphology
Monocytes: Normal number and
morphology
Platelets: Decreased
with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 2%
Promyelocytes: 7%
Myelocytes: 4%
Metas: 3%
Bands & PMN's: 22%
Eos: 1%
Baso: 0%
Monos: 2%
Lymphs: 4%
Plasma cells: 1%
Erythroids: 33%
M:E ratio: 0.79
Cellularity: 15%, markedly hypocellular for age
Megakaryopoiesis: Decreased
with normal maturation
Erythropoiesis: Relatively
increased, a few erythroids with nuclear-cytoplasmic dyssynchrony
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis:
Decreased with normal maturation, no increase in blasts
Lymphocytes: Decreased
with normal morphology
Plasma Cells: Normal
number and morphology
Others: Rare histiocytes with hemophagocytosis are seen in aspirate
Biopsy and clot
section: Markedly hypocellular for age; no evidence of granuloma, fibrosis or
abnormal cellular infiltrates
Iron content (biopsy and
clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
++++
9. B ALL s/p
Chemotherapy-No MRD-Hypocellular BM
Diagnosis
Peripheral
blood:
Pancytopenia
Bone
marrow:
Hypocellular for age (40%), S/P
chemotherapy
No morphologic or immunophenotypic
evidence of residual leukemia, see comment
Adequate iron stores
NDN 01/04/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-
-Bone
marrow aspirate was sent for chromosome analysis, FISH panel for ALL, and
quantitative PCR for BCR-ABL1.
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
26 year old
male with B-cell ALL, currently on chemotherapy
Gross Description
The
specimen is received in 2 parts, each labeled with the patient's name and
medical record number.
1.
Received in formalin in a container labeled with the
patient's name and "bone marrow clot" on the requisition is a
red-brown portion of clotted blood measuring 2.0 x 1.4 x 0.2 cm in
aggregate. The specimen is submitted in
toto in cassette 1A.
2. Received in formalin in a
container labeled with the patient's name and "bone marrow biopsy" on
the requisition is a tan-brown cylindrical core of bone measuring 1.5 cm in
length and 0.2 cm in diameter. The
specimen is submitted in toto in cassette 2A after a brief
decalcification. PY/dw 01/03/
Peripheral Smear
CBC
Results:
WBC 1.8 K/CMM LOW
RBC 3.23 M/CMM LOW
Hgb 9.8 g/dL LOW
Hct 28.0 % LOW
MCV 86.6 fL Normal
MCH 30.4 pg Normal
MCHC 35.1 g/dL Normal
RDW 14.3 % Normal
Platelet 105 K/CMM LOW
MPV 7.5 fL Normal
Segs 56.3 % Normal
Lymphocytes 19.6 % LOW
Monocytes 23.9 % HI
Eosinophils 0.1 % Normal
Basophils 0.1 % Normal
Segs-Bands
# 1.0 K/CMM LOW
Lymphocytes
# 0.4 K/CMM LOW
Monocytes # 0.4 K/CMM Normal
RBC
Morph Normal
Plt
Morph Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normocytic
hypochromic anemia with mild polychromasia
White cells: Decreased
in number
Granulocytes: Decreased with left shift
Lymphocytes: Decreased
with normal morphology
Monocytes: Normal number and
morphology
Platelets: Decreased
with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 3
Promyelocytes: 1
Myelocytes: 17
Metas: 2
Bands & PMN's: 36
Eos: 0
Baso: 0
Monos: 3
Lymphs: 14
Plasma cells: 0
Erythroids: 24
Other: M:E
ratio 2.5
Cellularity: 40%
(hypocellular for age), S/P chemotherapy
Megakaryopoiesis: Adequate with normal
maturation
Erythropoiesis: Decreased
with normal maturation
Iron Content (aspirate): Adequate iron stores
Granulopoiesis: Decreased
with normal maturation
Lymphocytes: Decreased
with normal morphology
Biopsy and clot section: No
clusters of blasts seen
Iron content (biopsy and clot section): Adequate iron
stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally
reviewed all specimen preparations and concur with the resident's
interpretation."
++++
Diagnosis
Peripheral
Blood:
-
Normochromic normocytic anemia
- Leukopenia
Bone
Marrow:
- Residual
leukemia (B cell lymphoblastic leukemia), 61% lymphoblasts, s/p chemotherapy
- Adequate
iron stores
02/13/
NDN 02/13/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-
Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-
- Bone
marrow aspirate was sent for FISH panel for ALL, ALL fusion profile.
- Drs Rios
and Kanaan were notified of the results on 2/13/18
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: B cell lymphblastic leukemia
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry:
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core biopsy,
decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
65 year old
female with B cell ALL diagnosed in 1/2018, abnl FISH
with 12 p-, neg bcr-abl1 by PCR; patient s/p 1st cycle Ritux-Mini
HyperCVAD
Gross Description
The
specimen is received in two parts each labeled with the patient's name and
medical record number.
1. Received in formalin in a container labeled
with the patient's name and "bone marrow clot" on the requisition is
a red-brown gelatinous portion of clotted blood measuring ___.3 x 1.4 x 0.4
cm. The clot is serially cross
sectioned to reveal red-brown gelatinous cut surfaces. The clot is submitted
in its entirety in cassette 1A.
2. Received in formalin in a container labeled with
the patient's name and "bone marrow biopsy" on the requisition is a
1.1 cm in
length red-brown, cylindrical core of bone measuring
0.2 cm in diameter. The specimen
is submitted in toto in cassette 2A after a brief decalcification. PY/jjb 02/13/
Peripheral Smear
CBC
Results:
WBC 1.6 K/CMM LOW
RBC 2.22 M/CMM LOW
Hgb 7.6 g/dL LOW
Hct 22.2 % LOW
MCV 99.9 fL HI
MCH 34.2 pg HI
MCHC 34.2 g/dL Normal
RDW 13.1 % Normal
Platelet 156 K/CMM Normal
MPV 7.8 fL Normal
Segs 51.7 % Normal
Lymphocytes 45.9 % HI
Monocytes 0.7 % LOW
Eosinophils 1.5 % Normal
Basophils 0.2 % Normal
Segs-Bands
# 0.8 K/CMM LOW
Lymphocytes
# 0.7 K/CMM LOW
Retic Auto 3.4 % HI
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic
normocytic anemia with mild polychromasia
White cells: Decreased
in number with no blasts seen
Granulocytes:
Decreased with
normal morphology
Lymphocytes: Decreased
with normal morphology
Monocytes: Decreased with
normal morphology
Platelets: Normal
number and morphology
Bone marrow
Differential (%)
Lymphoblasts: 61%
Promyelocytes: 0%
Myelocytes: 0%
Metas: 0%
Bands & PMN's: 24%
Eos: 0%
Baso: 0%
Monos: 1%
Lymphs: 3%
Plasma cells: 0%
Erythroids: 11%
Cellularity: 60%
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Markedly decreased
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis:
Decreased
Lymphocytes: Normal
morphology
Plasma Cells: Normal
morphology
Biopsy and clot
section: Diffuse distribution of lymphoblasts
Iron content (biopsy
and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
++++
Diagnosis
Peripheral
blood:
Chronic lymphocytic leukemia.
Bone
marrow:
Chronic lymphocytic leukemia, see
comment.
Decreased iron stores.
NDN 01/04/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-
Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-
-These results, together morphological findings
in peripheral blood and bone marrow, are consistent with chronic lymphocytic
leukemia (CLL).
- Bone
marrow aspirate was sent for chromosome analysis, CLL FISH panel, and IgVH mutation
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: chronic lymphocytic leukemia
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry:
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow
aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3. Peripheral
blood smear
Bone marrow
procedure was performed by IR
Clinical Information
68 year old
male with history of CLL (diagnosed in 2009); restaging bone marrow.
Gross Description
The
specimen is received in 2 parts, each labeled with the patient's name and
medical record number.
1.
Received in formalin and in a container labeled
with the patient's name and "bone marrow clot" on the requisition is
a red-brown gelatinous portion of clotted blood measuring 2.0 x 1.8 x 0.7 cm.
The clot is serially cross sectioned to reveal a red-brown gelatinous cut surface. The specimen is submitted in its entirety in
cassette 1A.
2.
Received in formalin and in a container labeled
with the patient's name and "bone marrow biopsy" on the requisition
is a 3.0 cm in length and 0.2 cm in diameter red-brown cylindrical core of bone
which is submitted in toto in cassette 2A after a
brief decalcification. PSY/mop
01/03/
Peripheral Smear
CBC
Results:
CBC
Results:
WBC 56.2 K/CMM CRIT
RBC 4.04 M/CMM LOW
Hgb 12.8 g/dL LOW
Hct 39.2 % LOW
MCV 97.3 fL HI
MCH 31.7 pg HI
MCHC 32.6 g/dL Normal
RDW 13.8 % Normal
Platelet 115 K/CMM LOW
MPV 10.2 fL Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normocytic
hypochromic anemia; mild polychromasia
White cells: Markedly
increased
Granulocytes: Normal
number and morphology
Lymphocytes: Markedly
increased with mature cytology,
many smudge cells seen
Monocytes: Normal number and
morphology
Platelets: Mild
decrease with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 1
Promyelocytes: 1
Myelocytes: 7
Metas: 3
Bands & PMN's: 8
Eos: 1
Baso: 0
Monos: 2
Lymphs: 67
Plasma cells: 1
Erythroids: 9
Other: M:E
ratio 2.3
Cellularity: 80%
Megakaryopoiesis: Decreased with
normal maturation
Erythropoiesis: Markedly
decreased with normal maturation
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis: Decreased
with normal maturation
Lymphocytes: Marked
increased in leukemic cells with mature cytology
Plasma cells: Normal
number and morphology
Biopsy and clot section: Diffuse
distribution of leukemic cells
Iron content (biopsy and clot section): Decreased iron
stores
Non Clinical Documentation
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
88305 - GC x2, 88313 -
GC x2, 88311, 85097, 85060
_
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
+++
12. CML-Acc
phase with Thrombocytopenia-Dry Tap
Diagnosis
Peripheral
Blood:
- Chronic
myeloid leukemia, accelerated phase
Bone
Marrow:
- Chronic
myeloid leukemia, accelerated phase
See comment
- Decreased
iron stores
02/12/
NDN 02/12/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Bone marrow
aspirate was with limited amount, not sufficient for additional studies besides
clot section. Retculin and trichrome stains are
pending to rule out myelofibrosis. Results will be reported in Addendum.
- The
morphologic findings in peripheral blood, bone marrow biopsy and touch preps
are most supportive of chronic myeloid leukemia in accelerated phase (platetlet count less than 100k while patient is not on
therapy for CML).
- Peripheral
blood samples were sent for cytogenetics; FISH panels for AML, CML, ALL; PCR
for quantitative BCR-ABL1; PCR for FLT3
- Findings
were notified to Dr. Kanaan on 2/9/2018
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: Chronic myeloid
leukemia, accelerated phase
Immunophenotyping
Immunohistochemistry: not performed
Flow
cytometry:
not performed,
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
40 year old
male with splenomegaly, marked leukocytosis and thrombocytopenia.
Gross Description
The
specimen is received in 2 parts, each labeled with the patient's name and
medical record number.
1.
Received in formalin in a container labeled
with the patient's name and "bone marrow clot" on the requisition are 2 red-brown cylindrical cores of
clotted blood measuring 0.8 and 2.0 cm in length and 0.2 cm in diameter.
The clot is submitted in toto in cassette 1A.
2. Received in formalin in a container labeled with the
patient's name and "bone marrow core" on
the requisition is a tan-brown cylindrical core of bone measuring 3.2 cm
in length and 0.2 cm in diameter. The specimen is submitted in toto in cassette 2A after a brief decalcification.
PSY/mop 02/09/
Peripheral Smear
2/8/18
WBC 117
RBC 5.18
Hgb 12.1
MCV 75.6
Plt
91
Differentials(%):
Seg 40
Band 18
Lymph 4
Mono 5
Eos 2
Baso
2
Meta 8
Myelo
15
Promyelo
2
Blasts 4
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Microcytic
hypochromic anemia, mild polychromasia
White cells: Marked
leukocytosis
Granulocytes: Neutrophilic
leukocytosis with left shift,
basophilia and eosinophilia
Lymphocytes: Reduced
with unremarkable morphology
Monocytes: Unremarkable
morphology
Other: 4%
circulating blasts
Platelets: Mild
thrombocytopenia with a few large forms
Bone marrow
Differential (%)
Myeloblasts: 6%
Promyelocytes: 9%
Myelocytes: 11%
Metas: 5%
Bands & PMN's: 49%
Eos: 6%
Baso: 5%
Monos: 0%
Lymphs: 4%
Plasma cells: 0%
Erythroids: 5%
M:E ratio: 18.2:1
Cellularity: 95%
Megakaryopoiesis: Decreased, most
megakaryocytes are small with hypolobated nuclei
Erythropoiesis: Marked
reduced, unremarkable morphology
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis: Increase
in eosinophils and basophils, also increased blasts (6%)
Lymphocytes: Reduced,
unremarkable morphology
Biopsy and clot section: Hypercellular
with marked increase in granulocytes. No clusters of blasts are seen
Iron content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
++++++
Diagnosis
Peripheral
blood:
Pancytopenia
Bone
marrow:
Hypercellular for age (50%)
Presence of 5% monoclonal plasma
cells, see comment
Presence of a small benign lymphoid
aggregate in clot section
Adequate iron stores
NDN 01/05/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-
Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-
-Immunohistochemical
stains, with adequate controls, are performed on biopsy for CD138, kappa and
lambda. The stains show 5% plasma cells (positive for CD138), most with
expression for cytoplasmic kappa and negative for lambda light-chain.
- The
current findings are most supportive of monoclonal gammopathy of undetermined
significance (MGUS). Clinical correlation is suggested.
-Bone
marrow aspirate was sent for chromosome analysis and FISH panel for multiple
myeloma
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
90 year old
male with a history of monoclonal gammopathy (less than 10% monoclonal plasma
cells in recent bone marrow).
Gross Description
Part 1 received
in formalin and labeled bone marrow clot is a 2.3 x 1.4 x 0.6 cm red-brown
gelatinous portion of clotted blood which is serially cross sectioned to reveal
a red-brown gelatinous cut surface. The
specimen is submitted in its entirety in cassette 1A-1C.
Part 2
received in formalin and labeled with the patient's name and bone marrow biopsy
on the requisition is a red-brown cylindrical core of bone measuring 1.5 cm in
length and 0.5 cm in diameter. The
specimen is submitted in toto in cassette 2A after a brief
decalcification. PY/dw
01/03/
Peripheral Smear
CBC Results:
WBC 3.5 K/CMM LOW
RBC 2.50 M/CMM LOW
Hgb 8.4 g/dL LOW
Hct 23.9 % LOW
MCV 95.7 fL
HI
MCH 33.6 pg
HI
MCHC 35.1 g/dL Normal
RDW 16.6 % HI
Platelet 100 K/CMM LOW
MPV 8.6 fL Normal
Segs 47.5 % Normal
Lymphocytes 36.0 % Normal
Monocytes 14.4 % HI
Eosinophils 1.7 % Normal
Basophils 0.4 % Normal
Segs-Bands
# 1.7 K/CMM Normal
Lymphocytes
# 1.3 K/CMM Normal
Monocytes
# 0.5 K/CMM Normal
Eosinophils
# 0.1 K/CMM Normal
Retic
Auto 1.4 % Normal
PT 13.6 seconds Normal
INR 1.04 Normal
PTT 33.7 seconds Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Macrocytic
hypochromic anemia with anisopoikilocytosis and mild polychromasia
White cells: Decreased
in number
Granulocytes: Normal
morphology
Lymphocytes:
Normal
morphology
Monocytes: Normal morphology
Platelets: Decreased
with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 2
Promyelocytes: 4
Myelocytes: 16
Metas: 9
Bands & PMN's: 15
Eos: 3
Baso: 0
Monos: 2
Lymphs: 11
Plasma cells: 2
Erythroids: 36
Other: M:E
ratio 1.4
Cellularity: 50%,
hypercellular for age
Megakaryopoiesis: Adequate, a few
megakaryocytes with hypolobated nuclei, many
megakaryocytes with no cytoplasm
Erythropoiesis: Increased
with mild dyserythropoiesis
Iron Content (aspirate): Adequate iron stores
Granulopoiesis: Decreased
with normal maturation
Lymphocytes: Normal
number and morphology
Plasma cells: Normal
number and morphology
Biopsy and clot section: Small
clusters of plasma cells seen. A small benign lymphoid aggregate is seen in
clot section. The lymphocytes in the aggregate have small nuclei with mature
morphology.
Iron content (biopsy
and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060, 88342, 88341x2
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally
reviewed all specimen preparations and concur with the resident's
interpretation."
+++++
14. Neg for
B cell Lymphoma-Hypocellular BM
Diagnosis
Peripheral
Blood:
- Pancytopenia
Bone
Marrow:
-
Hypocellular for age (20%)
- No
morphologic or immunophenotypic evidence of lymphoma, see comment
- Adequate
iron stores
Comment
- Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-18- ) shows
- Bone
marrow aspirate was sent for cytogenetics and NHL FISH panel. Results will be
reported in Addendum
Tumor
Summary
_
Specimen
Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical
Information
66-yo male
with recent diagnosis of high-grade B cell lymphoma of the cecal mass on
3/7/2018 (HS
Preop
Diagnosis: High-grade B cell lymphoma of cecal mass
Gross
Description
The specimen is
received in two parts, both labeled with patient's name and MRN.
1. Bone marrow
aspirate: Received is a dark red piece of tissue measuring 1.5 x 1.5 x 1 cm
that is submitted entirely in cassette 1A.
2. Bone marrow biopsy: Received is a tan-red piece of tissue
measuring 1.8 x 0.2 x 0.2 cm, which is submitted entirely in cassette 2A. AA/dg 03/09/
Peripheral
Smear
CBC
Results:
WBC 2.4 K/CMM LOW
RBC 2.71 M/CMM LOW
Hgb 8.6 g/dL LOW
Hct 25.5 % LOW
MCV 93.9 fL Normal
MCH 31.7 pg HI
MCHC 33.8 g/dL Normal
RDW 16.8 % HI
Platelet 90 K/CMM LOW
MPV 8.9 fL
Normal
Segs 70.7 % Normal
Lymphocytes 14.7 %
LOW
Monocytes 8.8 % Normal
Eosinophils 5.0 % HI
Basophils 0.8 % Normal
Segs-Bands
# 1.7 K/CMM Normal
Lymphocytes
# 0.4 K/CMM LOW
Monocytes
# 0.2 K/CMM Normal
Eosinophils
# 0.1 K/CMM Normal
Microscopic
Description
PERIPHERAL BLOOD:
Erythrocytes: Normocytic
hypochromic anemia with anisocytosis and mild polychromasia
White cells: Decreased
in number
Granulocytes: Unremarkable
morphology. No blasts seen
Lymphocytes: Decreased
with unremarkable morphology
Monocytes: Unremarkable
morphology
Platelets: Decreased
with normal morphology
Bone marrow
Differential (%)
on
aspirate
Myeloblasts: 0%
Promyelocytes: 2%
Myelocytes: 11%
Metas: 9%
Bands & PMN's: 33%
Eos: 3%
Baso: 0%
Monos: 0%
Lymphs: 7%
Plasma cells: 2%
Erythroids: 33%
M:E ratio: 1.7
Cellularity: 20%
Megakaryopoiesis: Normal maturation
with no dysplasia
Erythropoiesis: Mildly
increased with normal maturation and no dysplasia
Iron Content (aspirate): Adequate iron stores
Granulopoiesis: Normal maturation
with no dysplasia
Lymphocytes: Normal
number and morphology
Plasma cells: Normal
number and morphology
Biopsy and clot
section: No evidence
of lymphoma seen
Iron content (biopsy
and clot section): Adequate iron stores
Intradepartmental
Consultation
_
Non
Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching
Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and have
personally issued this report".
++++
Diagnosis
Peripheral
Blood:
- Pancytopenia
Bone Marrow:
- Hypocellular for age (30%)
- No histological evidence of Hemophagocytic Lymphohistiocytosis (HLH)
- No evidence of malignancy
- Decreased iron stores
NDN/LZ 01/30/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
No histologic
evidence of HLH or malignancy is seen in bone marrow. Patient's pancytopenia is
most likely secondary to hypocellular bone marrow. The etiologies for
hypocellular bone marrow may include: viral infection, medication effect, and
immune disorders. Clinical correlation is suggested.
Tumor Summary
N/A
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
Clinical
History: Lupus, rule out HLH
Gross Description
The
specimen is received in one part, labeled with the patient's name and medical
record number.
Received in formalin
and labeled with the patient's name and "bone marrow core" on the
requisition are two tan-brown cylindrical cores of bone each measuring 0.7 x
0.2 x 0.2 cm. The specimen is submitted
in toto in cassette 1A after a brief decalcification. PY/dg
01/29/
Peripheral Smear
CBC result
(1/29/
WBC 2.1 K/CMM LOW
RBC 2.15 M/CMM LOW
Hgb 7.0 g/dL CRIT
Hct 20.3 % LOW
MCV 94.7 fL Normal
MCH 32.7 pg HI
MCHC 34.6 g/dL Normal
RDW 15.6 % HI
Platelet 83 K/CMM LOW
MPV 7.5 fL Normal
Segs 61.6 % Normal
Lymphocytes 34.3 % Normal
Monocytes 3.8 % Normal
Basophils 0.3 % Normal
Segs-Bands
# 1.3 K/CMM LOW
Lymphocytes
# 0.7 K/CMM LOW
Monocytes
# 0.1 K/CMM Normal
Anisocyte 1+
Plt Morph Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic
normocytic anemia, mild polychromasia,
a few microspherocyes present
White cells: Leukopenia
Granulocytes: Left
shifted with myelocytes present
Lymphocytes: Normal
morphology
Monocytes: Normal morphology
Platelets: Thrombocytopenia
with normal morphology
Bone marrow
Differential (%): Unable to perform due to dry tap on the
aspirate and very few cells on the touch prep
Cellularity:30%
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis: decreased
Granulopoiesis: decreased with no increase in blasts
Lymphocytes: decreased
Biopsy: hypocellular with no abnormal cellular infiltrates
Iron content (biopsy): Decreased iron stores
Non Clinical Documentation
CPT:88305, 88313,
88311, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally reviewed the resident's preliminary
interpretation and all specimen preparations and have personally issued this
report".
++++
Diagnosis
Peripheral Blood:
- Normochromic
hypochromic anemia
Bone Marrow:
- Normocellular for
age
- No morphologic or
immunophenotypic evidence of
- Adequate iron stores
Comment
-Immunophenotyping of bone marrow aspirate by flow cytometry
(report HF- - ) shows
-Bone marrow aspirate was sent for cytogenetics, FISH panel
for
Specimen Source
1. Bone marrow aspirate and clot
2. Bone marrow core biopsy, decal, touch prep
3. Peripheral blood smear
Bone marrow procedure was performed by IR
Clinical
Information
Gross Description
[by Surg Path]
Microscopic Description
CBC Results
Date/time:
PERIPHERAL BLOOD:
Erythrocytes: Normochromic hypochromic anemia with anisopoikilocytosis, mild polychromasia
White cells:
Normal in number
Granulocytes: Normal morphology
Lymphocytes: Normal morphology
Monocytes: Normal morphology
Platelets: Normal number and morphology
Bone marrow
Differential (%)
Myeloblasts:
Promyelocytes:
Myelocytes:
Metas:
Bands &
PMN's:
Eos:
Baso:
Monos:
Lymphs:
Plasma cells:
Erythroids:
M:E ratio
Cellularity: %, normocellular for age
Megakaryopoiesis: Adequate with normal maturation
Erythropoiesis:
Adequate with normal maturation
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis: Adequate
with normal maturation
Lymphocytes:
Normal number and morphology
Plasma Cells:
Normal number and morphology
Biopsy and clot
section: No evidence of granuloma, fibrosis or abnormal cellular infiltrates
Iron content
(biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x 2, 88311, 85097, 85060
The positive controls and internal negative controls for the
special stains have been reviewed, and appropriate staining is confirmed by the
pathologist whose signature appears above.
++++
Diagnosis
Peripheral
Blood:
-
Pancytopenia
Bone
Marrow:
- B cell
lymphoblastic leukemia, see comment
- Decreased
iron stores
02/13/
NDN 02/13/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-
Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-
- Bone
marrow aspirate was sent for AFB/fungal stains and cultures, and cytogenetics.
- Dr N. Rodridguez was notified of the findings on 2/13/2018
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: B cell
lymphoblastic leukemia
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry:
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
Clinical
History: 6 y/o female with pancytopenia, acute onset fever, abdominal pain, MS
change
Gross Description
The
specimen is received in two parts each labeled with the patient's name and medical
record number.
1. Received in formalin in and labeled
"bone marrow clot" is a red-brown portion of clotted blood measuring
1.4 x 0.6 x 0.1 cm. The specimen is submitted in
toto in cassette 1A.
2. Received in formalin and labeled "bone
marrow" is a red-brown, cylindrical core of bone measuring 1.0 cm in length
and 0.2 cm in diameter. The specimen is
submitted in toto in cassette 2A after a brief decalcification. PY/jjb 02/13/
Peripheral Smear
CBC
Results:
WBC 1.5 K/CMM LOW
RBC 2.22 M/CMM LOW
Hgb 6.5 g/dL CRIT
Hct 19.2 % CRIT
MCV 86.4 fL Normal
MCH 29.4 pg Normal
MCHC 34.0 g/dL Normal
RDW 16.5 % HI
Platelet 93 K/CMM LOW
MPV 8.4 fL Normal
Segs 0.0
% LOW
Bands 0.0 %
Normal
Lymphocytes 98.0 %
HI
Atypical Lymphs 0.0
% Normal
Monocytes 2.0 % Normal
Tot Cell
Ct 25 NA
Anisocyte 1+
Polychrom
Moderate
Hypochrom 1+
Retic
Auto 0.2 %
LOW
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic
normocytic anemia with mild polychromasia
White cells: Decreased
in number
Granulocytes: Normal
morphology
Lymphocytes: Relatively increased with mature cytology
Monocytes: Normal morphology
Platelets: Decreased
with a few large platelets
Bone marrow
Differential (%)
Lymphoblasts: 94%
Promyelocytes: 0%
Myelocytes: 0%
Metas: 0%
Bands & PMN's: 0%
Eos: 0%
Baso: 0%
Monos: 0%
Lymphs: 2%
Plasma cells: 0%
Erythroids: 4%
Cellularity: 95%
Megakaryopoiesis: Decreased
Erythropoiesis: Markedly
decreased
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis: Markedly
decreased
Lymphocytes: Decreased
Biopsy and clot section: Diffuse
distribution of lymphoblasts
Iron content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
+++
18. Smoldering
myeloma-25% monoclonal plasma cells
Diagnosis
Peripheral
blood:
No pathologic changes
Bone marrow:
Presence of 25% monoclonal plasma cells in bone marrow,
see comment
Adequate iron stores
NDN 08/25/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-
-Immunohistochemical
stains, with adequate controls, are performed on biopsy for CD138, kappa and
lambda. The stains show 25% plasma cells in bone marrow (pos for CD138) with
cytoplasmic kappa light-chain restriction.
-Per
clinical history, patient currently does not have CRAB symptoms. The presence
of 25% monoclonal plasma cells in bone marrow in this setting is consistent
with smoldering
plasma cell myeloma. Clinical correlation is suggested.
-Bone marrow
aspirate was sent for cytogenetics and myeloma FISH panel.
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: bone marrow
Aspiration site: R post iliac crest
Biopsy site: R post iliac crest
Histologic type: smoldering plasma cell myeloma
Immunophenotyping
Immunohistochemistry: Performed
Flow cytometry: _
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone
marrow clot
2. Bone
marrow core biopsy, decal, touch prep
Peripheral
blood smear
Bone marrow
was obtained by IR
Clinical Information
Smoldering
multiple myeloma
63 year old male with history of moldering myeloma (16% monoclonal
plasma cells in bone marrow in 5/2016).
Kappa/lambda, free light-chain ratio = 22.48. Patient has been on treatment. Restaging BM in November 2016 showed changing
DX to MGUS (6% monoclonal plasma cells in BM).
Gross Description
The specimen
is received in two parts each labeled with the patient's name and medical
record number.
Part 1
received in formalin in a container and labeled with the patient's name and
bone marrow aspirate clot on the requisition is a red-brown gelatinous portion
of clotted blood measuring 2.0 x 1.2 x 0.4 cm.
The clot is serially cross sectioned to reveal a red-brown gelatinous
cut surface. The specimen is submitted
in its entirety in cassette 1A.
Part 2
received in formalin in a container and labeled with the patient's name and
bone marrow core biopsy on the requisition is a red-brown cylindrical core of
bone measuring 2.3 x 0.2 x 0.2 cm. The
specimen is submitted in toto in cassette 2A after a brief decalcification. PY/ddw 08/22/
2 blocks, 2
H&E
Peripheral Smear
CBC
Results:
WBC 4.5 K/CMM Normal
RBC 4.57 M/CMM LOW
Hgb 14.1 g/dL Normal
Hct 41.5 % LOW
MCV 90.9 fL Normal
MCH 30.9 pg Normal
MCHC 34.0 g/dL Normal
RDW 13.1 % Normal
Platelet 189 K/CMM Normal
MPV 8.3 fL
Normal
Segs 53.3 % Normal
Lymphocytes 28.0 % Normal
Monocytes 11.8 % Normal
Eosinophils 6.3 % HI
Basophils 0.6 % Normal
Segs-Bands
# 2.4 K/CMM Normal
Lymphocytes
# 1.3 K/CMM Normal
Monocytes
# 0.5 K/CMM Normal
Eosinophils
# 0.3 K/CMM Normal
Retic
Auto 1.0 % Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic
normocytic RBCs with mild polychromasia
White cells: Normal
in number
Granulocytes: Normal
number and morphology
Lymphocytes: Normal
number and morphology
Monocytes: Normal number and
morphology
Platelets: Normal
number and morphology
Bone marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 7
Myelocytes: 7
Metas: 7
Bands & PMN's: 19
Eos: 6
Baso: 2
Monos: 5
Lymphs: 7
Plasma cells: 16
Erythroids: 24
Other: M:E
ratio 2.2
Cellularity: 40%
Megakaryopoiesis: Adequate with normal
maturation
Erythropoiesis: Adequate
with normal maturation
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis: Adequate
with normal maturation
Lymphocytes: Normal
number and morphology
Plasma cells: Increased
in number (16% in aspirate, 25% in biopsy with immunostain), most with mature cytology
Biopsy and clot section: Clusters
of plasma cells are seen
Iron content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT 88305 x
2, 88313 x 2, 88311, 85097, 85060, 88342, 88341x2
Teaching Physician Statement
"I have personally
reviewed all specimen preparations and concur with the resident's
interpretation."
+++
Diagnosis
Peripheral Blood:
- Pancytopenia
Bone Marrow:
- Myelodysplastic syndrome with excess
blasts-1 (MDS EB-1)
- Adequate iron stores
NDN/DMM 03/16/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-18-131) in gate #2 shows a
normal lymphocytic population (B cell and T cells). Analysis of cells in gate#1
(blast area) shows a myeloblast population that is positive for CD34, CD13,
CD33, CD117, CD38, and HLA-DR. These blasts are negative for CD56, CD19, CD10,
and TdT. They aberrantly expressed CD4. The blasts
account for about 7% of the bone marrow nucleated cells (in line with manual
differential). These flow cytometry results, together with morphological findings,
are consistent with MDS with excess blasts-type 1 (MDS EB-1).
-Note that patient
received chemotherapy for NHL previously. A therapy-related MDS cannot be ruled
out. Clinical correlation is suggested.
-No evidence of
residual lymphoma is seen.
-Bone marrow biopsy is
pending decal process. Findings on biopsy will be reported in Addendum
-Bone marrow aspirate
was sent for cytogenetics, FISH panel for MDS.
- Dr Idowu
was notified of the findings on 3/16/18
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: MDS EB-1
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry:
Performed, see separate report (HF-18-xx)
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
83 year old
male with NHL s/p chemoradiation (initial diagnosis 5 yrs
ago) and relapse 1 yr ago with last treatment 1 yr ago who is presenting with pancytopenia x 2 months
concerning for relapse.
Gross Description
1. Received in
formalin labeled with the patient's name and MRN only
is a 1.5 x 1.5 x 1.0 cm cylindrical clot of dark red blood which is bisected
and submitted entirely in cassette 1A.
2. Received in
formalin labeled with the patient's name, MRN and
"core" is a 1.4 cm cylindrical portion of trabeculated bone measuring
0.2 cm in diameter. The specimen is submitted in its entirety in cassette 2A after a brief
decal. AG/myf 03/16/2018 02:01
Peripheral Smear
3/15/2018
CBC
Results:
WBC 0.9 K/CMM CRIT
RBC 2.55 M/CMM LOW
Hgb 8.4 g/dL LOW
Hct 24.6 % LOW
MCV 96.5 fL HI
MCH 32.9 pg HI
MCHC 34.1 g/dL Normal
RDW 24.7 % HI
Platelet 57 K/CMM LOW
MPV 7.5 fL Normal
Segs 25.3
% LOW
Lymphocytes 67.7 %
HI
Monocytes 4.3 %
Normal
Eosinophils 1.8 % Normal
Basophils 0.9 % Normal
Segs-Bands
# 0.2 K/CMM LOW
Lymphocytes
# 0.6 K/CMM LOW
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Macrocytic
hypochromic anemia with anisopoikilocytosis, mild
polychromasia
White cells: Markedly
decreased; no blasts seen
Granulocytes: Markedly decreased in
number with normal morphology
Lymphocytes: Decreased in number with
normal morphology
Monocytes: Decreased in number with
normal morphology
Platelets: Decreased in number with morphology
Bone marrow
Differential (%)
Myeloblasts: 7
Promyelocytes: 1
Myelocytes: 5
Metas: 2
Bands & PMN's: 3
Eos: 1
Baso: 0
Monos: 0
Lymphs: 14
Plasma cells: 0
Erythroids: 67
M:E ratio 0.28
Cellularity (clot
section): 30%, normocellular for age
Megakaryopoiesis: Adequate
with dysplastic forms
Erythropoiesis: Markedly
increased with dyserythropoiesis
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis:
Decreased with normal maturation
Lymphocytes: Normal
number and morphology
Others: Rare histiocytes with hemophagocytosis
Clot section: No
evidence of clusters of immature cells.
Iron content (clot
section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
++++
Diagnosis
Peripheral
Blood:
- Pancytopenia
Bone
Marrow:
- Hypercellular marrow for age (60%)
- Residual leukemic myeloblasts (5%), see comment
- Diffuse reticulin fibrosis (grade 1/3), and
focal trichrome fibrosis
- Increased iron stores
NDN/DMM 03/28/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF- 18-154 ) in gate #1 shows
an abnormal population (about 5% of bone marrow cells) in the same position
(CD45/SSC scattergram) as the leukemic cells in original bone marrow sample in
July 2017. The leukemic cells retain the same marker profile: positive for CD13,
CD33, CD38, CD4, CD7, CD117, CD34, HLA-DR; and negative for TdT.
These results indicate 5% residual blasts in this patient with AML.
-Immunohistochemical
stains, with adequte controls, are performed on
biopsy for CD3, CD7, CD34, CD117, E-Caherin. CD7 shows
20% of bone marrow cells being positive (T lymphocytes and leukemic blasts).
CD3 shows 15% bone marrow cells being positive (T lymphocytes). CD34 are
positive for blasts. CD117 is spositive for blasts
and early granulocytes/erythroids, E cadherin is positive
for scattered erythroids. The stains indicate 5%
residual leukemic myeloblasts that show co-expression of CD7, CD34, and CD117.
-Special
stains for reticulin and trichrome were performed on biopsy. The stains show
diffuse reticulin fibrosis (grade 1/3), and focal trichrome fibrosis
-Bone
marrow aspirate was sent for cytogenetics, FISH panel for AML, AML molecular
profile, FLT3/NPM1, and Quantitative PCR for BCR-ABL.
Tumor Summary
Specimen:
Peripheral
blood smear
Bone marrow
aspiration
Bone marrow
aspirate clot
Bone marrow
core (trephine) biopsy
Bone marrow
core touch preparation (imprint)
Procedure:
Bone marrow
Aspiration
site: R posterior iliac crest
Biopsy
site: R posterior iliac crest
Histologic
type: acute myeloid leukemia
Immunophenotyping
Immunohistochemistry: performed
Flow
cytometry: Performed, see separate report (HF-18-154)
Cytogenetic
studies: Performed, see separate report
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
71 y/o male
with AML, relapse BM in 2/2018 showed 82% residual blasts. Patient now s/p
chemotherapy
Gross Description
The
specimen is received in two parts each labeled with the patient's name and
medical record number.
Part 1
received in formalin and labeled "clot" is a red-brown portion of
clotted blood measuring 0.8 x 0.5 x 0.1 cm.
The specimen is submitted in toto in cassette 1A.
Part 2
received in formalin and labeled "core" is a tan-red cylindrical core
of bone measuring 2.4 x 0.2 x 0.2 cm.
The specimen is submitted in toto in cassette 2A after a brief
decalcification. PY/ddw
03/26/2018 17:43
2 blocks, 2
H&E
Microscopic Description
CBC Results
Date/time:
3/26/2018
CBC
Results:
WBC 1.0 K/CMM CRIT
RBC 2.75 M/CMM LOW
Hgb 7.9 g/dL LOW
Hct 22.3 % LOW
MCV 81.1 fL Normal
MCH 28.7
pg Normal
MCHC 35.4 g/dL Normal
RDW 16.6 % HI
MPV 8.7 fL Normal
Platelet 35 K/CMM LOW
Segs 2.0 % LOW
Bands 0.0
% Normal
Lymphocytes 92.0 %
HI
Atypical Lymphs 0.0 %
Normal
Monocytes 6.0 % Normal
Segs-Bands
# 0.0 K/CMM LOW
Lymphocytes
# 0.9 K/CMM LOW
Monocytes
# 0.1 K/CMM Normal
Tot Cell
Ct 50
NA
RBC
Morph Normal
Plt
Morph Normal
Retic Auto 0.1 % LOW
PERIPHERAL
BLOOD:
Erythrocytes:
Normocytic, normochromic anemia with anisocytosis, mild polychromasia.
White
cells: Marked leukopenia.
Granulocytes: Reduced, unremarkable
morphology, no blasts seen
Lymphocytes: Reduced, unremarkable
morphology.
Monocytes: Unremarkable.
Platelets: Thrombocytopenia with unremarkable
morphology.
Bone marrow
Aparticulate
aspirate with suboptimal touch prep. Differential cannot be performed.
Cellularity: 60%, hypercellular for age
Megakaryopoiesis:
Decreased
Erythropoiesis:
Decreased
Iron Content (aspirate): Increased
iron stores
Granulopoiesis:
Presence of 5% residual blasts
Lymphocytes:
Normal morphology
Plasma
Cells: Normal morphology
Biopsy and
clot section: Clot- does not demonstrate any particles. Biopsy-hypercellular
marrow with rare megakaryocytes identified, fibrosis, and hemosiderin laden
macrophages similar to findings in
previous biopsy. No evidence of granuloma or abnormal cellular
infiltrates.
Iron
content (biopsy): Increased iron stores
Non Clinical Documentation
CPT:88305 x
2, 88313 x 2, 88311, 85097, 85060, 88342, 88341 x4,
The positive
controls and internal negative controls for the special stains have been
reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Some of
the immunohistochemical tests in this panel were developed and their
performance characteristics determined by Memorial Hermann Southwest Hospital
Laboratory. They have not been cleared or approved by the U. S. Food
and Drug Administration. The FDA has determined that such clearance
or approval is not necessary. These tests are used for clinical
purposes. They should not be regarded as investigational or for
research. This laboratory is regulated under the Clinical Laboratory
Improvement Amendments of the 1988 (CLIA) as qualified to perform high
complexity clinical testing.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
+++++
Diagnosis
Peripheral Blood:
- Marked leukocytosis with left shift
- Normocytic hypochromic anemia.
Bone
Marrow:
- Markedly hypercellular for age (90%) with
increased granulopoiesis and megakaryopoiesis,
supportive of a myeloproliferative
neoplasm, NOS
- Decreased iron stores
NDN/DMM 03/29/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF- 18-157) in Gate #1 shows
a T cell population (about 90% of the cells analyzed) with no aberrant loss or
aberrant expression of T cell markers, a B cell population (about 7% of the
cells analyzed) that is negative for CD5, CD10, no surface light-chain
restriction. Analysis of the cells in the blast area (Gate 4) shows fewer than
3% normal myeloblasts (of the bone marrow cells) that are positive for CD13 and
CD33. These results indicate no abnormal immunophenotypes are found with flow
cytometry.
-The
morphologic findings in peripheral blood and bone marrow are most supportive of
a myeloproliferative neoplasm, NOS
-Bone
marrow aspirate was sent for cytogenetics, FISH panel for MPN.
-Dr Rios
was noified of the findings on 3/29/18
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration
site: R posterior iliac crest
Biopsy
site: R posterior iliac crest
Histologic
type: MPN, NOS
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry:
Performed, see separate report (HF-18-157)
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
Bone marrow
procedure was performed by IR
Clinical Information
76 year old
male with a possible myeloproliferative neoplasm.
Gross Description
The specimen is received in two parts each labeled with the
patient's name and medical record number.
1. Received
in formalin and labeled clot is a red-brown gelatinous portion of clotted blood
measuring 0.8 x 1.2 x 0.8 cm. The clot
is serially cross sectioned to reveal a red-brown gelatinous cut surface. The clot is submitted in its entirety in
cassette 1A.
2. Received
in formalin and labeled core is a red-brown cylindrical core of bone measuring
1.2 x 0.2 x 0.2 cm. The specimen is
submitted in toto in cassette 2A after a brief decalcification. PY/myf 03/27/2018 21:08
Microscopic Description
CBC Results
Date/time:
3/27/2018 10:00
CBC
Results:
WBC 39.9 K/CMM HI
RBC 4.14 M/CMM LOW
Hgb 12.5 g/dL LOW
Hct 37.8 % LOW
MCV 91.2 fL Normal
MCH 30.2 pg Normal
MCHC 33.1 g/dL Normal
RDW 16.2 % HI
MPV 9.4 fL Normal
Platelet 195 K/CMM Normal
Segs 70.0 %
Normal
Bands 0.0 % Normal
Lymphocytes 11.0 % LOW
Atypical Lymphs 0.0
% Normal
Monocytes 15.0 % HI
Eosinophils 1.0 % Normal
Metamyelocytes 2.0
% HI
Myelocytes 1.0 %
HI
Segs-Bands
# 27.9 K/CMM HI
Lymphocytes
# 4.4 K/CMM Normal
Monocytes
# 6.0 K/CMM HI
Eosinophils
# 0.4 K/CMM Normal
RBC
Morph Normal
Plt
Morph Normal
Retic Auto 2.4 % HI
PERIPHERAL
BLOOD:
Erythrocytes:
Hypochromic normochromic anemia with anisocytosis, mild polychromasia.
White
cells: Leukocytosis.
Granulocytes: Increased with left
shift.
Lymphocytes: Unremarkable morphology.
Monocytes: Increased with
unremarkable morphology.
Platelets: Adequate with unremarkable
morphology.
Bone marrow
Differential
(%)
Myeloblasts:
3
Promyelocytes:
5
Myelocytes:
17
Metas: 6
Bands &
PMN's: 46
Eos: 1
Baso:
1
Monos:
1
Lymphs:
3
Plasma
cells: 0
Erythroids:
17
M:E ratio
5.9
Cellularity: 90%, hypercellular for age
Megakaryopoiesis:
Markedly increased with normal maturation
Erythropoiesis:
Adequate, no evidence of dysplasia.
Iron Content (aspirate): Decreased
iron stores.
Granulopoiesis:
Markely increased, no evidence of dysplasia or
eosinophilia/basophilia.
Lymphocytes:
Reduced, unremarkable morphology.
Biopsy and
clot section: Markedly hypercellular with increased granulopoiesis and megakaryopoiesis
Iron
content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x
2, 88313 x 2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
+++++
22. AML with
myelodysplasia-related changes
Diagnosis
Peripheral
Blood:
-
Pancytopenia with many circulating blasts
Bone
Marrow:
- Acute
myeloid leukemia with myelodysplasia-related changes,
see comment
- Adequate
iron stores
Comment
-
Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-18- )
shows
- The
current findings of 82% blasts and dysplastic changes in bone marrow cells of
this patient with history of MDS are
most consistent with AML with myelodysplasia-related changes
- Bone
marrow aspirate was sent for cytogenetics, FISH panel for AML, FISH panel for
MDS, AML molecular profile, PCR for FLT3, and PCR for bcr/abl1
- Dr Rios
was notified of the findings on 4/10/2018
Tumor
Summary
Specimen:
Peripheral
blood smear
Bone marrow
aspiration
Bone marrow
aspirate clot
Bone marrow
core (trephine) biopsy
Bone marrow
core touch preparation (imprint)
Procedure:
Bone marrow
Aspiration site:Left iliac crest
Biopsy
site: Left iliac crest
Histologic
type: acute myeloid leukemia, with myelodysplasia-related changes
Immunophenotyping:
Immunohistochemistry:
not performed
Flow
cytometry:
Performed,
see separate report (HF-18- )
Cytogenetic
studies: Performed, see separate report
Specimen
Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical
Information
Patient is a 76-year-old female referred by Dr. Jorge Quesada to
MHH-TMC with the diagnosis of MDS with excess blasts transforming into acute
myeloid leukemia, and severe pancytopenia.
Gross
Description
1. Received
in formalin and labeled with the patient's name, MRN and "clot" is a
1.5 x 1.2 x 0.8 cm dark red blood clot. The specimen is bisected and submitted
in its entirety in cassette 1A.
2. Received
in formalin and labeled with the patient's name, MRN and "core" are
three fragments of bone ranging in size from 0.5 x 0.2 cm to 1.3 x 0.2 cm. Part 2A is submitted in light decal. CL/ddw 04/09/
2 blocks, 2
H&E, 1 decal
Peripheral
Smear
_
Microscopic
Description
CBC Results
Date/time:
04/09/18; 05:02:00 CDT
CBC
Results:
WBC 2.9 K/CMM LOW
RBC 2.44 M/CMM LOW
Hgb 7.5 g/dL LOW
Hct 22 % LOW
MCV 90.4 fL Normal
MCH 30.7 pg Normal
MCHC 34.0 g/dL Normal
RDW 23.8 % HI
MPV 10.4 fL Normal
Platelet 31 K/CMM LOW
Segs 13.0 % LOW
Lymphocytes 39.0 % Normal
Monocytes 18.0 % HI
Eosinophils 1 %
Normal
Basophils 0.8 % Normal
Blasts 20.0
H
Segs-Bands
# 0.6 K/CMM LOW
Lymphocytes
# 1.1 K/CMM Normal
Monocytes
# 0.5 K/CMM Normal
Anisocyte 1+
Polychrom Moderate
Hypochrom 1+
Plt
Morph Normal
Retic
Auto 1.9 % HI
PERIPHERAL
BLOOD:
Erythrocytes:Normocytic
hypochromic anemia with anisopoikilocytosis, mild
polychromasia
White
cells: Decreased in number with many blasts seen
Granulocytes: Decreased with hypogranular
PMN's
Lymphocytes: Decreased with normal
morphology
Monocytes: Normal number and
morphology
Platelets: Decreased with normal morphology
Bone marrow
Differential
(%)
Blasts: 82
Promyelocytes:
00
Myelocytes:
01
Metas: 01
Bands &
PMN's: 02
Eos: 03
Baso:
00
Monos:
01
Lymphs:
08
Plasma
cells: 00
Erythroids:
02
Cellularity: 90%, hypercellular for age
Megakaryopoiesis:
Decreased with dysplastic changes
Erythropoiesis:
Decreased with dysplastic changes
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis:
Decreased in mature granulocytes with numerous blasts (82%)
Lymphocytes:
Normal number and morphology
Biopsy and
clot section: Diffuse distribution of blasts
Iron
content (biopsy and clot section): Adequate iron store
Intradepartmental
Consultation
_
Non
Clinical Documentation
CPT:88305 x
2, 88313 x 2, 88311, 85097, 85060
The positive
controls and internal negative controls for the special stains have been reviewed,
and appropriate staining is confirmed by the pathologist whose signature
appears above.
Teaching
Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
+++++
23.
Myeloproliferative neoplasm, NOS in accelerated phase (12% myeloblasts)
Diagnosis
Peripheral
blood:
-
Normocytic hypochromic anemia
- Marked
leukocytosis with left shift
- No
increase in basophils or eosinophils
Bone
marrow:
- Myeloproliferative
neoplasm, NOS in accelerated phase (12% myeloblasts)
- Decreased
iron stores
NDN/NDN 04/12/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-
-These
result by flow cytometry, together with morphological findings, are most
consistent with a myeloproliferative disorder, NOS. Morphology in peripheral
blood and bone marrow are not supportive of CML or atypical CML. The blast
count in bone marrow is 12% by manual count, confirmed by flow cytometry
gating. The number of blasts in the bone marrow is consistent with
Myeloproliferative neoplasm, NOS in accelerated phase.
-
Peripheral blood samples were sent for cytogenetics; FISH panels for MPN, MPN
molecular profile
- Findings
were notified to Dr. Juneja on 4/11/2018
Tumor Summary
Specimen:
Peripheral
blood smear
Bone marrow
aspiration
Bone marrow
aspirate clot
Bone marrow
core (trephine) biopsy
Bone marrow
core touch preparation (imprint)
Procedure:
Bone marrow
Aspiration
site: R posterior iliac crest
Biopsy
site: R posterior iliac crest
Histologic
type: MPN, NOS in accelerated phase
Immunophenotyping
Immunohistochemistry:
not performed
Flow
cytometry:
performed
(report HF-
Cytogenetic
studies: Performed, see separate report
Specimen Source
1. Bone
marrow clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
80 year old
suspicious for CML but peripheral blood sample was negative PCR for Bcr-abl1.
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
MRN.
Part 1
received in formalin in a container labeled with the patient's name and bone
marrow clot on the requisition is a red-brown portion of clotted blood
measuring 1.0 x 1.4 x 0.8 cm. The clot
is serially cross sectioned and reveal a red-brown gelatinous cut surface. The clot is submitted in its entirety in
cassettes 1A-1B.
Part 2
received in formalin in a container labeled with the patient's name and bone
marrow biopsy on the requisition is a red-brown delicate cylindrical core of
bone measuring 1.3 cm in length and 0.1 to 0.2 cm in diameter. The specimen is submitted entirely in
cassette 2A after decalcification.
PY/kg 04/10/
Peripheral Smear
CBC
Results:
WBC 249
K/CMM CRIT
RBC 3.01
M/CMM LOW
Hgb 7.5
g/dL LOW
Hct
24.9 % LOW
MCV 82.6 fL
MCH 24.8 pg LOW
MCHC 30.0
g/dL LOW
RDW 19.4 %
HIGH
Platelet 177
K/CMM
MPV 9.0 fL Normal
Segs 54.0 %
Normal
Lymphocytes
6.0 % Normal
Monocytes
8.0 % HI
Segs-Bands
# 139.9 K/CMM Normal
Lymphocytes
# 15.0 K/CMM HIGH
Monocytes #
20.0 K/CMM Normal HIGH
Retic Auto
2.6 % HIGH
Microscopic Description
PERIPHERAL
BLOOD:
Erythrocytes:
Normocytic hypochromic anemia, occasional nucleated RBCs, mild polychromasia
White
cells: Marked leukocytosis, presence of a few blasts
Granulocytes:
Neutrophilic leukocytosis with left shift, no increase in basophils or
eosinophils
Lymphocytes:
Increased with unremarkable morphology
Monocytes: Increased with unremarkable morphology
Platelets:
Normal in number with unremarkable morphology
Bone marrow
Differential
(%)
Myeloblasts:
12%
Promyelocytes:
8%
Myelocytes:
25%
Metas: 16%
Bands&
PMN's: 24%
Eos: 1%
Baso:
1%
Monos:
3%
Lymphs:
4%
Plasma
cells: 0%
Erythroids:
6%
M:E ratio:
15:1
Cellularity:
95%
Megakaryopoiesis:
Increased with normal maturation, no dwarf megakaryocytes seen
Erythropoiesis:
Marked reduced, unremarkable morphology
Iron
Content (aspirate): Decreased iron stores
Granulopoiesis:
Increased blasts (12%), no increase in eosinophils and basophils,
Lymphocytes: Unremarkable morphology
Biopsy and
clot section: Hypercellular with marked increase in granulocytes.
Iron
content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x
2, 88313 x 2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report."
++++
Diagnosis
Peripheral
Blood:
- Pancytopenia
Bone
Marrow:
-
Myelofibrosis, see comment
- Increased
iron stores
NDN/VJ 04/13/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Reticulin
and Trichrome stains on biopsy show collagen fibrosis and reticulin fibrosis
(grade 2 out of 3)
-Immunohistochemical
stains, with adequate controls, are performed on biopsy for CD34, CD117, MPO,
Factor VIII, and ECadherin. The MPO and Ecdherin stains show increase in granulocytes and decrease
in erythoids. CD34 shows less than 2% positive cells.
CD117 shows normal distribution of early granulocytes. FVIII stain shows normal
distribution of megakaryocytes.
-Diffuse
myelofibrosis is seen in biopsy which is the cause of pancytopenia and paucity
of aspirate cells. Primary myelofibosis or
myelofibrosis due to other pre-existing myeloproliferatibe
neoplasms (P. vera, CML, and essential thrombocythemia) are unlikely due to
lack of prefibrotic presentations. The current
peripheral blood smear also shows no evidence of tear-drop cells, NRBCs or
leukocyte left shift, typical findings in myelofibrosis associated with MPNs.
Acute panmyelosis with myelofibrosis is ruled out
without increase in myeloblasts. Other
etiologies are also unlikely: lymphoma (especially Hodgkin lymphoma), reneal osteodystrophy, metastatic carcinoma. The following etiolgies may be considered in this patient: viral
infection, auto immune disease such as SLE in this patient, among others.
Clinical correlation is suggested.
-Bone
marrow was sent for cytogenetics, and FISH panels for MDS and MPN, MPN
molecular profile.
-Findings
were discussed with Dr. G .Segal and Dr Juneja on
4/12/18
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
39 year old
female with history of SLE, thrombocytopenia, anemia, encephalopathy, auto
immune hemolysis, PLEX for APLS. Bone
marrow for workup of pancytopenia.
Gross Description
The specimen
is received in two parts, each labeled with the patient's name and MRN.
Part 1
received in formalin and labeled bone marrow is a red-brown gelatinous portion
of clotted blood measuring 2.8 x 1.1 x 0.8 cm. The clot is serially cross
sectioned to reveal a red-brown gelatinous cut surface. The clot is submitted in its entirety in cassettes
1A-1C.
Part 2
received in formalin and labeled bone marrow core is a red-brown cylindrical
core of bone measuring 2.1 cm in length and 0.2 cm in diameter. The specimen is
submitted entirely in cassette 2A after a brief decalcification. PY/kg
04/10/
Peripheral Smear
CBC
Results:
WBC 1.6
K/CMM LOW
RBC 2.38
M/CMM LOW
Hgb 6.7
g/dL LOW
Hct 20.0 % LOW
MCV 84.0 fL
HI
MCH 28.3
pg HI
MCHC 33.6 g/dL Normal
RDW 16.0
% HI
Platelet 13 K/CMM LOW
MPV 10.7 fL HI
Segs 71 % Normal
Lymphocytes 21.4 % Normal
Monocytes 7.4% Normal
Eosinophils 0.0 % Normal
Basophils 0.2 % Normal
Segs-Bands # 1.2 K/CMM LOW
Lymphocytes # 0.3 K/CMM LOW
Monocytes # 0.1 K/CMM Normal
RBC Morph Normal
Plt Morph Normal
Retic Auto 0.0 % LOW
Microscopic Description
PERIPHERAL
BLOOD:
Erythrocytes:
Normocytic hypochromic anemia, no polychromasia. NRBCs and tear-drop cells are
not seen
White cells:
Markedly decreased in number, normal morphology, no blasts seen
Granulocytes:
Decreased with normal morphology , no left shift seen
Lymphocytes:
Decreased with normal morphology
Monocytes:
Decreased with normal morphology
Platelets:
Markedly decreased with normal morphology
Bone marrow
(100 cells counted on touch prep)
Differential
(%)
Myeloblasts:
0%
Promyelocytes:
0%
Myelocytes:
17%
Metas: 3%
Bands&
PMN's: 52%
Eos: 0%
Baso:
0%
Monos:
5%
Lymphs:
22%
Plasma
cells: 0%
Erythroids:
1%
Cellularity:
90%
Megakaryopoiesis:
Adequate with normal maturation
Erythropoiesis:
Decreased
Iron
Content (aspirate): Increased iron stores
Granulopoiesis:
Increased with no increase in blasts
Lymphocytes:
Relatively increased with normal morphology
Biopsy and
clot section: Diffuse myelofibrosis, no evidence of granuloma or clusters of imature cells
Iron
content (biopsy and clot section): Increased iron stores
Non Clinical Documentation
CPT:88305 x
2, 88313 x 4, 88311, 85097, 85060, 88342, 88341 x4
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Some of the
immunohistochemical tests in this panel were developed and their performance characteristics
determined by Memorial Hermann Southwest Hospital Laboratory. They have not
been cleared or approved by the U. S. Food and Drug Administration. The FDA has
determined that such clearance or approval is not necessary. These tests are
used for clinical purposes. They should not be regarded as investigational or
for research. This laboratory is regulated under the Clinical Laboratory
Improvement Amendments of the 1988 (CLIA) as qualified to perform high
complexity clinical testing
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
++++
25.
Neutropenia with Arrest of Granulocyte Maturation
Diagnosis
Peripheral
Blood:
- Normochromic hypochromic anemia and neutropenia
Bone
Marrow:
- Normocellular for age (30%)
- Increased erythropoiesis with mild dyserythropoiesis
- Arrest of granulocyte maturation
- Adequate iron stores
NDN/VJ 04/13/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Arrest of
granulocyte maturation is seen in bone marrow which is likely the cause of
neutropenia in this patient. Etiologies may include medication effect, among
others. Clinical correlation is suggested
-Bone
marrow aspirate was sent for cytogentetics and MDS
FISH Panel; also microbiolgy cultures/stains
Tumor Summary
-
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
80 y/o male
presenting with neutropenia. Bone marrow in 2015 showed a normocellular marrow
for age. MDS FISH negative and cytogenetics showed loss of Y chromosome. Now
clinical concern about bone marrow suppression vs viral infection. Leukopenia, unclear origin, PMN of NIC on
dialysis.
Gross Description
The specimen is received in two parts each labeled with the
patient's name and medical record number.
1. Received
in formalin and labeled clot is a red-brown portion of clotted blood measuring
1.0 x 0.6 x 0.1 cm. The specimen is
submitted in toto in cassette 1A.
2. Received
in formalin and labeled core are two red-brown delicate cylindrical cores of
soft tissue measuring 0.1 and 1.0 cm in length and 0.1 cm in diameter. The specimen is submitted in toto in cassette
2A after a brief decalcification. PY/myf 04/12/
Peripheral Smear
CBC Results
Date:4/12/18
WBC 2.6
K/CMM
RBC 2.68
M/CMM
Hgb 7.7
g/dL
Hct
23.5 %
MCV 87.7 fL
MCH 28.9 pg
MCHC 33
g/dL
RDW 15.3 %
Platelet
331 K/CMM
Microscopic Description
PERIPHERAL
BLOOD:
Erythrocytes:
Normochromic hypochromic anemia with anisopoikilocytosis,
mild polychromasia
White
cells: Decreased in number
Granulocytes: Neutropenia with normal
morphology
Lymphocytes: Normal morphology
Monocytes: Normal morphology
Platelets: Normal number and morphology
Bone marrow
Differential
(%)
Myeloblasts:
03
Promyelocytes:
03
Myelocytes:
12
Metas: 02
Bands &
PMN's: 01
Eos: 06
Baso:
00
Monos:
02
Lymphs:
08
Plasma
cells:03
Erythroids:
67
M:E ratio:
0.4
Cellularity:
30%, normocellular for age
Megakaryopoiesis:
Adequate with normal maturation
Erythropoiesis:
Erythroid hyperplasia with mild dyserythropoiesis
(irregular nuclear contours and nuclear-cytoplasmic dyssynchrony)
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis:
Decreased with arrested maturation (very few bands/PMNs).
Lymphocytes:
Normal number and morphology
Plasma Cells:
Normal number and morphology
Biopsy and
clot section: No evidence of granuloma, fibrosis or abnormal cellular
infiltrates
Iron
content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x
2, 88313 x 2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
++++
Diagnosis
Peripheral Blood:
- Chronic myeloid
leukemia
Bone Marrow:
- Chronic myeloid
leukemia, in chronic phase
See comment
- Decreased iron stores
NDN/VJ 04/30/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Bone
marrow aspirate was sent for cytogenetics, CML-FISH panel, and quantitative PCR
for bcr/abl1
-Dr Rios
was notified of the diagnosis on 4/30/18
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: Bone marrow
Aspiration site: Iliac crest
Biopsy site: Iliac
crest
Histologic type:
Chronic myeloid leukemia, chronic phase
Immunophenotyping
Immunohistochemistry:
not performed
Flow cytometry:
Not performed
Cytogenetic studies:
Performed, see separate report
Specimen Source
1. Bone marrow clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure was performed by IR
Clinical Information
46 year-old
male with no significant PMHx who was admitted for concern for leukemia.
Patient initiall presentation was fever, chills,
malaise and productive cough. He was found to have leukocytosis from an outside
facility.
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin
and labeled clot is a red-brown portion of clotted blood measuring 1.0 x 0.3 x
0.1 cm. The clot is submitted in toto in
cassette 1A.
2. Received
in formalin and labeled core is a tan-red cylindrical core of bone measuring
1.9 cm in length and 0.2 cm in diameter.
The specimen is submitted in toto in cassette 2A after a brief
decalcification. PY/dw
04/27/
Peripheral Smear
Erythrocytes:
Normocytic normochromic anemia, mild anisocytosis, mild polychromasia
White cells: Marked
leukocytosis
Granulocytes: Neutrophilic
leukocytosis with left shift, basophilia and eosinophilia, a few blasts (2%)
Lymphocytes:
Unremarkable morphology
Monocytes: Unremarkable
morphology
Platelets:
CBC on
4/27/2018 at 10:18 CDT
CBC
Results:
WBC 189.2 K/CMM CRIT
RBC 3.89 M/CMM LOW
Hgb 10.8 g/dL LOW
Hct 34.7 % LOW
MCV 89.2 fL
MCH 27.8 pg
MCHC 31.2 g/dL LOW
RDW 16.4 % HI
MPV 9.1 fL
Platelet 293 K/CMM
Segs 69.0 %
Bands 4.0 %
Lymphocytes 1.0 % LOW
Atypical Lymphs 0.0
%
Monocytes 2.0 %
Eosinophils 1.0 %
Basophils 2.0 % HI
Metamyelocytes 6.0 % HI
Myelocytes 12.0 %
HI
Promyelocytes 1.0 % HI
Blasts 2.0 %
HI
Segs-Bands
# 138.1 K/CMM HI
Lymphocytes
# 1.9 K/CMM
Monocytes
# 3.8 K/CMM HI
Eosinophils
# 1.9 K/CMM
HI
Basophils
# 3.8 K/CMM
HI
Plt
Morph
Microscopic Description
Bone marrow
Differential (%)
Myeloblasts: 2%
Promyelocytes: 4%
Myelocytes: 15%
Metas: 16%
Bands& PMN's: 58%
Eos: 3%
Baso: 2%
Monos: 0%
Lymphs: 1%
Plasma cells: 0%
Erythroids: 1%
M:E ratio: 98:1
Cellularity: 95%
Megakaryopoiesis: Increased,
many megakaryocytes are small with hypolobated nuclei
Erythropoiesis:
Markedly reduced, unremarkable morphology
Iron Content
(aspirate): Decreased iron stores
Granulopoiesis:
Markedly increased with left shift, increased eosinophils and basophils,
Lymphocytes: Reduced in
number, unremarkable morphology
Biopsy and clot
section: Hypercellular with high M/E ration, many
small megakaryocytes with hypolobated nuclei
Iron content (biopsy
and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls and internal negative controls for the special stains have been reviewed, and appropriate staining is confirmed by the pathologist whose signature appears above.
Teaching Physician Statement
I have personally
reviewed the test results and concur with the resident's interpretation.
++++++++++++++++
Diagnosis
Peripheral Blood:
- Pancytopenia
Bone Marrow:
- Normocellular for age
(60%)
- Hemophagocytosis
identified, see comment
- No evidence of
malignancy
- Adequate iron stores
NDN/DMS 05/01/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
A moderate number of
histiocytes in bone marrow are found with hemophagocytosis.
The following findings in this patient support the diagnosis of Hemophagocytic Lymphohistiocytosis (HLH): pancytopenia, fever, markedly elevatd ferritin
Dr Kaysal was notified of the fiondings on 4/30/18
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure was performed by IR
Clinical Information
43 year old
male with a PMH significant for pancytopenia and CNS vasculitis with concern
for HLH.
Gross Description
The
specimen is received in two parts each labeled with the patient's name and
medical record number.
1. Received in formalin
in a container labeled with the patient's name and bone marrow clot on the requisition
is two red-brown gelatinous portions of clotted blood ranging from 0.8 x 0.8 x
0.1 cm to 1.5 x 1.1 x 1.0 cm. The larger
clot is serially cross sectioned to reveal red-brown gelatinous cut
surfaces. The clot is submitted in its entirety in cassette 1A.
2. Received in
formalin in a container labeled with the patient's name and bone marrow core on the requisition
is a tan-red cylindrical core of bone measuring 2.6 cm in length and 0.2
cm in diameter. The
specimen is submitted in toto in cassette 2A
after a brief decalcification.
PY/myf
05/01/
Peripheral Smear
CBC result (4/30/2018)
WBC 1.8 K/CMM LOW
RBC 3.33 M/CMM LOW
Hgb 9.8 g/dL CRIT
Hct 29.6 % LOW
MCV 88.9 fL
MCH 29.5 pg
MCHC 33.2 g/dL
RDW 16.7 % HI
Platelet 56 K/CMM LOW
MPV 10.0 fL
Segs 85.6 %
Lymphocytes 5.9 % LOW
Monocytes 4.9 %
Basophils 0.5 %
Segs-Bands # 1.5
K/CMM
Lymphocytes # 0.1 K/CMM
LOW
Monocytes # 0.1 K/CMM
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normocytic hypochromic anemia with anisopoikilocytosis,
minimal polychromasia
White cells: Decreased
in number
Granulocytes: Left
shift with bandemia
Lymphocytes:
Monocytes:
Platelets: Decreased in
number with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 0%
Promyelocytes: 1%
Myelocytes: 6%
Metas: 4%
Bands & PMN's: 62%
Eos: 3%
Baso: 0%
Monos: 4%
Lymphs: 8%
Plasma cells:0%
Erythroids: 12%
M:E ratio 7:1
Cellularity: 60%,
normocellular for age
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Adequate with normal maturation.
Iron Content
(aspirate): Adequate iron stores
Granulopoiesis:
Adequate with normal maturation, no increase in blasts
Lymphocytes:
Biopsy and clot
section: No evidence of granuloma, fibrosis or abnormal cellular infiltrates
Others: A moderate
number of histiocytes with phagocytosis are seen in aspirate and biopsy
Iron content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls and internal negative controls for the special stains have been reviewed, and appropriate staining is confirmed by the pathologist whose signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
+++++++++++++
Diagnosis
Peripheral Blood:
- Hypochromic normocytic
anemia
Bone marrow:
- Hypocellular for age
(40%)
- No evidence of
residual leukemic promyelocytes or leukemic myeloblasts, see comment
- Decreased iron stores
NDN/DMS 05/02/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of aspirate by flow
cytometry (report HF-
-Bone
marrow aspirate was sent for cytogenetics, FLT3 mutation, and PML/RARA by quantitativePCR
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure was performed by IR
Clinical Information
36 y/o male with a hx
of APL (diagnosed in 1/2018), postive FLT3 mutation,
s/p chemotherapy. The most recent bone marrow (4/2018) was negative for
cytogenetics, AML FISH panel and PCR for PML/RARA.
Gross Description
The specimen is
received in two parts each labeled with the patient's name and medical record
number.
Part 1 received in
formalin and labeled "clot" is a red-brown gelatinous portion of
clotted blood measuring 2.0 x 1.0 x 0.5 cm.
The clot is serially cross sectioned to reveal a red-brown gelatinous
cut surface. The clot is submitted in its entirety in cassette 1A.
Part 2 received in
formalin and labeled "core" is a red-brown cylindrical core of bone
measuring 2.0 cm in length and 0.2 cm in diameter. The bone is submitted in its entirety in
cassette 2A after a brief decalcification.
PY/ddw
05/01/
2 blocks, 2 H&E
Peripheral Smear
Date:
5/1/2018
WBC 9.2 K/CMM
RBC 4.52 M/CMM LOW
Hgb 12.6 g/dL LOW
Hct 36.9 % LOW
MCV 81.7 fL
MCH 27.8 pg
MCHC 34.1 g/dL
RDW 15.6 % HI
Platelet 376 K/CMM
MPV 8.7 fL
Segs 66.8 %
Lymphocytes 20.4 %
Monocytes 9.3 %
Eosinophils 2.4 %
Basophils 1.1 % HI
Segs-Bands # 6.2 K/CMM
LOW
Lymphocytes # 1.9 K/CMM
Monocytes # 0.9 K/CMM
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normocytic hypochromic anemia, slight polychromasia
White cells:
Granulocytes:
Lymphocytes:
Monocytes:
Platelets:
Bone marrow
Differential (%)
Myeloblasts: 1%
Promyelocytes: 2%
Myelocytes: 13%
Metas: 2%
Bands& PMN's: 30%
Eos: 4%
Baso: 0%
Monos: 4%
Lymphs: 13%
Plasma cells: 1%
Erythroids: 30%
M:E ratio: 1.9
Cellularity: 40%
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Adequate with normal maturation
Iron Content
(aspirate): Decreased iron stores
Granulopoiesis:
Adequate with normal maturation; no leukemic promyelocytes seen; no increase in
blasts
Lymphocytes:
Biopsy and clot
section: Hypocellular with no abnormal cellular infiltrates
Iron content (biopsy
and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
++++++++++++++
Diagnosis
Peripheral Blood:
- Hypochromic
normocytic anemia.
- Moderate leukocytosis
with left shift.
- Marked
thrombocytosis.
Bone Marrow:
- Essential
thrombocythemia, see comment
- Increased iron stores
NDN/DMS 05/02/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-The
morphologic findings in peripheral blood, bone marrow and positive JAK2 V617F
are supprtive of essential thrombocythemia.
-Bone
marrow biopsy was sent for cytogenetics, MPN FISH panel, and MPN molecular
profile (NGS).
- Dr Idowu
was notified of the findings on 5/2/18
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: Bone marrow
Aspiration site: R
posterior iliac crest
Biopsy site: R
posterior iliac crest
Histologic type:
essential thrombocythemia
Immunophenotyping
Immunohistochemistry:
not performed
Flow cytometry:
not performed
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core biopsy,
decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure was performed by IR
Clinical Information
50 year old male with
JAK2 mutation and thrombocytosis (platelet count
Gross Description
The specimen is received
in two parts each labeled with the patient's name and medical record number.
Part 1 received in
formalin and labeled "clot" is a red-brown gelatinous portion of
clotted blood measuring 1.5 x 1.0 x 0.4 cm.
The clot is serially cross sectioned to reveal a red-brown gelatinous
cut surface. The clot is submitted in its entirety in cassette 1A.
Part 2 received in formalin and labeled "core" is a tan-brown
cylindrical core of bone measuring 2.6 cm in length and 0.2 cm in
diameter. The specimen is submitted in
toto in cassette 2A after a brief decalcification. PY/ddw 05/01/
2 blocks, 2 H&E
Microscopic Description
Date/time: 5/1/2018
CBC Results:
WBC 25.1 K/CMM HI
RBC 3.14 M/CMM LOW
Hgb 8.8 g/dL LOW
Hct 26.9 % LOW
MCV 85.9 fL
MCH 28.0 pg
MCHC 32.6 g/dL
RDW 14.6 % HI
MPV 8.7 fL
Platelet 851 K/CMM CRIT
Segs 73.1 %
Lymphocytes 14.2 % LOW
Monocytes 9.3 %
Eosinophils 2.6 %
Basophils 0.8 %
Segs-Bands # 18.4 K/CMM
HI
Lymphocytes # 3.6 K/CMM
Monocytes # 2.3 K/CMM
HI
Eosinophils # 0.6 K/CMM
HI
Basoophils # 0.2 K/CMM
Retic Auto 2.1 % HI
PERIPHERAL BLOOD:
Erythrocytes:
Normocytic, hypochromic anemia with anisocytosis, mild polychromasia.
White cells: Increased
in number, no blasts seen
Granulocytes: Many band
forms
Lymphocytes:
Monocytes: Increased
with normal morphology
Platelets: Markedly
increased in number.
Bone marrow:
Differential (%)
Myeloblasts: 0
Promyelocytes: 2
Myelocytes: 17
Metas: 5
Bands& PMN's: 49
Eos: 3
Baso: 0
Monos: 2
Lymphs: 5
Plasma cells: 0
Erythroids: 17
Cellularity: 60%,
hypercellular for age
Megakaryopoiesis: Increased
with enlarged and mature megakaryocytes.
Erythropoiesis:
Adequate with normal maturation, no dysplasia
Iron Content
(aspirate): Increased iron stores
Granulopoiesis:
Adequate with normal maturation, no increase in blasts
Lymphocytes:
Biopsy and clot
section: Hypercellular with many enlarged and mature megakaryocytes.
Iron content (biopsy): Increased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls and internal negative controls for the special stains have been reviewed, and appropriate staining is confirmed by the pathologist whose signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
+++++++++++++
30. Neutropenia due to arrest of
granulocytic maturation
Diagnosis
Peripheral
blood:
-Neutropenia
-Thrombocytopenia
Bone
marrow:
-Normocellular
for age (70%)
-Arrest of
granulocytic maturation, see comment
-Adequate
iron stores
NDN/VJ 05/04/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Arrest of
granulocytic maturation is seen in bone marrow granulocytes. This is likely the
etiology of neutropenia. Effect of medication is a consideration. Clinical
correlation is suggested.
-Bone
marrow aspirate was sent for cytogenetics, and MDS FISH panel.
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure was performed by IR
Clinical Information
34 y/o
female with GERD, HTN, CAD, cardiac arrest, was on ECMO, on hemodialysis for
AKI, neutropenia of unknown etiology
Gross Description
The
specimen is received in two parts each labeled with the patient's name and
medical record number.
1. Received in formalin
in a container labeled with the patient's name and bone marrow clot on the requisition
is a red-brown gelatinous portion of clotted blood measuring 1.7 x 1.0 x
0.8 cm which is serially sectioned to reveal a
red-brown gelatinous cut surface.
The specimen is submitted in its entirety in
cassettes 1A-1B.
2. Received in
formalin and labeled with the patient's name and bone
marrow core biopsy on the requisition are three red-brown cylindrical
cores of bone ranging from 0.2 to 0.8 cm in length and 0.2 cm in diameter. The specimen is submitted
in toto in cassette 2A after a brief decalcification. PY/myf 05/04/
Peripheral Smear
CBC Results
Date:5/3/18
CBC
Results:
WBC 0.7 K/CMM CRIT
RBC 5.06 M/CMM
Hgb 13.9 g/dL
Hct 41.4 %
MCV 81.9 fL
MCH 27.6 pg
MCHC 33.7 g/dL
RDW 15.6 % HI
MPV 8.5 fL
Platelet 93 K/CMM
LOW
Segs xxxxxxx
Lymphocytes See Note
Monocytes xxxxxxx
Eosinophils xxxxxxx
Segs-Bands
# xxxxxxx
Lymphocytes
# xxxxxxx
Monocytes
# xxxxxxx
Eosinophils
# xxxxxxx
RBC
Morph
Retic
Auto 3.5 % HI
Microscopic Description
Erythrocytes:
Normochromic normochromic RBCs, no increase in schistocytes
seen.
White cells: Decreased
in number
Granulocytes:
Neutropenia with few reactive PMN's
Lymphocytes:
Monocytes:
Platelets: Decreased in
number, no clumps seen
Differential (%)
Myeloblasts: 1%
Promyelocytes: 1%
Myelocytes: 17%
Metas: 12%
Bands& PMN's: 4%
Eos: 1%
Baso: 0
Monos: 3
Lymphs: 13
Plasma cells: 1
Erythroids: 47
M:E ratio: 0.8:1
Cellularity: 70%,
normocellular
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Increased with normal maturation
Iron Content
(aspirate): Adequate iron stores
Granulopoiesis: Arrest
of maturation; no increase in blasts
Lymphocytes:
Plasma cells:
Biopsy and clot
section: No evidence of granuloma, fibrosis or abnormal cellular infiltrates
Iron content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls and internal negative controls for the special stains have been reviewed, and appropriate staining is confirmed by the pathologist whose signature appears above.
Teaching Physician Statement
"I have personally reviewed the resident's preliminary interpretation and all specimen preparations and have personally issued this report".
+++++
Diagnosis
Peripheral Blood:
- Normochromic hypochromic anemia
- Thrombocytopenia
- Monocytosis with
no circulating blasts
Bone Marrow:
- Chronic Myelomonocytic Leukemia -2
- Decreased iron stores
NDN/VJ 05/08/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-
-Bone marrow aspirate
was sent for cytogenetics, FISH panel for MPN, and NGS- MPN targeted molecular
profile
- Findings were
discussed with Dr A Rios and Dr Z Kanaan on 5/8/2018
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: Iliac crest
Biopsy site: Iliac crest
Histologic type: Chronic Myelomonocytic Leukemia -2
Immunophenotyping
Immunohistochemistry: Not performed
Flow cytometry:
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
74 year old
male with chronic monocytosis and thrombocytopenia.
Gross Description
The specimen
is received in two parts each labeled with the patient's name and medical
record number.
Part 1
received in formalin and labeled "clot" is a red-brown gelatinous
portion of clotted blood measuring 7.5 x 1.0 x 0.6 cm. The clot is serially cross sectioned to
reveal a red-brown gelatinous cut surface.
The clot is submitted in its entirety in cassette 1A.
Part 2
received in formalin and labeled "core" is a red-brown cylindrical
core of bone measuring 1.4 cm in length and 0.2 cm in diameter. The specimen is submitted in toto in cassette
2A after brief decalcification. PY/ddw 05/04/
Peripheral Smear
CBC Results
Date/time: 5/4/18,
13:44 CDT
CBC
Results:
WBC 7.3 K/CMM
RBC 3.46 M/CMM LOW
Hgb 8.8 g/dL
LOW
Hct 27.8 %
LOW
MCV 80.2 fL
MCH 25.4 pg LOW
MCHC 31.6 g/dL LOW
RDW 17.9 % HI
MPV 10.0 fL
Platelet 70 K/CMM LOW
Segs 50.9 %
Lymphocytes 11.9 % LOW
Monocytes 36.6 % HI
Eosinophils 0.3 %
Basophils 0.3 %
Segs-Bands
# 3.7 K/CMM
Lymphocytes
# 0.9 K/CMM LOW
Monocytes
# 2.7 K/CMM HI
Anisocyte 1+
Hypochrom 1+
Retic
Auto 2.1
% HI
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic
hypochromic anemia with slight polychromasia
White cells:
Granulocytes:
Lymphocytes:
Monocytes: Increased, with normal
morphology
Platelets: Decreased, with normal morphology. No platelet clumps are seen
Bone Marrow
Differential (%)
Blasts: 11
Promyelocytes: 02
Myelocytes: 09
Metas: 07
Bands & PMN's: 22
Eos: 01
Baso: 00
Monos: 13
Lymphs: 06
Plasma cells: 01
Erythroids: 28
M:E ratio: 2.3:1
Cellularity: 95%, hypercellular for age
Megakaryopoiesis: Increased
with normal maturation
Erythropoiesis:
Adequate with normal maturation
Iron Content (aspirate): Decreased iron
stores
Granulopoiesis:
Increased in monocytes (13%) and blasts (11%)
Lymphocytes:
Plasma Cells:
Biopsy and clot
section: Increase in monocytes and blasts
Iron content (biopsy and
clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report".
+++++
32. Non IgM MGUS vs. Plasma cell myeloma,
Negative Congo Red for Amyloid
Diagnosis
Peripheral Blood:
- Normochromic normochromic
RBCs
- Neutrophilia
Bone Marrow:
-
Normocellular for age (40%)
- Presence
of 5% monoclonal plasma cells in bone marrow, see comment
-
Negative for amyloid deposit by Congo Red stain
- A
small benign lymphoid aggregate in clot section
-
Adequate iron stores
NDN/MDA 05/11/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-
- Immunohistochemical stains, with adequate
controls, are performed on biopsy for CD138. The stain show 5% of plasma cells
in bone marrow (positive for CD138); some plasma cells in small clusters.
- The overall findings
in bone marrow are supportive of a plasma cell dyscrasia which may include non
IgM monoclonal gammopathy of undetermined significance (MGUS) and plasma cell
myeloma, mostly dependent on clinical symptoms/findings (CRAB criteria).
Clinical correlation is suggested.
- Congo Red red, with adequate control, is performed on biopsy which
shows negative expression of amyloid using polarized light.
-Bone marrow aspirate
was sent for cytogenetics, FISH panel for multiple myeloma
Tumor Summary
-
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
63 year-old
male with PMHx significant for HTN, biventricular heart failure, and pulmonary
hypertension with recent diagnosis of amyloidosis (soft tissue abdominal
biopsy; 5/08/18) and MRI showing increased myocardial wall thickness suggestive
of infiltrative/inflammatory process.
Gross Description
The
specimen is received in two parts each labeled with the patient's name and
medical record number.
Part 1 received
in formalin and labeled "clot" is a red-brown gelatinous portion of
clotted blood measuring 1.2 x 1.2 x 0.8 cm.
The clot is serially cross sectioned to reveal a red-brown gelatinous
cut surface. The specimen is submitted
in its entirety in cassette 1A.
Part 2
received in formalin and labeled "core" are three tan-red hard portions
of bone ranging from 0.2 x 0.1 x 0.1 cm to 0.4 x 0.2 x 0.2 cm. The specimen is submitted in toto in cassette
2A after a brief decalcification. PY/ddw 05/09/
2 blocks, 2
H&E, 1 decal
Peripheral Smear
CBC Results
Date/time: 5/9/2018 at
03:13
CBC
Results:
WBC 13.6 K/CMM HI
RBC 4.51 M/CMM LOW
Hgb 14.4 g/dL
Hct 42.7 %
MCV 94.7 fL HI
MCH 32.0 pg HI
MCHC 33.8 g/dL
RDW 15.7 % HI
MPV 8.5 fL
Platelet 196
K/CMM
Segs 86.1 % HI
Lymphocytes 8.6 % LOW
Monocytes 4.8 %
Basophils 0.5 %
Segs-Bands
# 11.7 K/CMM HI
Lymphocytes
# 1.2 K/CMM
Monocytes
# 0.7 K/CMM
Basophils #
0.1 K/CMM
Retic
Auto 1.2 %
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normochromic normchromic RBCs, mild polychromasia
White cells: Increased
in number, neutrophilic leukocytosis
Granulocytes: Increased in number
Lymphocytes:
Monocytes:
Platelets:
Bone marrow
Differential (%) on
aspirate
Myeloblasts: 0
Promyelocytes: 6
Myelocytes: 5
Metas: 4
Bands & PMN's: 32
Eos: 5
Baso: 0
Monos: 3
Lymphs: 9
Plasma cells: 5
Erythroids: 31
M:E ratio: 1.7
Cellularity: 40%, normocellular for age
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Adequate with normal maturation
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis:
Adequate with normal maturation
Lymphocytes:
Plasma Cells: Slightly
increased number (4%) with unremarkable morphology
Biopsy and clot
section: No evidence of granuloma, fibrosis or sheets of plasma cells. A small
benign lymphoid aggregate is seen in clot section. The lymphocytes in clot section
have small nuclei with normal morphology.
Iron content (biopsy
and clot section):
Adequate iron stores
Non Clinical Documentation
CPT: 88305 x 2, 88313 x
2, 88311, 85097, 85060, 88342, 88312
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Some of
the immunohistochemical tests in this panel were developed and their
performance characteristics determined by Memorial Hermann Southwest Hospital
Laboratory. They have not been cleared or approved by the U. S. Food
and Drug Administration. The FDA has determined that such clearance
or approval is not necessary. These tests are used for clinical
purposes. They should not be regarded as investigational or for
research. This laboratory is regulated under the Clinical Laboratory
Improvement Amendments of the 1988 (CLIA) as qualified to perform high
complexity clinical testing.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report".
+++++
33. Hypocellular bone marrow with cytopenia
Diagnosis
Peripheral Blood:
- Hypochromic
normocytic anemia
- Leukopenia with
neutropenia
Bone Marrow:
-
Hypocellular for age (40%), see comment
- No
morphologic evidence of malignancy
-
Decreased iron stores
NDN/MDA 05/11/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-No evidence of malignancy is seen in bone marrow. The findings in peripheral blood and bone marrow are most supportive of cytopenia due to hypocellular bone marrow. Etiologies may include medication, viral infection, and immune disorders. Clincal correlation is suggested.
-Bone marrow aspirate
was sent for cytogenetics, FISH panel for MDS
Tumor Summary
-
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
21 year-old
male with PMHx significant for NICM and cardiogenic shock, admitted for bone
marrow biopsy as part of leukopenia work up prior to tranplant
Gross Description
The
specimen is received in two parts each labeled with the patient's name and medical
record number.
Part 1
received in formalin in a container labeled with the patient's name and
"bone marrow aspiration clot" on the requisition is a red-brown
gelatinous portion of clotted blood measuring 1.5 x 1.3 x 1.0 cm. The clot is
serially cross sectioned to reveal a red-brown gelatinous cut surface. The
specimen is submitted in its entirety in cassette 1A.
Part 2
received in formalin in a container labeled with the patient's name and
"bone marrow biopsy" on the requisition is a red-brown cylindrical
core of bone measuring 2.3 cm in length and 0.2 cm in diameter. The specimen is
submitted in toto in cassette 2A after a brief decalcification. PY/ddw 05/10/
2 blocks, 2
H&E, 1 decal
Peripheral Smear
CBC
Results:
WBC 2.8 K/CMM LOW
RBC 4.35 M/CMM LOW
Hgb 13.1 g/dL LOW
Hct 38.8 % LOW
MCV 89.3 fL
MCH 30.2 pg
MCHC 33.8 g/dL
RDW 16.0 % HI
MPV 8.2 fL
Platelet 133 K/CMM
Segs 45.6 %
Lymphocytes 44.3 % HI
Monocytes 7.2 %
Eosinophils 2.6 %
Basophils 0.3 %
Segs-Bands
# 1.3 K/CMM LOW
Lymphocytes
# 1.2 K/CMM
Monocytes
# 0.2 K/CMM
Eosinophils
# 0.1 K/CMM
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Mild
hypochromic normocytic anemia, mild polychromasia
White cells: Decreased
in number
Granulocytes: Decreased in number,
normal morphology
Lymphocytes:
Monocytes:
Platelets:
Bone marrow
Differential (%) from
aspirate
Myeloblasts: 0
Promyelocytes: 5
Myelocytes: 13
Metas: 10
Bands & PMN's: 23
Eos: 2
Baso: 0
Monos: 1
Lymphs: 8
Plasma cells: 2
Erythroids: 36
M:E ratio: 1.5
Cellularity: 40%, hypocellular for age
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Decreased with normal maturation; no dysplasia seen
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis:
Decreased in number, left shift with mild arrest of maturation, no increase in
blasts
Lymphocytes:
Plasma Cells:
Biopsy and clot section:
No evidence of granuloma, fibrosis or abnormal cellular infiltrates
Iron content (biopsy
and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive
controls and internal negative controls for the special stains have been reviewed,
and appropriate staining is confirmed by the pathologist whose signature
appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen preparations
and have personally issued this report".
++++
34. IgM monoclonal gammopathy
of undetermined significance (MGUS), no BM involvement
Diagnosis
Peripheral blood:
- Normocytic
normochromic anemia
Bone marrow:
- Normocellular for age
(30%)
- No evidence of
monoclonal B cells or monoclonal plasma cells, see comment
- Decreased iron stores
NDN/FGA 06/15/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF18-312) shows a T cell
population with no aberrant loss or aberrant expression of T cell markers, a B
cell population that is negative for CD5, CD10, also no surface light-chain
restriction. Plasma cells account for less than 2% of the cells analyzed and
show no evidence of cytoplasmic light chain restriction. These results indicate
no evidence of monoclonal B cells or monoclonal plasma cells by flow cytometry.
- The finding of
IgM/lambda monoclonal gammopathy by serum immunofixation is most supportive of
IgM monoclonal gammopathy of undetermined significance (MGUS). Clinical
correlation is suggested.
-Bone marrow aspirate
was sent for chromosome analysis, PCR for MYD88, and FISH panel for multiple
myeloma
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure was performed by IR
Clinical Information
78 year old
female with monoclonal gammopathy, IgM-lambda isotype
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin
in a container labeled with the patient's name and "bone marrow clot" on the requisition is a red-brown, gelatinous portion of
clotted blood measuring 2.0 x 1.3 and ranging in thickness from 0.1 to
1.0 cm. The clot is serially cross
sectioned to reveal a red-brown, gelatinous cut surface. The specimen is submitted
in its entirety in cassette 1A.
2. Received in formalin
in a container labeled with the patient's name and
"bone marrow core biopsy" on the
requisition is a red-brown, cylindrical core of bone measuring 2.1 cm in
length and 0.2 cm in diameter. The
specimen is submitted in toto in cassette 2A after a
brief decalcification. PY/dcr 06/14/2018 17:02
Peripheral Smear
(CBC
results on 6/14/2018)
CBC Results:
WBC 6.2 K/CMM Normal
RBC 3.56 M/CMM LOW
Hgb 10.7 g/dL LOW
Hct 32.2 % LOW
MCV 90.4 fL Normal
MCH 30.0 pg Normal
MCHC 33.2 g/dL Normal
RDW 14.6 % HI
MPV 9.0 fL Normal
Platelet 183 K/CMM Normal
Segs 53.0 % Normal
Bands 0.0 % Normal
Lymphocytes 35.0 % Normal
Atypical Lymphs 0.0
% Normal
Monocytes 7.0 % Normal
Eosinophils 4.0 % Normal
Metamyelocytes 1.0 % Normal
Segs-Bands
# 3.3 K/CMM Normal
Lymphocytes
# 2.2 K/CMM Normal
Monocytes
# 0.4 K/CMM Normal
Eosinophils
# 0.2 K/CMM Normal
RBC
Morph Normal
Plt
Morph See Note
Retic
Auto 1.0 % Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
normocytic normochromic anemia with mild anisocytosis, and mild polychromasia
White cells: Adequate
in number
Granulocytes: Normal
morphology
Lymphocytes: Normal
morphology
Monocytes: Normal
morphology
Platelets: Adequate in
number with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 3
Myelocytes: 5
Metas: 6
Bands& PMN's: 36
Eos: 3
Baso: 0
Monos: 0
Lymphs: 8
Plasma cells: 2
Erythroids: 37
Other: M:E ratio 1.43
Cellularity: 30%,
normocellular for age
Megakaryopoiesis: Adequate,
with normal maturation
Erythropoiesis:
Increased with normal maturation
Iron Content
(aspirate): Decreased iron stores
Granulopoiesis: Adequate
with normal maturation
Lymphocytes: Normal
number and morphology
Plasma cells: Normal
number and morphology
Biopsy and clot
section: No evidence of lymphoid aggregates or large clusters of plasma cells
Iron content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
+++++
35. Lymphoplasmacytic lymphoma
Diagnosis
Peripheral blood:
- Normocytic
hypochromic anemia with rouleaux formation
Bone marrow:
- Normocellular for age
(30%)
- Lymphoplasmacytic
lymphoma, see comment
- Decreased iron stores
NDN/DCR 06/18/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Immunophenotyping of
leukocytes in bone marrow aspirate by flow cytometry (report HF-18-315) shows
an abnormal B cell population (about 60% of the lymphocytes analyzed, or 30% of
bone marrow cells) that is positive for CD19, CD20, CD22, FMC7, and surface
kappa light chain restriction. These B cells are negative for CD5, and CD10.
These B cells are small in nuclear size (based on forward-scatter signal).
Analysis of CD38-positive cells shows a small abnormal plasma cell population
with cytoplasmic kappa light-chain restriction. They are negative for CD56.
These results, together with morphological findings in bone marrow, are
consistent with lymphoplasmacytic lymphoma in this patient with a history of
macroglobulinemia. Clinical correlation is suggested.
-Bone marrow aspirate
was sent for chromosome analysis, PCR for MYD88, and FISH panel for multiple
myeloma
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: Bone marrow
Aspiration site: R
posterior iliac crest
Biopsy site: R
posterior iliac crest
Histologic type:
lymphoplasmacytic lymphoma
Immunophenotyping
Immunohistochemistry:
not performed
Flow cytometry:
Performed, see separate
report (HF-18-315)
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure was performed by IR
Clinical Information
78
year old male with Waldenstrom macroglobulinemia, K/L
ratio of 4.55
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin
and labeled "clot" is a red-brown portion of clotted blood measuring
1.3 x 1.0 x 0.8 cm. The clot is serially
cross sectioned to reveal a red-brown, gelatinous cut surface. The clot is submitted
in its entirety in cassette 1A
2. Received in
formalin labeled "core" are two red-brown,
cylindrical cores of bone measuring 0.4 and 1.8 cm in length and 0.2 cm
in diameter. The specimen is submitted in toto in cassette 2A after a brief decalcification. PY/dcr 06/15/2018
14:11
Peripheral Smear
(CBC
results on 6/15/2018)
CBC
Results:
WBC 3.9 K/CMM Normal
WBC 4.0 K/CMM Normal
RBC 2.62 M/CMM LOW
RBC 2.60 M/CMM LOW
Hgb 8.3 g/dL LOW
Hgb 8.2 g/dL LOW
Hct 24.5 % LOW
Hct 24.0 % LOW
MCV 93.5 fL Normal
MCV 92.4 fL Normal
MCH 31.6 pg HI
MCH 31.6 pg HI
MCHC 33.8 g/dL Normal
MCHC 34.2 g/dL Normal
RDW 16.2 % HI
RDW 15.9 % HI
MPV 7.6 fL Normal
MPV 8.1 fL Normal
Platelet 143 K/CMM Normal
Platelet 146 K/CMM Normal
Segs 60.8 % Normal
Lymphocytes 34.8 % Normal
Monocytes 3.7 % Normal
Eosinophils 0.4 % Normal
Basophils 0.3 % Normal
Segs-Bands
# 2.4 K/CMM Normal
Lymphocytes
# 1.4 K/CMM Normal
Monocytes
# 0.1 K/CMM Normal
RBC
Morph Normal
Plt
Morph Normal
Retic Auto 1.8 % HI
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
normocytic hypochromic anemia with rouleaux formation, mild anisocytosis and
mild polychromasia
White cells: Adequate
in number
Granulocytes: Normal
morphology
Lymphocytes: Normal
morphology
Monocytes: Normal
morphology
Platelets: Adequate in
number with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 0
Myelocytes: 2
Metas: 8
Bands& PMN's: 10
Eos: 5
Baso: 0
Monos: 0
Lymphs: 60
Plasma cells: 8
Erythroids: 7
Cellularity: 30%, normocellular
for age
Megakaryopoiesis: Adequate,
with normal maturation
Erythropoiesis: Decreased
with normal maturation
Iron Content
(aspirate): Decreased iron stores
Granulopoiesis:
Adequate, with normal maturation
Lymphocytes: Increased
in number with mature cytological features (with interstitial infiltrate
pattern in biopsy)
Plasma cells: Increased
with normal morphology
Biopsy and clot
section: Increased in lymphocytes and plasma cells with mature cytological features
(with interstitial infiltrate pattern in biopsy)
Iron content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
++++
36. Myelodysplastic syndrome with multi-
lineage dysplasia
Diagnosis
Peripheral Blood:
-Pancytopenia
Bone Marrow:
- Myelodysplastic
syndrome with multi- lineage dysplasia
- Increased iron stores
with no increase in ring-sideroblasts
- A small benign lymphoid
aggregate
NDN/JAA 06/19/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-18-318) in Gate 1 by flow
cytometry shows a T cell population (about 87% of the cells analyzed) with no
aberrant loss or aberrant expression of T cell markers, a B cell population
(about 9% of the cells analyzed) that is negative for CD5, CD10, no surface
light-chain restriction. The lymphocytes have small nuclear size (based on
forward-scatter signal). Analysis of the cells in the blast area (Gate 2) shows
fewer than 2% normal myeloblasts (of the bone marrow cells) that are positive
for CD13 and CD33. These results indicate no abnormal immunophenotypes with
flow cytometry.
-Bone marrow aspirate
was sent for cytogenetics, and FISH panel for MDS.
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: Bone marrow
Aspiration site: R
posterior iliac crest
Biopsy site: R
posterior iliac crest
Histologic type: MDS
with multi-lineage dysplasia
Immunophenotyping
Immunohistochemistry:
not performed
Flow cytometry:
Performed, see separate
report (HF-18-xx)
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure was performed by IR
Clinical Information
Preop
Diagnosis: MDS
Postop
Diagnosis: MDS
62
year old male with a history of MDS with complex karyotype, requiring frequent
transfusions and no longer responding to neupogen;
currently receiving Revlimid.
Gross Description
1. Received in formalin
labeled with the patient's name, mrn
and date of birth is a blood clot measuring 1.5 x 0.6 x 0.7 cm. The specimen is entirely
submitted in cassette 1A.
2. Received in formalin
labeled with the patient's name, medical record
number consists of two cylindrical core biopsies measuring 1.2 and 1.5 cm in
length and 0.2 cm in diameter. The
specimen is entirely submitted after a brief light decalcification. LZ/dcr 06/18/2018 16:47
Peripheral Smear
CBC
Results:
WBC 0.7 K/CMM CRIT
RBC 1.47 M/CMM LOW
Hgb 4.3 g/dL CRIT
Hct 13.0 % CRIT
MCV 88.1 fL Normal
MCH 29.6 pg Normal
MCHC 33.6 g/dL Normal
RDW 14.9 % HI
MPV 9.1 fL Normal
Platelet 18 K/CMM CRIT
Segs 10.4 % LOW
Lymphocytes 69.2 % HI
Monocytes 6.3 % Normal
Eosinophils 13.0 % HI
Basophils 1.1 % HI
Segs-Bands
# 0.1 K/CMM LOW
Lymphocytes
# 0.5 K/CMM LOW
Eosinophils
# 0.1 K/CMM Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normochromic normochromic anemia with anisopoikilocytosis, slight polychromasia
White cells: Markedly
decreased in number, without dysplasia. No circulating blasts present.
Granulocytes: Normal
morphology
Lymphocytes: Normal
morphology
Monocytes: Normal
morphology
Platelets: Markedly
decreased in number, with occasional large forms. No hypogranular
forms present.
Bone marrow
Differential (%)
Myeloblasts: 1%
Promyelocytes: 1%
Myelocytes: 1%
Metas: 1%
Bands & PMN's: 13%
Eos: 4%
Baso: 1%
Monos: 1%
Lymphs: 13%
Plasma cells: 0%
Erythroids: 64%
Cellularity: 60%,
hypercellular for age.
Megakaryopoiesis: Adequate,
more than 10% with dysplastic forms (hypolobated
nuclei or separate nuclear lobes)
Erythropoiesis: Increased,
with significant dysplasia present (numerous forms showing nuclear/cytoplasmic dyssynchrony, nuclear irregularity in contour and a few
forms showing cytoplasmic vacuolation).
Iron Content
(aspirate): Increased iron stores; no increase in ring-sideroblasts.
Granulopoiesis:
Decreased, with normal maturation; no increase in blasts
Lymphocytes: Normal
number and morphology.
Biopsy and clot
section: A single small lymphoid aggregate is present in the clot section. The
lymphocytes in the aggregate have small nuclei with mature cytology. No
evidence of granuloma, or fibrosis is seen.
Iron content (biopsy
and clot section): Increased iron stores, no increase in ring-sideroblasts.
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls and internal negative controls for the special stains have been reviewed, and appropriate staining is confirmed by the pathologist whose signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
++++
37. Non IgM MGUS with no monoclonal plasma
cells in bone marrow
Diagnosis
Peripheral Blood:
- Normochromic
hypochromic anemia
Bone Marrow:
- Normocellular for age
- No morphologic or
immunophenotypic evidence of plasma cell myeloma, see comment
- Adequate iron stores
NDN/FGA 06/21/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF18-322 ) shows a T cell population
(about 83% of the cells analyzed) with no aberrant loss or aberrant expression
of T cell markers, a B cell population (about 10% of the cells analyzed) that
is negative for CD5, CD10, no surface light-chain restriction. Plasma cells
account for less than 2% of the cells analyzed and show no evidence of
cytoplasmic light chain restriction. These results indicate no evidence of
monoclonal plasma cells by flow cytometry.
-The current findings
of serum IFE (with IgG-Lambda monoclonal gammopathy) are most supportive of
monoclonal gammopathy of undetermined significance (MGUS).
-Bone marrow aspirate was sent for cytogenetics, and FISH panel for multiple myeloma
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure was performed by IR
Clinical Information
63
year old male with a medical history of CKD stage V with possible monoclonal
gammopathy (SPE with M spike, serum IFE with IgG-Lambda monoclonal gammopathy,
constriction band in gamma region of UPE). Normal serum IgG, IgA, decreased
IgM, and normal K/L free light chain. Bone marrow biopsy to rule out myeloma.
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin
and labeled with the patient's name and bone marrow clot on requisition is a
red-brown gelatinous portion of blood measuring 1.3 x 1.2 x 1.0 cm. The clot is serially cross sectioned to
reveal a red-brown gelatinous cut surface.
The clot is submitted in its entirety in cassette 1A.
2. Received
in formalin and labeled with the patient's name and bone marrow biopsy on the
requisition is a red-brown cylindrical core of bone measuring 1.3 cm in
length and 0.2 cm in diameter. The
specimen is submitted in toto in cassette 2A after a
brief decalcification. PY/dw 06/19/2018 13:33
Peripheral Smear
(CBC
results on 6/19/2018)
CBC
Results:
WBC 6.0 K/CMM Normal
RBC 3.28 M/CMM LOW
Hgb 9.9 g/dL LOW
Hct 29.6 % LOW
MCV 90.3 fL Normal
MCH 30.1 pg Normal
MCHC 33.4 g/dL Normal
RDW 16.2 % HI
MPV 7.9 fL Normal
Platelet 245 K/CMM Normal
Segs 78.7 % HI
Lymphocytes 5.0 % LOW
Monocytes 14.3 % HI
Eosinophils 1.3 % Normal
Basophils 0.7 % Normal
Segs-Bands
# 4.8 K/CMM Normal
Lymphocytes
# 0.3 K/CMM LOW
Monocytes
# 0.9 K/CMM HI
Eosinophils
# 0.1 K/CMM Normal
Retic
Auto 0.6 % Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normocytic normochromic anemia with mild polychromasia; no rouleaux formation
seen
White cells: Normal in
number
Granulocytes: Normal in
number and morphology
Lymphocytes: Decreased
in number with normal morphology
Monocytes: Increased in
number with normal morphology
Platelets: Normal
number and morphology
Bone marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 2
Myelocytes: 13
Metas: 12
Bands & PMN's: 31
Eos: 7
Baso: 0
Monos: 0
Lymphs: 12
Plasma cells: 2
Erythroids: 21
M:E ratio 2.95
Cellularity: 40%,
normocellular for age
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Adequate with normal maturation
Iron Content (aspirate):
Adequate iron stores
Granulopoiesis:
Adequate with normal maturation
Lymphocytes: Normal
number and morphology
Plasma Cells: Normal
number and morphology
Biopsy and clot
section: No clusters of plasma cells seen
Iron content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
++++
Diagnosis
Peripheral blood:
- Hypchromic
normocytic anemia
- Mild leukopenia
Bone marrow:
- Presence of 40%
monoclonal plasma cells in bone marrow,
consistent with plasma cell myeloma,
see comment
- Congo Red stain is
negative for amyloid deposit in bone marrow
- Adequate iron stores
NDN/FGA 06/22/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-18-326) in gate #1 shows a T
cell population (about 72% of the lymphocytes analyzed) with no aberrant loss
or aberrant expression of T cell markers, a small B cell population (2% of the
lymphocytes analyzed). Analysis of cells gated for CD38 positivity shows a
large monoclonal plasma cell population that is positive for cytoplasmic lambda
light-chain restriction. These plasma cells are negative for CD19 and CD56.
These results, together with the finding of 40% plasma cells in bone marrow,
are consistent with plasma cell myeloma.
- Immunohistochemical
stains, with adequate controls, are performed on clot and biopsy for CD138. The
stains show 40% plasma cells in bone marrow (pos for CD138).
- Congo Red stain is
performed on clot and biopsy. The stain (under polarized light) show no
evidence of amyloid deposit
- Bone marrow aspirate was sent for cytogenetics, and myeloma FISH panel.
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: Bone marrow
Aspiration site: R
posterior iliac crest
Biopsy site: R
posterior iliac crest
Histologic type: plasma
cell myeloma
Immunophenotyping
Immunohistochemistry:
performed
Flow cytometry:
Performed, see separate report (HF-18-326)
Specimen Source
1. Bone marrow clot
2. Bone marrow core
biopsy, decal, touch prep
Peripheral blood smear
Bone marrow was obtained by IR
Clinical Information
59 year old
male with a medical history of multiple myeloma (diagnosed 2005). He was
admitted during that time for acute kidney injury. Renal biopsy showed tubulointerstitial
nephritis and immune complex glomerulonephritis. Subsequent bone marrow showed
10% plasma cell and concurrent SPEP and IFE showed monoclonal gammopathy
IgG-lambda isotype. The patient is noncompliant and refused treatment during
that time. He returned on May 2016 presenting with a submandibular mass, which
was excised and is positive for amyloidosis. The patient is undergoing bone
marrow biopsy to assess underlying disease and for treatment plan.
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin
and labeled "clot" are multiple red-brown portions of clotted blood
measuring 2.8 x 1.4 x 1.0 cm in aggregate.
The clot is serially cross sectioned to reveal a red-brown, gelatinous
cut surface. The clot is submitted in
its entirety in cassettes 1A
2. Received in formalin
labeled "core" are three red-brown,
cylindrical cores of bone, two measuring 0.8 cm in length and 0.2 cm in
diameter and one measuring 0.3 cm in length and 0.2 cm in diameter. The specimen is submitted in toto in cassette
2A after a brief decalcification.
Peripheral Smear
(CBC
results on 6/20/2018)
CBC
Results:
WBC 3.6 K/CMM LOW
RBC 4.27 M/CMM
LOW
Hgb 12.2 g/dL LOW
Hct 38.1 % LOW
MCV 89.1 fL Normal
MCH 28.5 pg Normal
MCHC 31.9 g/dL LOW
RDW 14.8 %
HI
MPV 9.4 fL Normal
Platelet 148 K/CMM Normal
Segs 67.7 % Normal
Lymphocytes 27.4 % Normal
Monocytes 3.2 % Normal
Eosinophils 1.3 %
Normal
Basophils 0.4 % Normal
Segs-Bands
# 2.4 K/CMM Normal
Lymphocytes
# 1.0 K/CMM Normal
Monocytes
# 0.1 K/CMM Normal
Retic
Auto 0.4 % LOW
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Hypochromic normocytic anemai with mild polychromasia
White cells: Mild
decrease in number
Granulocytes: Normal
number and morphology
Lymphocytes: Normal
number and morphology
Monocytes: Normal
number and morphology
Platelets: Normal
number and morphology
Bone marrow
Differential (%)
performed on touch prep
Myeloblasts: 1
Promyelocytes: 1
Myelocytes: 12
Metas: 15
Bands& PMN's: 41
Eos: 2
Baso: 0
Monos: 1
Lymphs: 9
Plasma cells: 18
Erythroids: 37
Other: M:E ratio 1.9
Cellularity: 30%
Aspirate: Inadequate
sample due to lack of spicules; a few plasma cells are seen
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Increased with normal maturation
Iron Content
(aspirate): Adequate iron stores
Granulopoiesis:
Adequate with normal maturation
Lymphocytes: Normal
number and morphology
Plasma cells: Increased
in number (18% in touch prep, 40% in biopsy and clot section with CD138 immunostain), most with mature cytology
Biopsy and clot
section: Clusters of plasma cells are seen
Iron content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT 88305 x 2, 88313 x
3, 88311, 85097, 85060, 88342, 88341
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Some of the immunohistochemical tests in this panel were developed and their performance characteristics determined by Memorial Hermann Southwest Hospital Laboratory. They have not been cleared or approved by the U. S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. These tests are used for clinical purposes. They should not be regarded as investigational or for research. This laboratory is regulated under the Clinical Laboratory Improvement Amendments of the 1988 (CLIA) as qualified to perform high complexity clinical testing.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
+++++
39. CD5-positive low grade B-cell proliferative
disorder
Diagnosis
Peripheral blood:
- CD5-positive low
grade B-cell proliferative disorder, see comment
Bone marrow:
- CD5-positive low grade
B-cell proliferative disorder, see comment
- Decreased iron stores.
NDN/FGA 06/22/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF18-327) shows an abnormal B
cell population (about 96% of the lymphocytes analyzed) that is positive for
CD5, CD19, CD20 (bright signal), CD22, FMC7, no surface light chain, and
negative for CD10, CD23. Cytoplasmic lambda light chain restriction is detected
for the abnormal B lymphocytes. The lymphocytes have small nuclear size (based
on forward-scatter signal).
- The immunophenotypical results are compatible with a
CD5-positive low grade B-cell proliferative disorder. Note that the expression
of FMC7, bright CD20, negative CD23 are not typical for a diagnosis of chronic
lymphocytic leukemia (CLL), therefore, mantle cell lymphoma (which typically
has expression of FMC7, bright CD20, negative CD23) can not
be ruled out. Cyclin D1 (bcl1) immunohistochemical stain is pending on bone
marrow biopsy to rule out mantle cell lymphoma. Result will be reported in
Addendum.
- Bone marrow aspirate
was sent for chromosome analysis, CLL FISH panel, and IgVH
hypermutation
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: Bone marrow
Aspiration site: R
posterior iliac crest
Biopsy site: R
posterior iliac crest
Histologic type: -CD5-positive
low grade B-cell proliferative disorder, see comment
Immunophenotyping
Immunohistochemistry:
not performed
Flow cytometry:
Performed, see separate
report
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood smear
Bone marrow procedure was performed by IR
Clinical Information
66 year old
female with a medical history of chronic lymphocytic leukemia (diagnosed in
July 2017) who is being followed by an outside oncologist. She has never
received treatment nor had a bone marrow biopsy done for confirmation. She had
received transfusions in the past and was recently diagnosed with bilateral
multifocal pneumonia after presenting with increasing shortness of breath and
fatigue.
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin
and labeled "bone marrow clot" is a red-brown, gelatinous portion of clotted
blood measuring 0.4 x 1.3 x 0.8 cm. The
clot is cross sectioned to reveal a red-brown, gelatinous cut surface. The clot is submitted in its entirety in cassette 1A.
2. Received in formalin
labeled "bone marrow biopsy" is a
red-brown, cylindrical core of bone measuring 1.1 cm in length and 0.2 cm in
diameter. The specimen is submitted in
toto in cassette 2A after a brief decalcification. PY/dcr
06/21/2018 17:06
Peripheral Smear
(CBC
results on 6/21/2018)
CBC
Results:
WBC 14.4 K/CMM HI
RBC 2.37 M/CMM LOW
Hgb 8.0 g/dL LOW
Hct 23.6 % LOW
MCV 99.8 fL HI
MCH 33.7 pg HI
MCHC 33.8
g/dL Normal
RDW 22.1 % HI
MPV 11.4 fL HI
Platelet 41 K/CMM LOW
Segs 3.4 % LOW
Lymphocytes 93.7 % HI
Monocytes 2.1 % Normal
Eosinophils 0.8 % Normal
Segs-Bands
# 0.5 K/CMM LOW
Lymphocytes
# 13.5 K/CMM HI
Monocytes
# 0.3 K/CMM Normal
Eosinophils
# 0.1 K/CMM Normal
Anisocyte 1+
Retic
Auto 1.0 % Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normocytic hypochromic anemia; mild polychromasia
White cells: Markedly
increased
Granulocytes: Decreased
with normal morphology
Lymphocytes: Markedly increased
with mature cytology, a few smudge cells seen
Monocytes: Normal number
and morphology
Platelets: Moderately
decreased with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 0
Myelocytes: 0
Metas: 0
Bands& PMN's: 0
Eos: 0
Baso: 0
Monos: 0
Lymphs: 98
Plasma cells: 0
Erythroids: 2
Cellularity: 90%
Megakaryopoiesis: Decreased
with normal maturation
Erythropoiesis:
Markedly decreased with normal maturation
Iron Content
(aspirate): Decreased iron stores
Granulopoiesis: Markedly
decreased
Lymphocytes: Marked
increase in leukemic lymphocytes with mature cytology
Biopsy and clot
section: Diffuse distribution of leukemic lymphocytes with mature cytology
Iron content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
88305 - GC x2, 88313 -
GC x2, 88311, 85097, 85060
The positive controls and internal negative controls for the special stains have been reviewed, and appropriate staining is confirmed by the pathologist whose signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
Addendum Diagnosis
Bone marrow:
- CD5-positive low
grade B-cell proliferative disorder
- Cyclin D1 (bcl1) is
negative, see comment
NDN/NDN 06/25/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
Immunohistochemical
stain Cyclin D1 (bcl1), with adequate control, was performed on bone marrow
biopsy. Cyclin D1 is negative for the lymphoma/leukemic lymphocytes. This finding
rules out mantle-cell lymphoma.
Finding was
reported to Dr Kanaan on 6/25/18
Some of the
immunohistochemical tests in this panel were developed and their performance
characteristics determined by Memorial Hermann Southwest Hospital Laboratory.
They have not been cleared or approved by the U. S. Food and Drug
Administration. The FDA has determined that such clearance or approval is not
necessary. These tests are used for clinical purposes. They should not be regarded
as investigational or for research. This laboratory is regulated under the
Clinical Laboratory Improvement Amendments of the 1988 (CLIA) as qualified to
perform high complexity clinical testing.
Non Clinical Documentation
CPT 88342
+++
40. Pancytopenia
with increased erythropoiesis and dyserythropoiesis
Diagnosis
Peripheral Blood:
- Pancytopenia
Bone Marrow:
- Normocellular for age
(40%)
- Increased
erythropoiesis with dyserythropoiesis, see comment
- Adequate iron stores
with no increase in ring-sideroblasts
NDN/JAA 06/22/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-18-328) in Gate 1 shows a T
cell population (about 69% of the cells analyzed) with no aberrant loss or
aberrant expression of T cell markers, a B cell population (about 3% of the
cells analyzed) that is negative for CD5, CD10, no surface light-chain
restriction. The lymphocytes have small nuclear size (based on forward-scatter
signal). Analysis of the cells in the blast area (Gate 2) shows fewer than 1%
blasts (of the bone marrow cells) that are positive for CD13 and CD33. These
results indicate no abnormal immunophenotypes with flow cytometry.
-Bone marrow aspirate
was sent for cytogenetics and FISH panel for MDS.
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
55 year old
male with a history of drug-induced ITP due to doxycycline, BKA due to MVA, and
CHF s/p orthotopic heart transplant (5/2018), now with pancytopenia in the
setting of immunosuppression.
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin
and labeled "bone marrow clot" is a red-brown gelatinous portion of
clotted blood measuring 1.4 x 1.3 x 1.1 cm.
The clot is serially cross sectioned to reveal a red-brown gelatinous
cut surface. The clot is submitted in
its entirety in cassette 1A.
2. Received
in formalin and labeled "bone marrow biopsy" are four red-brown
portions of bone ranging from 0.2 x 0.1 x 0.1 cm to 0.8 x 0.2 x 0.2 cm. The specimen is submitted in toto in cassette
2A after a brief decalcification. PY/dw 06/21/2018 17:08
Peripheral Smear
CBC
Results:
WBC 2.5 K/CMM LOW
RBC 2.55 M/CMM LOW
Hgb 8.1 g/dL LOW
Hct 23.9 % LOW
MCV 93.5 fL Normal
MCH 31.9 pg HI
MCHC 34.1 g/dL Normal
RDW 22.8 % HI
MPV 7.2 fL LOW
Platelet 90 K/CMM LOW
Segs 76.6 %
HI
Lymphocytes 12.8 %
LOW
Monocytes 7.2 %
Normal
Eosinophils 2.7 % Normal
Basophils 0.7 % Normal
Segs-Bands
# 1.9 K/CMM Normal
Lymphocytes
# 0.3
K/CMM LOW
Monocytes
# 0.2 K/CMM Normal
Eosinophils
# 0.1 K/CMM Normal
Retic
Auto 3.6 % HI
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Hypchromic normocytic anemia with anisopoikilocytosis,
moderate polychromasia
White cells: Decreased
in number
Granulocytes: Normal
morphology; no blasts seen
Lymphocytes: Decreased
in number, with normal morphology
Monocytes: Normal
morphology
Platelets: Decreased in
number, with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 2%
Promyelocytes: 5%
Myelocytes: 6%
Metas: 6%
Bands & PMN's: 17%
Eos: 1%
Baso: 0%
Monos: 1%
Lymphs: 4%
Plasma cells: 0%
Erythroids: 58%
M:E ratio: 0.64
Cellularity: 40%,
normocellular for age
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Increased, moderate number of normoblasts with dyspoietic
features, including nuclear/cytoplasmic dyssynchrony,
and nuclear irregular contour.
Iron Content
(aspirate): Adequate iron stores
with no increase in ring-sideroblasts
Granulopoiesis: Decreased,
with normal maturation, no increase in blasts
Lymphocytes: Decreased
number, with normal morphology
Biopsy and clot
section: No evidence of granuloma, fibrosis or abnormal cellular infiltrates
Iron content (biopsy
and clot section): Adequate iron stores
with no increase in ring-sideroblasts
Non Clinical Documentation
CPT 88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
++++
41. IgM
monoclonal gammopathy of undetermined significance (MGUS) with BM Involvement
Diagnosis
Peripheral blood:
- Normocytic
normochromic anemia
Bone marrow:
- Normocellular for age
(30%)
- Presence of 8%
monoclonal B lymphocytes and 2% monoclonal plasma cells, see comment
- Decreased iron stores
Comment
- Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF18- ) shows
- The current findings
are most supportive of IgM monoclonal gammopathy of undetermined significance
(MGUS). Clinical correlation is suggested.
-Bone marrow aspirate
was sent for chromosome analysis, PCR for MYD88, and FISH panel for multiple
myeloma
Tumor Summary
_
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure was performed by IR
Clinical Information
78 year old
female with monoclonal gammopathy, IgM-lambda isotype
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and medical
record number.
1. Received in formalin
in a container labeled with the patient's name and "bone marrow clot" on the requisition is a red-brown, gelatinous portion of
clotted blood measuring 2.0 x 1.3 and ranging in thickness from 0.1 to
1.0 cm. The clot is serially cross
sectioned to reveal a red-brown, gelatinous cut surface. The specimen is submitted
in its entirety in cassette 1A.
2. Received in formalin
in a container labeled with the patient's name and
"bone marrow core biopsy" on the requisition
is a red-brown, cylindrical core of bone measuring 2.1 cm in length and
0.2 cm in diameter. The specimen is submitted in toto in cassette 2A after a brief decalcification. PY/dcr 06/14/
Peripheral Smear
(CBC
results on 6/14/2018)
CBC Results:
WBC 6.2 K/CMM
RBC 3.56 M/CMM LOW
Hgb 10.7
g/dL LOW
Hct 32.2 % LOW
MCV 90.4 fL
MCH 30.0 pg
MCHC 33.2 g/dL
RDW 14.6 % HI
MPV 9.0 fL
Platelet 183
K/CMM
Segs 53.0
%
Bands 0.0 %
Lymphocytes 35.0 %
Atypical Lymphs 0.0 %
Monocytes 7.0
%
Eosinophils 4.0
%
Metamyelocytes 1.0
%
Segs-Bands # 3.3
K/CMM
Lymphocytes # 2.2
K/CMM
Monocytes # 0.4
K/CMM
Eosinophils # 0.2
K/CMM
RBC Morph
Plt Morph See Note
Retic Auto 1.0
%
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
normocytic normochromic anemia with mild anisocytosis, and mild polychromasia
White cells: Adequate
in number
Granulocytes:
Lymphocytes:
Monocytes:
Platelets: Adequate in
number with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 3
Myelocytes: 5
Metas: 6
Bands& PMN's: 36
Eos: 3
Baso: 0
Monos: 0
Lymphs: 8
Plasma cells: 2
Erythroids: 37
Other: M:E ratio 1.43
Cellularity: 30%, normocellular
for age
Megakaryopoiesis: Adequate,
with normal maturation
Erythropoiesis:
Increased with normal maturation
Iron Content
(aspirate): Decreased iron stores
Granulopoiesis:
Adequate with normal maturation
Lymphocytes:
Plasma cells:
Biopsy and clot
section: No evidence of lymphoid aggregates or large clusters of plasma cells
Iron content (biopsy and clot section): Decreased iron stores
Intradepartmental
Consultation
_
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
+++++
Diagnosis
Peripheral Blood:
- Pancytopenia
Bone Marrow:
- Myelofibrosis, see
comment
- Increased iron stores
NDN/VJ 04/13/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Reticulin and
Trichrome stains on biopsy show collagen fibrosis and reticulin fibrosis (grade
2 out of 3)
-Immunohistochemical
stains, with adequate controls, are performed on biopsy for CD34, CD117, MPO,
Factor VIII, and ECadherin. The MPO and Ecdherin stains show increase in granulocytes and decrease
in erythoids. CD34 shows less than 2% positive cells.
CD117 shows normal distribution of early granulocytes. FVIII stain shows normal
distribution of megakaryocytes.
-Diffuse myelofibrosis
is seen in biopsy which is the cause of pancytopenia and paucity of aspirate
cells. Primary myelofibosis or myelofibrosis due to
other pre-existing myeloproliferatibe neoplasms (P.
vera, CML, and essential thrombocythemia) are unlikely due to lack of prefibrotic presentations. The current peripheral blood
smear also shows no evidence of tear-drop cells, NRBCs or leukocyte left shift,
typical findings in myelofibrosis associated with MPNs. Acute panmyelosis with myelofibrosis is ruled out without
increase in myeloblasts. Other
etiologies are also unlikely: lymphoma (especially Hodgkin lymphoma), reneal osteodystrophy, metastatic carcinoma. The following etiolgies may be considered in this patient: viral infection,
auto immune disease such as SLE in this patient, among others. Clinical
correlation is suggested.
-Bone marrow was sent
for cytogenetics, and FISH panels for MDS and MPN, MPN molecular profile.
-Findings were
discussed with Dr. G .Segal and Dr Juneja on 4/12/18
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
39 year old
female with history of SLE, thrombocytopenia, anemia, encephalopathy, auto
immune hemolysis, PLEX for APLS. Bone
marrow for workup of pancytopenia.
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
MRN.
Part 1
received in formalin and labeled bone marrow is a red-brown gelatinous portion
of clotted blood measuring 2.8 x 1.1 x 0.8 cm. The clot is serially cross
sectioned to reveal a red-brown gelatinous cut surface. The clot is submitted in its entirety in cassettes
1A-1C.
Part 2
received in formalin and labeled bone marrow core is a red-brown cylindrical
core of bone measuring 2.1 cm in length and 0.2 cm in diameter. The specimen is
submitted entirely in cassette 2A after a brief decalcification. PY/kg
04/10/
Peripheral Smear
CBC Results:
WBC 1.6
K/CMM LOW
RBC 2.38
M/CMM LOW
Hgb 6.7
g/dL LOW
Hct 20.0 % LOW
MCV 84.0
fL HI
MCH 28.3
pg HI
MCHC 33.6 g/dL
RDW 16.0
% HI
Platelet 13
K/CMM LOW
MPV 10.7
fL HI
Segs 71
%
Lymphocytes
21.4 %
Monocytes 7.4%
Eosinophils 0.0
%
Basophils 0.2
%
Segs-Bands # 1.2 K/CMM LOW
Lymphocytes # 0.3 K/CMM LOW
Monocytes # 0.1 K/CMM
RBC Morph
Plt Morph
Retic Auto 0.0
% LOW
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normocytic hypochromic anemia, no polychromasia. NRBCs and tear-drop cells are
not seen
White cells: Markedly
decreased in number, normal morphology, no blasts seen
Granulocytes: Decreased
with normal morphology , no left shift seen
Lymphocytes: Decreased
with normal morphology
Monocytes: Decreased
with normal morphology
Platelets: Markedly
decreased with normal morphology
Bone marrow (100 cells
counted on touch prep)
Differential (%)
Myeloblasts: 0%
Promyelocytes: 0%
Myelocytes: 17%
Metas: 3%
Bands& PMN's: 52%
Eos: 0%
Baso: 0%
Monos: 5%
Lymphs: 22%
Plasma cells: 0%
Erythroids: 1%
Cellularity: 90%
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Decreased
Iron Content
(aspirate): Increased iron stores
Granulopoiesis:
Increased with no increase in blasts
Lymphocytes: Relatively
increased with normal morphology
Biopsy and clot
section: Diffuse myelofibrosis, no evidence of granuloma or clusters of imature cells
Iron content (biopsy
and clot section): Increased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
4, 88311, 85097, 85060, 88342, 88341 x4
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Some of the immunohistochemical tests in this panel were developed and their performance characteristics determined by Memorial Hermann Southwest Hospital Laboratory. They have not been cleared or approved by the U. S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. These tests are used for clinical purposes. They should not be regarded as investigational or for research. This laboratory is regulated under the Clinical Laboratory Improvement Amendments of the 1988 (CLIA) as qualified to perform high complexity clinical testing
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
++++
Diagnosis
Peripheral Blood:
Acute myeloid leukemia
Normocytic normochromic anemia
Thrombocytopenia
Bone Marrow:
Acute myeloid leukemia, 46% blasts
Increased iron stores
05/03/
NDN 05/03/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
peripheral blood leukocytes by flow cytometry (report HF-
- Bone marrow aspirate
was sent for ALM-FISH panel, cytogenetics, PCR testing for CEBPA, NPM1, C KIT,
and FLT3
-Bone marrow clot and
biopsy are pending (for processing). Results of clot and biopsy will be reported
in Addendum
-Clinical Hematology
team and Oncology team (Dr Rios) were notified of the diagnosis on 5/3/2017
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: bone marrow
Aspiration site: R post
iliac crest
Biopsy site:_R post iliac crest
Histologic type: _acute
myeloid leukemia
Immunophenotyping
Immunohistochemistry: not performed,
Flow cytometry: _
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow clot
2. Bone marrow biopsy,
decal, touch prep
Peripheral blood
Bone marrow was
obtained by IR
Clinical Information
21 year old female with
PMH of medulloblastoma s/p resection, chemotherapy and radiotherapy (2012).
Presented with worsening SOB and fatigue and blasts in peripheral smear
Gross Description
Received in Surgical
Pathology:
1. Bone marrow clot
2. Bone marrow biopsy
Peripheral Smear
CBC Results:
WBC 11.5 K/CMM HI
RBC 3.15 M/CMM LOW
Hgb 8.7 g/dL LOW
Hct 25.4 % LOW
MCV 80.7 fL
MCH 27.6 pg
MCHC 34.1 g/dL
RDW 15.3 % HI
Platelet 57 K/CMM LOW
MPV 11.1 fL HI
Segs 18.0 % LOW
Bands 0.0 %
Lymphocytes 33.0 %
Atypical Lymphs 0.0
%
Monocytes 16.0 % HI
Eosinophils 1.0 %
Metamyelocytes 1.0 %
Myelocytes 8.0 % HI
Blasts 22.0 % HI
Segs-Bands
# 2.1 K/CMM
Lymphocytes
# 3.8 K/CMM
Monocytes
# 1.8 K/CMM HI
Eosinophils
# 0.1 K/CMM
NRBC 38 /100WB NA
Anisocyte 1+
Plt
Morph
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic
normocytic anemia with slight polychromasia, rare NRBCs seen
White cells: Increased
in number
Granulocytes:
PMNs with
unremarkable morphology
Lymphocytes:
Monocytes: Increased in
number, 22% blasts seen,
Platelets: Decrease
in number with normal morphology
Bone
marrow
Differential (%)
Monoblasts and promonocytes:
46
Promyelocytes: 1
Myelocytes: 6
Metas: 2
Bands & PMN's: 6
Eos: 0
Baso: 0
Monos: 13
Lymphs: 10
Plasma cells: 2
Erythroids: 14
Cellularity: pending
biopsy and clot section processing
Megakaryopoiesis: Markedly decreased
in number
Erythropoiesis: Decrease
with normal maturation
Iron Content (aspirate): Increased
iron stores
Granulopoiesis: Increased
in monocytes; numerous monoblasts and promonocytes
Lymphocytes:
Plasma cells: A
few plasma cells seen with unremarkable morphology
Biopsy and clot section: pending
processing
Iron content (biopsy and clot section): pending biopsy and clot section processing
Non Clinical Documentation
CPT: 88313-GC , 85097-GC x 1, 85060-GC x 1
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
_
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
++++
44. AML (transformed from MPN/MDS)
Diagnosis
Peripheral
Blood:
Marked
leukocytosis with left shift and a few blasts
Normocytic anemia and
thrombocytopenia
Bone
Marrow:
Acute
myeloid leukemia, see comment
Decreased
iron stores
06/20/
NDN 06/21/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Immunophenotyping
of bone marrow aspirate by flow cytometry was not performed due to insufficient
quantity and clotted sample
-
Immunohistochemical stains, with adequate controls are performed on biopsy (2A)
for CD3, CD4, CD8, CD15, CD20, CD34, CD68, Ki67, MPO, and Pan Melanoma. The
malignant cells are positive for CD4, Ki67 (90%), CD15, and CD68. They are
negative for CD3, CD20, CD8, CD34, MPO, and Pan Melanoma
- Bone
marrow aspirate was sent for cytogenetics, MPN/MDS FISH panels, myeloid
molecular profile (NGS), PCR testing for FLT3, NPM1, Kit , MPL, CALR, and JAK2
-Reiculin and trichrome stains are pending on biopsy.
Results will be reported in Addendum.
-The
current findings are consistent with AML (acute myelomonocytic type)
transformed from MPN/MDS. Patient also presents in this admission with myeloid
sarcoma (R abdominal lymph node). Note that immunophenotyping of
right abdominal lymph node biopsy by flow cytometry (HF-17286) shows a predominant
monoblast population that is positive for CD33, CD38,
CD14, and CD11b. These blasts are negative for CD13, CD34, MPO, TdT, CD5, CD16, CD19, CD20, CD22, and CD117. These results
indicate myeloid sarcoma in this patient with AML (transformed from MPN/MDS)
-Dr Rios
and Kanaan were notifed of the results on 6/21/17
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: AML, NOS
Immunophenotyping
Immunohistochemistry: Performed
Flow cytometry:
Not performed (QNS)
Cytogenetic studies: Performed, see separate report
Not performed
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
Clinical
Information: 72 year old male with history of metastatic melanoma, also RCC;
patient with MDS/MPN (bone marrow 5/5/17 with normal MDS and MPN FISH panels,
mild stromal fibrosis, positive mutations of ASXL1, TETZ, USAF1, and BRAF
genes; normal cytogenetics)
Preoperative
Diagnosis: Suspected MDS/MPN
Postoperative
Diagnosis: Suspected MDS/MPN
Gross Description
The specimens are received in two containers of formalin
accompanied by a requisition form, both labeled with the patient's name and medical record
number.
1. Specimen
is designated on container and requisition as "BM clot". The specimen consists of a red-brown,
aggregate of blood clot material, measuring 1.5 x 1.0 x 0.3 cm. The specimen is submitted entirely in
cassette 1A.
2. Specimen
is designated on container and requisition as "BM biopsy". The specimen consists of a pink-tan,
trabeculated, bony needle core biopsy, measuring 2.3 cm in length x 0.2 cm in
diameter. The specimen is decalcified
and submitted entirely in cassette 2A.
CC/jjj
06/20/
Peripheral Smear
CBC
Results:
WBC 41.9 K/CMM HI
RBC 2.87 M/CMM LOW
Hgb 7.4 g/dL LOW
Hct 23.1 % LOW
MCV 80.4 fL
MCH 25.7 pg LOW
MCHC 31.9 g/dL LOW
RDW 18.5 % HI
Platelet 42 K/CMM LOW
MPV 9.4 fL
Segs 58.0 %
Bands 35.0 % HI
Lymphocytes 3.0 % LOW
Atypical Lymphs 0.0
%
Monocytes 3.0 %
Myelocytes 1.0 % HI
Segs-Bands
# 39.0 K/CMM HI
Lymphocytes
# 1.3 K/CMM
Monocytes
# 1.3 K/CMM HI
Anisocyte 1+
Macrocyte 1+
Microcyte 1+
Hyperseg Moderate
Plt
Morph
Retic
Auto 1.4 %
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normocytic
hypochromic anemia with anisocytosis and mild polychromasia with presence of
occasional elliptocytes
White cells: Leukocytosis,
marked
Granulocytes: Increased
granulocytes with left shift presence of many immature precursors, a few blasts
Lymphocytes:
Monocytes: Increased, normal
morphology
Platelets: Decreased
with rare large forms
Bone
marrow
Differential (%)
performed on touch prep due to hemedilate aspirate
Monoblasts: 30
Promyelocytes: 2
Myelocytes: 5
Metas: 8
Bands & PMN's: 10
Eos: 0
Baso: 0
Monos: 21
Lymphs: 11
Plasma cells: 0
Erythroids: 13
Cellularity: 80%
Megakaryopoiesis: Presence of a few
dysplastic megakaryocytes
Erythropoiesis: Decreased
with normal maturation
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis: Increased
with marked increase in monoblasts and monocytes
Lymphocytes:
Biopsy and clot section: Diffuse
infiltrate with monoblasts and monocytes
Iron content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060, 88342, 88341 x9
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Some of
the immunohistochemical tests in this panel were developed and their
performance characteristics determined by Memorial Hermann Southwest Hospital
Laboratory. They have not been cleared or approved by the U. S. Food
and Drug Administration. The FDA has determined that such clearance
or approval is not necessary. These tests are used for clinical
purposes. They should not be regarded as investigational or for
research. This laboratory is regulated under the Clinical Laboratory
Improvement Amendments of the 1988 (CLIA) as qualified to perform high
complexity clinical testing.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and have personally issued
this report."
++++
Diagnosis
Peripheral
Blood:
Microcytic
hypochromic anemia
Thrombocytopenia
Bone
Marrow:
Trilineage
hematopoiesis with markedly increased megakaryopoiesis,
see comment
Normocellular
marrow for age
No
evidence of malignancy
Reduced
iron stores
06/22/
NDN 06/23/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- The morpoholgic findings in peripheral
blood and bone marrow are supportive for acute immune thrombocytopenia (ITP).
Clinical correlation is suggested
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
62 year old
male with history of ITP diagnosed in 2014 s/p splenectomy and Rituximab, with
stabilized platelets counts, now patient presents with Plt
count of 8 (up to 74 on day of bone marrow biopsy)
Gross Description
The
specimen is received in two parts each
labeled with the patient's name and medical record number.
Part 1
received in formalin in a container labeled with the patient's name and bone
marrow clot on the requisition is a red-brown gelatinous portion of clotted
blood measuring 3.1 x 1.4 x 1.0 cm. The
clot is serially cross sectioned to reveal a red-brown gelatinous cut
surface. The clot is submitted in its
entirety in cassettes 1A-1F.
Part 2
received in formalin in a container labeled with the patient's name and bone
marrow core biopsy on the requisition are two red-brown cylindrical cores of
bone measuring 0.7 and 0.3 cm in length and 0.2 cm in diameter. The specimen is submitted in toto in cassette
2A after a brief decalcification. PY/ddw 06/22/
7 blocks, 7
H&E
Peripheral Smear
CBC
Results:
WBC 7.9 K/CMM
RBC 5.30 M/CMM
Hgb 12.5 g/dL LOW
Hct 40.2 % LOW
MCV 76.0 fL LOW
MCH 23.7 pg LOW
MCHC 31.1 g/dL LOW
RDW 19.5 %
HI
Platelet 74 K/CMM LOW
MPV 9.4 fL
Segs 53.0 %
Bands 12.0 % HI
Lymphocytes 23.0 %
Atypical Lymphs 0.0
%
Monocytes 12.0 %
Segs-Bands
# 5.1 K/CMM
Lymphocytes
# 1.8 K/CMM
Monocytes
# 0.9 K/CMM HI
Anisocyte 1+
Polychrom Moderate
Microcyte 1+
Acanthocyte Moderate
Schistocyte
Plt
Morph
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Microcytic
hypochromic anemia with anisopoikilocytosis and
slight polychromasia
White cells:
Granulocytes:
Unremarkable
morphology
Lymphocytes: Unremarkable
morphology
Monocytes: Unremarkable
morphology
Platelets: Thrombocytopenia,
few large forms
Bone
marrow
Differential (%)
Myeloblasts: 2
Promyelocytes: 2
Myelocytes: 11
Metas: 9
Bands & PMN's: 29
Eos: 0
Baso: 0
Monos: 4
Lymphs: 21
Plasma cells: 0
Erythroids: 22
M:E ratio: 2.6
Cellularity: 40%
Megakaryopoiesis: Markedly increased, frequent
early forms with hypolobated nuclei and basophilic
cytoplasm consistent with high turn-over
Erythropoiesis: Adequate
with normal maturation
Iron Content (aspirate): Reduced
iron stores
Granulopoiesis: Adequate
with normal maturation
Lymphocytes: Slightly
increased with normal morphology
Biopsy and clot section: Increased
megakaryocytes with frequent early forms. No evidence of malignancy is seen
Iron content (biopsy and clot section): Reduced iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose signature
appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
++++
46. MDS-Multilineage Dysplasia
Diagnosis
Peripheral
blood:
Normocytic hypochromic anemia
Neutropenia
Bone
marrow:
Myelodysplastic syndrome,
multilineage dysplasia
Hypocellular with megakaryocytic and
erythroid dysplasia, see comment
No increase in blasts
Increased iron stores with no increase
in ring-sideroblasts
NDN 07/20/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-
- The
current findings are consistent with patient's history of MDS with
chromosomal abnormalities. Bone marrow aspirate was sent for
cytogenetics and MDS FISH panel
Tumor Summary
Specimen: bone marrow
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: bone marrow
Aspiration site: R post iliac crest
Biopsy site: R post
iliac crest
Histologic type: refractory anemia (MDS)
Immunophenotyping
Immunohistochemistry: not performed,
Flow cytometry: _
Performed,
Not performed
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow clot
2. Bone marrow biopsy ,
decal, touch prep
Peripheral blood smear
Bone marrow was
obtained by IR
Clinical Information
Preoperative Diagnosis:
MDS
Postoperative
Diagnosis: MDS
61
year old male with PMH of transfusion-dependent pancytopenia secondary to
hypocellular MDS diagnosed in 3/2017.
(FISH panel showing + 5q, -7q, - 20q) presented with symptomatic
anemia. No therapy due to loss to
follow up
Gross Description
The specimen is received in two containers of formalin and is
accompanied by a requisition form, both labeled with the patient's name and medical record
number.
1. The specimen
designated on a container and requisition as bone marrow aspirate clot . The specimen consists of a red-brown,
cylindrically shaped portion of blood clot material, measuring 2.0 x 1.4 x 0.8
cm. The specimen is serially sectioned
and submitted entirely in cassette 1A.
2. The specimen
designated on a container and requisition as bone marrow biopsy. The specimen consists of a pink--tan, bony
needle core biopsy, measuring 0.8 x 0.2 x 0.2 cm. The specimen is decalcified and submitted
entirely in cassette 2A. CC/ddw 07/19/
2 blocks, 2 H&E
Peripheral Smear
CBC
Results:
WBC 2.6 K/CMM LOW
RBC 2.43 M/CMM LOW
Hgb 7.8 g/dL LOW
Hct 22.1 % LOW
MCV 90.8 fL
MCH 32.0 pg HI
MCHC 35.3 g/dL
RDW 20.7 % HI
Platelet 203 K/CMM
MPV 9.3 fL
Segs 11.0 % LOW
Lymphocytes 82.0 % HI
Monocytes 5.0 %
Eosinophils 1.0 %
Basophils 1.0 %
Segs-Bands
# 0.3 K/CMM LOW
Lymphocytes
# 2.2 K/CMM
Monocytes
# 0.1 K/CMM
Anisocyte 2+
Polychrom Moderate
Macrocyte 1+
Microcyte 1+
Target
Cell Moderate
Large Plt
Slight
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normocytic
hypochromic anemia with slight polychromasia
White cells: Decreased
in number
Granulocytes: Decreased with normal morphology
Lymphocytes:
Monocytes:
Platelets:
Bone
marrow
Differential (%)
Myeloblasts: 4
Promyelocytes: 1
Myelocytes: 5
Metas: 3
Bands & PMN's: 7
Eos: 3
Baso: 0
Monos: 5
Lymphs: 31
Plasma cells: 2
Erythroids: 39
Other: M:E
ratio 0.7
Cellularity: 20%
Megakaryopoiesis: Increased with
dysplastic forms
Erythropoiesis: Relatively
increased with dysplastic forms
Iron Content (aspirate): Increased
iron stores with no increase in ring- sideroblasts
Granulopoiesis: Decreased
with normal maturation
Lymphocytes:
Plasma cells:
Biopsy and clot section: Hypocellular
with no clusters of blasts seen. A small benign lymphoid aggregate is seen in
clot section
Iron content (biopsy and clot section): Increased iron stores with no increase in ring-sideroblasts
Non Clinical Documentation
"I have personally
reviewed all specimen preparations and concur with the resident's
interpretation."
Teaching Physician Statement
CPT: 88305
x 2, 88313 x 2, 88311, 85097, 85060
++++
47. Lymphoplasmacytic Lymphoma
Diagnosis
Peripheral
blood:
Mild thrombocytopenia
Bone
marrow:
Hypocellular for age
Lymphoplasmacytic
lymphoma, see comment
Adequate iron stores
NDN 07/26/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunohistochemical
stains, with adequate controls, are performed on clot (1A) for CD3, CD20,
CD79a, and CD138. The stains show a subset of CD20-pos and CD79a-pos B
lymphocytes (about 20% of bone marrow cells) and scattered CD138-pos plasma
cells (about 5% of bone marrow cells); admixed with T lymphocytes (pos for CD3)
-Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-
-These flow cytometry
results, together with morphological findings in bone marrow (increase in
lymphocytes with mature cytology, some with plasmacytoid forms, admixed with
plasma cells), are most consistent with lymphoplasmacytic lymphoma
-Bone
marrow aspirate was sent for cytogenetics, multiple myeloma FISH panel and NHL
FISH panel, also PCR testing for MYD88.
-Dr Rios
was notified of the findings on 7/26/17
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: bone marrow
Aspiration site: R post iliac crest
Biopsy site: R post iliac crest
Histologic type: lymphoplasmacytic lymphoma
Immunophenotyping
Immunohistochemistry: Performed,
Flow cytometry: _
Performed,
Not performed
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone
marrow clot
2. Bone
marrow biopsy, touch prep, decal
Peripheral
blood smear
Bone marrow
was obtained by IR
Clinical Information
Multiple
myeloma vs Waldenstrom macroglobulinemia
44 year old male, with previous diagnosis from outside hospital of
multiple myeloma vs Waldenstrom macroglobulinemia,
not treated
Gross Description
The
specimen is received in two parts each labeled with the patient's name and
medical record number.
Part 1
received in formalin in a container and labeled with the patient's name and
clot on the requisition is a red-brown portion of clotted blood measuring 1.5 x
1.3 x 0.2 cm. The clot is submitted in
toto in cassette 1A.
Part 2 received in formalin in a container and labeled with the patient's name
and bone marrow biopsy is a red-brown cylindrical core of bone measuring 1.8 x
0.2 x 0.2 cm. The specimen is submitted
in toto in cassette 2A after a brief decalcification. PY/ddw 07/24/
2 blocks, 2
H&E
Peripheral Smear
CBC Results:
WBC 4.8 K/CMM
RBC 4.68 M/CMM LOW
Hgb 14.9 g/dL
Hct 43.9 %
MCV 94.0 fL
MCH 31.9 pg HI
MCHC 33.9 g/dL
RDW 14.2 %
Platelet 122 K/CMM LOW
MPV 8.7 fL
Segs 68.3 %
Lymphocytes 19.2 %
LOW
Monocytes 6.9 %
Eosinophils 4.8 % HI
Basophils 0.8 %
Segs-Bands
# 3.2 K/CMM
Lymphocytes
# 0.9 K/CMM LOW
Monocytes
# 0.3 K/CMM
Eosinophils
# 0.2 K/CMM
Retic
Auto 0.6 %
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic
normocytic RBCs, mild polychromasia
White cells:
Granulocytes:
Lymphocytes: A
few plasmacytoid lymphocytes seen
Monocytes:
Platelets: Slight
decrease with normal morphology
Bone
marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 2
Myelocytes: 11
Metas: 13
Bands & PMN's: 9
Eos: 2
Baso: 0
Monos: 1
Lymphs: 27
Plasma cells: 2
Erythroids: 33
Other: M:E
ratio 1.1
Cellularity: 30%
Megakaryopoiesis: Adequate with normal
maturation
Erythropoiesis: Adequate
with normal maturation
Iron
Content (aspirate): Adequate iron
stores
Granulopoiesis: Adequate
with normal maturation
Lymphocytes: Increased
with mature cytology; a subset with plasmacytoid features
Plasma cells:
Biopsy and clot section: Biopsy
is suboptimal with small intact areas. Clot section shows increase in
lymphocytes
Iron content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT: 88305
x 2, 88313 x 2, 88311, 85097, 85060, 88342 x1, 88341 x3
Teaching Physician Statement
"I have personally
reviewed all specimen preparations and concur with the resident's
interpretation."
+++
Diagnosis
Peripheral
blood:
B Lymphoblastic leukemia
Bone
marrow:
B Lymphoblastic leukemia, see comment
Adequate iron stores
NDN 07/28/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping
of peripheral blood by flow cytometry (report HF-
-The immunophenotype
results and morphology are consistent with precursor B lymphoblastic leukemia.
Dr. A. Rios was notified of the findings on 7/25/17.
-Bone
marrow aspirate was sent for chromosome analysis, FISH panel for ALL, and PCR
for bcr/abl1.
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: bone marrow
Aspiration site: R post iliac crest
Biopsy site: R post iliac crest
Histologic type: B lymphoblastic leukemia
Immunophenotyping
Immunohistochemistry: not performed,
Flow cytometry: _
Performed,
Cytogenetic studies: Performed, see separate report
Specimen Source
Bone marrow
aspirate and clot
Bone marrow
core biopsy, decal, touch prep
Peripheral
blood smear
Bone marrow
procedure was performed by IR
Clinical Information
55 year old
male admitted for loss of consciousness with acute subdural hematoma. His PB smear showed 53% blasts, flow
cytometry immunophenotyping is consistent with B lymphoblastic leukemia
Gross Description
The
specimen is received
in two parts each labeled with the patient's name and
MRN.
1. The
specimen is red-purple, irregularly-shaped soft piece of tissue measuring
1.5 x 1.3 x 0.5 cm. The specimen is submitted entirely in cassette 1A.
2. The
specimen is labeled "BM BX" and is pink-tan, elongated,
hard piece of tissue measuring 2.5 x 0.3 x 0.2 cm. The specimen is
submitted entirely in cassette 2A. The
specimen is submitted in light decalcification. AM/myf 07/27/
Peripheral Smear
CBC
Results:
WBC 26.0 K/CMM HI
RBC 3.72 M/CMM LOW
Hgb 10.9 g/dL LOW
Hct 32.7 % LOW
MCV 87.9 fL
MCH 29.4 pg
MCHC 33.4 g/dL
RDW 15.7 % HI
Platelet 122 K/CMM LOW
MPV 8.3 fL
Segs 30.0 % LOW
Bands 2.0 %
Lymphocytes 20.0 %
Atypical Lymphs 0.0 %
Monocytes 4.0 %
Metamyelocytes 1.0 %
Promyelocytes 1.0 % HI
Blasts 42.0 % HI
Segs-Bands
# 8.3 K/CMM HI
Lymphocytes
# 5.2 K/CMM
Monocytes
# 1.0 K/CMM
HI
NRBC 2 /100WB NA
Anisocyte 1+
Smudge slight
Retic
Auto 0.5 %
PT 15.1 seconds HI
INR 1.17
PTT 29.3 seconds
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normocytic
hypochromic anemia with a few NRBCs, mild polychromasia
White cells: Increased
in number
Granulocytes:
Decreased with
normal morphology
Lymphocytes:
Monocytes:
Other: Numerous
lymphoblasts seen
Platelets: Decreased
with normal morphology
Bone
marrow
Differential (%)
Lymphoblasts:
79
Promyelocytes: 1
Myelocytes: 1
Metas: 1
Bands & PMN's: 4
Eos: 0
Baso: 0
Monos: 0
Lymphs: 0
Plasma cells: 1
Erythroids: 5
Cellularity: 95%
Megakaryopoiesis: Markedly decreased
Erythropoiesis: Markedly
decreased
Iron Content (aspirate): Adequate iron stores
Granulopoiesis: Markedly
decreased
Lymphocytes: Decreased
mature lymphocytes; marked increase in lymphoblasts
Biopsy and clot section: Diffuse
distribution of lymphoblasts
Iron content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT: 88305
x 2, 88313 x 2, 88311, 85097, 85060
Teaching Physician Statement
"I have personally
reviewed all specimen preparations and concur with the resident's
interpretation."
+++
Diagnosis
Peripheral
blood:
Normocytic hypochromic anemia
Leukocytosis with numerous blasts
(80%)
Thrombocytopenia
Bone
marrow:
Acute myeloid leukemia, see comment
Increased iron stores
NDN 01/10/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-
Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-17- 20) in gate #1 (blast area) contains a predominant
blast population (more than 60% of the bone marrow cells). These cells are
positive for CD2, CD7, CD13, CD15 (partial), CD33, CD34, CD38, CD117, TdT (partial), and HLA-DR. They are negative for other T
cell markers (other than CD2 and CD7), CD19, CD20, CD10, CD64, and MPO. These
results are consistent with the patient's previous diagnosis of acute myeloid
leukemia. The baseline bone marrow shows similar marker profile (report AF-
- Findings
were notified to Neuro Trauma team on 1/6/17 @ 18:30
- Bone
marrow aspirate was sent for cytogenetics, AML- FISH panel, PCR testing for
PLT3, NPM1, CEBPA, and KIT mutations.
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R ilac crest
Biopsy site: R ilac crest
Histologic type: Acute
myeloid leukemia, NOS
Immunophenotyping
Immunohistochemistry: Not performed,
Flow cytometry:
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow clot
2. Bone marrow core, decal, touch prep
Peripheral
blood smear
Bone marrow
was obtained by IR
Clinical Information
Clinical
History: AML; 67 year old female with past medical history of DLBCL (treated),
HIV, diagnosed with AML (December 2015), lost to follow up until December
2016. Patient now presents with CNS
bleeding
Gross Description
Part 1: Received in formalin, labeled with the patient's name and
medical record number only is an irregular portion of maroon clotted blood (1.4
x 1.3 x 1.0 cm), which is serially sectioned and entirely submitted in 1A.
Part 2: Received in formalin, labeled with the patient's name and
medical record number only is a cylindrical portion of tan bone (1.6 cm in
length x 0.2 cm in diameter), which is entirely submitted into A following
decalcification. CG/ec
01/09/
Peripheral Smear
CBC
Results:
WBC 12.4 K/CMM HI
RBC 2.40 M/CMM LOW
Hgb 6.8 g/dL CRIT
Hct 21.2 % LOW
MCV 88.1 fL
MCH 28.2 pg
MCHC 32.0 g/dL
RDW 15.7 % HI
Platelet 96 K/CMM LOW
MPV 9.4 fL
Segs 3.0 % LOW
Bands 0.0 %
Lymphocytes 14.0 % LOW
Atypical Lymphs 0.0
%
Monocytes 1.0 % LOW
Metamyelocytes 1.0 %
Myelocytes 1.0 % HI
Blasts 80.0 % HI
Segs-Bands
# 0.4 K/CMM LOW
Lymphocytes
# 1.7 K/CMM
Monocytes
# 0.1 K/CMM
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normocytic
hypochromic anemia with slight polychromasia
White cells: Increased
in number
Granulocytes: Numerous
blasts (80%)
Lymphocytes:
Monocytes:
Platelets: Decreased
with normal morphology
Bone
marrow
Differential (%)
Myeloblasts: 80%
Promyelocytes: 2
Myelocytes: 2
Metas: 1
Bands & PMN's: 0
Eos: 0
Baso: 0
Monos: 2
Lymphs: 3
Plasma cells: 0
Erythroids: 10
Cellularity: 95%
Megakaryopoiesis: Decreased with
normal maturation
Erythropoiesis: Decreased
with normal maturation
Iron Content (aspirate): Increased
iron stores
Granulopoiesis: Marked
decreased in mature granulocytes, numerous myeloblasts (80%)
Lymphocytes:
Biopsy and clot section: Hypercellular
with marked increase in blasts
Iron content (biopsy and clot section): Increased iron stores
Non Clinical Documentation
CPT: 88305
x 2, 88313 x 2, 88311, 85097, 85060
Teaching Physician Statement
"I have personally
reviewed all specimen preparations and concur with the resident's
interpretation."
++++
Diagnosis
Peripheral
blood:
Macrocytic hypochromic anemia
Thrombocytopenia
Bone marrow:
Normocellular for age
Increased erythropoiesis with mild dyserythropoiesis,
see comment
Increased megakaryopoiesis
with mild dysplasia
Increased iron stores with no increase
in ring-sideroblasts
NDN 01/12/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Mild
dysplastic changes are seen in erythroids and
megakaryocytes. Myelodysplastic syndrome
(MDS) cannot be ruled out
-Bone
marrow aspirate was sent for MDS-FISH panel and cytogenetics to rule out MDS.
Specimen Source
1. Bone marrow clot
2. Bone marrow core, decal, touch prep
Peripheral
blood smear
Bone marrow
was obtained by IR
Clinical Information
Pancytopenia
83 year old male with a medical history of chronic afib, CAD, ICM who present with GI bleeding and
pancytopenia.
Gross Description
1. Received in formalin labeled with patient's name, medical record number, and "BM clot" is an irregular
portion of maroon-clotted blood (1.5 x 1.5 x 1.0 cm) which is sectioned and
entirely submitted in 1A.
2. Received in formalin labeled with patient's name, medical record number, and "BM biopsy" are two cylindrical portions of red bone (1.8 cm
in length and 0.2 cm in diameter, in aggregate) which are entirely submitted in
2A, following decalcification. CG/ea 01/11/
Peripheral Smear
CBC
Results:
WBC 7.2 K/CMM
RBC 2.48 M/CMM LOW
Hgb 8.2 g/dL LOW
Hct 24.1 % LOW
MCV 97.1 fL HI
MCH 33.2 pg HI
MCHC 34.2 g/dL
RDW 26.7 % HI
Platelet 100 K/CMM LOW
MPV 9.4 fL
Segs 81.7 %
HI
Lymphocytes 7.9 %
LOW
Monocytes 7.5 %
Eosinophils 2.6 %
Basophils 0.3 %
Segs-Bands
# 5.8 K/CMM
Lymphocytes
# 0.6 K/CMM LOW
Monocytes
# 0.5 K/CMM
Eosinophils
# 0.2 K/CMM
Anisocyte 2+
Retic
Auto 1.3 %
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Macrocytic hypochromic anemia with slight polychromasia
White cells:
Granulocytes: PMNs with reactive changes
Lymphocytes: Decreased
in number with normal morphology
Monocytes:
Platelets: Decreased
in number with few large forms
Bone
marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 3
Myelocytes: 10
Metas: 22
Bands & PMN's: 28
Eos: 2
Baso: 0
Monos: 1
Lymphs: 6
Plasma cells: 0
Erythroids: 28
Cellularity: 30%
Megakaryopoiesis: Increased with few hypolobulated forms of mature megakaryocytes
Erythropoiesis: Increased
with mild dyserythropoiesis
Iron
Content (aspirate): Increased iron
stores with no increase in ring-sideroblasts
Granulopoiesis: Adequate
with left-shift, no increase in blasts, rare histiocytes with hemophagocytosis
Lymphocytes:
Biopsy and clot section: Megakaryopoiesis is increased with a few hypolobulated forms.
No evidence of granuloma, fibrosis or abnormal cellular infiltrates
Iron content (biopsy and clot section): Increased iron stores with no increase in ring-sideroblasts
Non Clinical Documentation
CPT: 88305
x 2, 88313 x 2, 88311, 85097, 85060
Teaching Physician Statement
"I have personally
reviewed all specimen preparations and concur with the resident's interpretation."
Addendum Diagnosis
Bone
marrow:
MDS Fluorescence
In Situ Hybridization (FISH) results:
_ Abnormal
results with 5q-.
nuc
ish 5p15.31(D5S630,D5S2064)x2, 5q31 (EGR1x1)[7/200]
nuc
ish 7p11(EGFRx
nuc
ish 8cen(D8Z2x2)[200]
nuc
ish 20q12(D20S108x2)[200]
NDN/LCN 01/18/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
Genoptix
report dated 1/17/2017.
Dr Apostolidu was notified of this results which confirm the
diagnosis of MDS with isolated
++++
Diagnosis
Peripheral Blood:
- Chronic lymphocytic
leukemia
- Normocytic hypochromic
anemia
- Thrombocytopenia
Bone Marrow:
- Chronic lymphocytic
leukemia
- Decreased iron stores
01/17/
NDN 01/17/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
peripheral blood leukocytes by flow cytometry shows an abnormal B cell
population (about 97% of the cells analyzed) that is positive for CD5, CD19,
CD20, CD22, CD23 (subset of 28% lymphocytes), CD38, surface lambda light chain
restriction (dim signal). These B cells are negative for CD10, FMC7. These B
cells have small nuclear size (based on forward-scatter signal). These results
are most consistent with chronic lymphocytic leukemia (CLL).
- Bone marrow aspirate was
sent for cytogenetics, CLL-FISH panel and FISH testing for t(11; 14)
- Immunohistichemical
stains for bcl1 and CD23 on biopsy are pending. Results will be reported in
Addendum
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: bone marrow
Aspiration site: R
posterior iliac crest
Biopsy site: R
posterior iliac crest_
Histologic type:
Chronic lymphocytic leukemia
Immunophenotyping
Immunohistochemistry: Performed,
Flow cytometry: _
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate and clot
2. Bone marrow core biopsy, decal, touch prep
3. Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
Clinical History: 69
year old man with suspected CLL, s/p leukopheresis
Gross Description
Part 1: Received in formalin, labeled with the patient's name and
medical record number only is an irregular portion of maroon clotted blood (1.5
x 1.3 x 0.3 cm), which is submitted in toto in 1A.
Part 2: Received in formalin, labeled with the patient's name and
medical record number only is a cylindrical portion of pink-white, brittle bone
(2.3 cm in length x 0.2 cm in diameter), which is entirely submitted into A
following decalcification. CG/ec 01/16/
Peripheral Smear
CBC
Results:
WBC 175.3 K/CMM CRIT
RBC 2.75 M/CMM LOW
Hgb 8.7 g/dL LOW
Hct 25.6 % LOW
MCV 93.0 fL
MCH 31.5 pg HI
MCHC 33.9 g/dL
RDW 18.3 % HI
Platelet 17 K/CMM CRIT
Platelet
Count Blue Top 67 K/CMM LOW
MPV 8.9 fL
Segs 14.0 %
LOW
Bands 0.0 %
Lymphocytes
80.0 % HI
Atypical Lymphs 0.0
%
Monocytes 6.0 %
Segs-Bands
# 24.5 K/CMM HI
Lymphocytes
# 140.2 K/CMM HI
Monocytes
# 10.5 K/CMM
HI
NRBC 2 /100WB NA
Polychrom Moderate
Hypochrom 1+
Toxic
Gran Moderate
Smudge Moderate
Retic
Auto 0.7 %
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic
hypochromic anemia with occasional nucleated forms, and slight polychromasia
White cells: Markedly
increased
Granulocytes: Reactive
neutrophils present
Lymphocytes: Increased
in number with a few prolymphocytes,
many smudge cells
Monocytes:
Platelets: Decreased
in number with a few platelet clumps
Bone
marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 0
Myelocytes: 0
Metas: 0
Bands & PMN's: 5
Eos: 0
Baso: 0
Monos: 0
Lymphs: 83
Prolymphs: 8
Plasma cells: 0
Erythroids: 4
Cellularity: Hypercellular,
95%
Megakaryopoiesis: Decreased with
normal maturation
Erythropoiesis: Markedly
decreased
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis: Markedly
decreased
Lymphocytes: Markedly
increased (83%) with 8% prolymphocytes
Biopsy and clot section: Diffuse
distribution of leukemic lymphocytes
Iron content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT: 88305 x 2, 88313 x
2, 88311, 85097, 85060
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
+++
52. Follicullar
Lymphoma in BM
Diagnosis
Peripheral
Blood:
-Mild
eosinophilia
Bone
Marrow:
-A
low-grade B-cell lymphoma involvement in bone marrow, see comment
-Decreased
iron stores
02/06/
NDN 02/07/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-
-Lymphoma
infiltrates are seen surrounding trabecular bone (paratrabecular
pattern). The lymphoma cells have small nuclei with clumped chromatin,
consistent with lymphoma metastasis in this patient with recent diagnosis of
low-grade follicular lymphoma.
-Due to
discrepancy between CD10 results (negative in flow cytometry study for this
bone marrow and positive in lymph node sample by immunohistochemical stain),
immunohistochemical stains were ordered on this bone marrow biopsy for CD20,
CD3, CD10, Bcl-2, and Bcl-6. Results will be reported in Addendum
- Bone
marrow aspirate was sent for cytogenetics
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: _
Aspiration site: R post
iliac crest_
Biopsy site:_R post iliac crest_
Histologic type:
low-grade B cell lymphoma
Immunophenotyping
Immunohistochemistry: Performed,
Flow cytometry: _
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate and clot
2. Bone marrow core biopsy, decal, touch prep
3. Peripheral blood smear
Bone marrow procedure
was performed by IR
Clinical Information
27 year-old female with
recent diagnosis of follicular lymphoma on retroperitoneal lymph node.
Gross Description
1. Received in formalin labeled with the
patient's name and medical record number only is an irregular portion of maroon
clotted blood (1.6 x 1.2 x 0.6 cm) which is sectioned and entirely submitted in
1A
2. Received in
formalin labeled with the patient's name and medical record number only is a
cylindrical portion of tan-gray to red bone (1.1 cm in length x 0.2 cm
in diameter) which is entirely submitted in 2A, following
decalcification. CG/ea 02/03/
Peripheral Smear
CBC Results:
WBC 6.9 K/CMM
RBC 4.25 M/CMM
Hgb 12.4 g/dL
Hct 37.5 %
MCV 88.2 fL
MCH 29.1 pg
MCHC 33.0 g/dL
RDW 14.8 % HI
Platelet 180 K/CMM
MPV 8.1 fL
Segs 48.2 %
Lymphocytes
32.2 %
Monocytes 7.0 %
Eosinophils 11.8 % HI
Basophils 0.8 %
Segs-Bands
# 3.3 K/CMM
Lymphocytes
# 2.2 K/CMM
Monocytes # 0.5 K/CMM
Eosinophils
# 0.8 K/CMM HI
Basophils
# 0.1 K/CMM
Retic
Auto 1.7 %
HI
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic,
normocytic red cells
White cells:
Granulocytes: PMN's
with unremarkable morphology; eosinophilia
Lymphocytes: Adequate
in number with reactive forms
Monocytes: Adequate
in number with unremarkable morphology
Platelets: Adequate
in number with a few large forms
Bone
marrow
Differential (%)
Myeloblasts: 1
Promyelocytes: 1
Myelocytes: 23
Metas: 14
Bands & PMN's: 36
Eos: 1
Baso: 0
Monos: 0
Lymphs: 9
Plasma cells: 1
Erythroids: 14
M:E ratio: 5.07
Cellularity: 70%
Megakaryopoiesis: Adequate with normal
maturation
Erythropoiesis: Adequate
with normal maturation
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis: Mature
and maturing forms present; no increase
in blasts
Lymphocytes:
Plasma cells:
Biopsy and clot section: Lymphoma
infiltrates are seen surrounding trabecular bone (paratrabecular
pattern). The lymphoma cells have small nuclei with clumped chromatin,
consistent with lymphoma metastasis in this patient with recent diagnosis of
low-grade follicular lymphoma.
Iron content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT: 88305
x 2, 88313 x 2, 88311, 85097, 85060
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen preparations
and have personally issued this report."
Addendum Diagnosis
Bone
marrow:
-Follicular
lymphoma involvement in bone marrow, see comment
NDN/NDN 02/08/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
Due to
discrepancy between CD10 results (negative in flow cytometry study for this
bone marrow and positive in lymph node sample by immunohistochemical stain),
immunohistochemical stains with adequate controls were performed on this bone
marrow biopsy for CD20, CD3, CD10, Bcl-2, and Bcl-6. The malignant
lymphocytes are positive for CD20, CD10, bcl2 and bcl6. They are negative for
CD3. The immunohistochemical stains demonstrate significant interstitial
lymphoma involvement in addition to paratrabacular
pattern. The negative CD10 result by flow cytometry most likely represents
different sensitivity of flow cytometry marker.
Non Clinical Documentation
++++
53. AML transformed from MDS-EB2
Diagnosis
Peripheral
Blood:
-
Normocytic hypochromic anemia
-
Leukopenia with numerous blasts (20%)
-Thrombocytopenia
Bone
Marrow:
- Acute
myeloid leukemia, transformed from refractory anemia with excess blasts
(RAEB-2)
- Adequate
iron stores
02/07/
NDN 02/07/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-
Immunophenotyping of peripheral blood by flow cytometry (report HF-
- The flow cytometry
results, together with morphological findings in peripheral blood (more than
20% blasts) and bone marrow (79% blasts) are most consistent with transformation
to acute myeloid leukemia in this patient with history of refractory anemia
with excess blasts-type 2 (RAEB-2). The marker profile of the blasts is
essentially the same as that in recent bone marrow with diagnosis of RAEB-2.
- Findings
were discussed with Dr Kanaan and Dr Segal on 2/4/2017
- Bone
marrow aspirate was sent for chromosome analysis, FISH testing for for AML panel, BCR-ABL, PCR testing for FLT3, NPM1, KIT (D816V), and CEBPA
- Bone
marrow clot and biopsy are pending due to processing. Results will be reported
in addendum.
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: _
Aspiration site: R post
iliac crest_
Biopsy site:_R post iliac crest
Histologic type: acute
myeloid leukemia_
Immunophenotyping
Flow cytometry: _
Performed, see separate report (HF-
on peripheral blood
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy,
decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
Clinical
History: 47 year old male with history of RAEB II history (diagnosed in Dec
2016), now with numerous blasts
Gross Description
1. Received in formalin
labeled with the patient's name and medical record number only is an irregular
portion of maroon clotted blood (1.7 x 1.0 x 0.4 cm) which is submitted in toto
in 1A.
2. Received in
formalin labeled with the patient's name and medical record number only is a cylindrical portion of red-yellow bone (2.3 cm in length x
0.2 cm in diameter) which is entirely
submitted in 2A, following decalcification. CG/jca 02/07/
Peripheral Smear
CBC
Results:
WBC 3.3 K/CMM LOW
RBC 3.19 M/CMM LOW
Hgb 9.2 g/dL LOW
Hct 27.3 % LOW
MCV 85.8 fL
MCH 28.8 pg
MCHC 33.6 g/dL
RDW 17.7 % HI
Platelet 95 K/CMM LOW
MPV 7.1 fL LOW
Segs 32.0 % LOW
Bands 0.0 %
Lymphocytes 38.0 %
Atypical Lymphs 0.0 %
Monocytes 6.0 %
Eosinophils 4.0 %
Blasts 20.0 % HI
Segs-Bands
# 1.1 K/CMM LOW
Lymphocytes
# 1.3 K/CMM
Monocytes
# 0.2 K/CMM
Eosinophils
# 0.1 K/CMM
NRBC 2 /100WB NA
Tot
Anisocyte 1+
Smudge Moderate
Plt
Morph
Retic Auto 3.3 % HI
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normocytic,
hypochromic anemia, slight polychromasia
White cells: Leukopenia
Granulocytes: Numerous blasts identified (20%)
Lymphocytes: Adequate
in number with unremarkable morphology
Monocytes: Adequate in number
with unremarkable morphology
Platelets: Decreased
in number with a few large forms
Bone
marrow
Differential (%)
Blasts: 79
Promyelocytes: 0
Myelocytes: 5
Metas: 4
Bands & PMN's: 4
Eos: 0
Baso: 0
Monos: 0
Lymphs: 8
Plasma cells: 0
Erythroids: 5
M:E ratio: 17.5
Cellularity: 80%
Megakaryopoiesis: Markedly decreased
Erythropoiesis: Decreased
with unremarkable morphology
Iron
Content (aspirate): Adequate iron
stores
Granulopoiesis: Many
blasts seen (79%) with abundant cytoplasm and prominent nuclei; decreased in
more mature forms
Lymphocytes: Decreased
with unremarkable morphology
Biopsy and Clot section: pending
Iron content (biopsy and clot section): pending
Non Clinical Documentation
CPT: 88305
x 2, 88313 x 2, 88311, 85097, 85060
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report."
++++
Diagnosis
Peripheral
blood:
Leukocytosis with numerous blasts
Normocytic hypochromic anemia
Thrombocytopenia
Bone
marrow:
B lymphoblastic leukemia, see comment
Decreased iron stores
NDN 03/09/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate leukocytes by flow cytometry (report HF-
-Bone
marrow aspirate was sent for cytogenetics, and ALL-FISH panel.
-Bone
marrow biopsy and clot are pending processing. Results will be reported in
Addendum
-Results
were notified to Dr Z Kanaan on 3/9/2017
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: _
Aspiration site: _R post
iliac crest
Biopsy site:_R post iliac crest
Histologic type: _B lymphoblastic leukemia
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry: _
Performed, see separate report (_HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
29 year old
female present with anemia, thrombocytopenia, gingival bleeding, and leukocytosis;
found to have 50% blasts in peripheral blood at outside hospital
Gross Description
Specimens
submitted:
1. Bone
marrow clot
2. Bone
marrow core biopsy, decal
Peripheral Smear
CBC
Results:
PB Smear
Path
WBC 34.3 K/CMM
HI
RBC 3.40 M/CMM LOW
Hgb 9.7 g/dL LOW
Hct 28.2 % LOW
MCV 83.0 fL
MCH 28.5 pg
MCHC 34.3 g/dL
RDW 17.1 % HI
Platelet 16 K/CMM CRIT
MPV 8.7 fL
Segs 5.0 % LOW
Bands 0.0 %
Lymphocytes 16.0 % LOW
Atypical Lymphs 0.0 %
Monocytes 3.0 %
Blasts 76.0 %
HI
Segs-Bands
# 1.7 K/CMM
Lymphocytes
# 5.5 K/CMM
Monocytes
# 1.0 K/CMM HI
Tot
RBC
Morph
Plt
Morph
Retic
Auto 0.4 % LOW
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normocytic
hypochromic anemia with mild polychromasia
White cells: Leukocytosis
Granulocytes: Markedly
decreased
Lymphocytes: Markedly
decreased in mature lymphocytes
Monocytes: A few mature
monocytes
Other: Numerous
lymphoblasts
Platelets: Markedly
decreased with occasional large forms
Bone
marrow
Differential (%)
Lymphoblasts: 91
Promyelocytes: 0
Myelocytes: 0
Metas: 0
Bands & PMN's: 2
Eos: 0
Baso: 0
Monos: 3
Lymphs: 3
Plasma cells: 0
Erythroids: 1
Cellularity: Pending
biopsy and clot section
Megakaryopoiesis: Markedly decreased
Erythropoiesis: Markedly
decreased
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis: Markedly
decreased
Lymphocytes: Markedly
decreased in normal forms,
numerous lymphoblasts (91%)
Biopsy and clot section: Pending
Iron
content (biopsy and clot section): Pending
Non Clinical Documentation
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
85097,
88305 x2, 85060, 88313 x2, 88311
_
Teaching Physician Statement
"I have personally
reviewed all specimen preparations and concur with the resident's
interpretation."
+++
Diagnosis
Peripheral
blood:
No pathological changes
Bone
marrow:
B- cell lymphoma involvement in bone
marrow, see comment
Increased iron stores
NDN 03/17/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-
-Immunohistochemical
stains, with adequate controls, are performed on biopsy for CD20, CD10, bcl6
and bcl2. The lymphoma cells are positive for CD20, CD10, bcl6 and bcl2. The
stains show lymphoma
cells with paratrabecular pattern, some with
interstitial pattern
-Bone
marrow aspirate was sent for cytogenetics and NHL-FISH panel
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: _
Aspiration site: R post
iliac crest
Biopsy site:_R post iliac crest
Histologic type: _B
cell lymphoma
Immunophenotyping
Immunohistochemistry: Performed,
Flow cytometry: _
Performed, see separate report (HF-
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Clot
2. Bone marrow biopsy, touch prep, decal
Peripheral
blood smear
Bone
marrow was performed by IR
Clinical Information
Clinical
History: Follicular lymphoma/DLBCL
60 year old male diagnosed with follicular lymphoma/DLBCL of
mediastinal mass and and
pleural diagnosed on 3/1/17.
Gross Description
The
specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received in formalin, labeled with the
patient's name and "bone marrow clot" on the requisition is a
red-brown portion of clotted blood measuring 2.0 x 1.0 x 0.8 cm. The clot is
serially cross sectioned to reveal a red-brown gelatinous cut surface. The
specimen is submitted in toto in cassettes 1A and 1B.
2. Received in formalin in a container labeled
with the patient's name and "bone marrow biopsy" on the requisition
is a red-brown cylindrical core of bone measuring 2.2 x 0.2 x 0.2 cm. The
specimen is submitted in toto in cassette 2A after a brief decalcification. PY/ec 03/16/
Peripheral Smear
CBC
Results:
WBC 8.2 K/CMM
RBC 4.73 M/CMM
Hgb 14.0 g/dL
Hct 40.0 % LOW
MCV 84.6 fL
MCH 29.6 pg
MCHC 35.0 g/dL
RDW 13.3 %
Platelet 186 K/CMM
MPV 9.2 fL
Segs 78.0 % HI
Bands 0.0 %
Lymphocytes 14.0 % LOW
Atypical Lymphs 0.0
%
Monocytes 7.0 %
Eosinophils 1.0 %
Segs-Bands
# 6.4 K/CMM
Lymphocytes
# 1.1 K/CMM
Monocytes
# 0.6 K/CMM
Eosinophils
# 0.1 K/CMM
Tot
RBC
Morph
Plt
Morph
Retic
Auto 1.6 % HI
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Normochromic
normocytic RBCs, slight polychromasia
White cells:
Granulocytes:
Lymphocytes:
Monocytes:
Platelets:
Bone
marrow
Differential (%)
Myeloblasts: 2
Promyelocytes: 6
Myelocytes: 15
Metas: 11
Bands & PMN's: 25
Eos: 3
Baso: 0
Monos: 0
Lymphs: 21
Plasma cells: 0
Erythroids: 17
Cellularity: 60%
Megakaryopoiesis: Adequate with normal
maturation
Erythropoiesis: Adequate
with normal maturation
Iron Content (aspirate): Increased
iron stores with no increase in ring-sideroblasts
Granulopoiesis: Adequate
with normal maturation
Lymphocytes: Increased
in number
Biopsy and clot section: Several
large aggregates of lymphoma cells are seen with paratrabecular
pattern, a few with interstitial pattern.
The lymphoma cells consists of a
mixture of centrocytes and centroblasts
Iron content (biopsy and clot section): Increased with no increase in ring-sideroblasts
Non Clinical Documentation
CPT: 88305
x 2, 88313 x 2, 88311, 85097, 85060, 88342, 88341 x 3
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Some of the immunohistochemical tests in this panel were developed and their performance characteristics determined by Memorial Hermann Southwest Hospital Laboratory. They have not been cleared or approved by the U. S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary. These tests are used for clinical purposes. They should not be regarded as investigational or for research. This laboratory is regulated under the Clinical Laboratory Improvement Amendments of the 1988 (CLIA) as qualified to perform high complexity clinical testing.
Teaching Physician Statement
"I have personally
reviewed all specimen preparations and concur with the resident's interpretation."
+++
Diagnosis
Peripheral
Blood:
Hypochromic
normocytic anemia
Leukocytosis
and thrombocytosis
Bone
Marrow:
Hypercellular
for age
Marked
increase in megakaryocytes, see comment
Adequate
iron stores
04/20/
NDN 04/20/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- The
morphological findings in peripheral blood, bone marrow and clinical
information are supportive of a myeloproliferative neoplasm, most likely essential
thrombocytopenia; clinical correlation is suggested.
- Bone
marrow aspirate was sent for cytogenetics, FISH for bcr/abl1,
PCR for JAK2 (V617F), CALR,and MPL. Results will be
reported in addendum
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure:
bone marrow
Aspiration
site: R post iliac crest
Biopsy
site: R post iliac crest
Histologic
type: myeloproliferative neoplasm
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry: _
Not performed
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone
marrow clot
2. Bone
marrow biopsy, decal, touch prep
Peripheral
blood smear
Bone marrow
was performed by IR
Clinical Information
Clinical
History: 37 year old female with PMH of splenomegaly and splenic rupture s/p
splenectomy in 2/2017, now presents with elevated platelets count (2
million). She under
went 2 thrombocytapheresis procedures. Current plt count
670k; Concern for ET
Preoperative
diagnosis: Thrombocytosis
Gross Description
The specimen is received in two containers with formalin and is
accompanied by a requisition form, both labeled with the patient's name and medical record
number.
1. The
specimen is designated on the container and requisition as "aspirate
clot". The specimen consists of a
red-brown cylindrically-shaped portion of blood clot material measuring 1.9 x
1.4 x 1.2 cm. The specimen is serially
sectioned and submitted entirely in cassette 1A.
2. The
specimen is designated on the container and requisition as "bone
biopsy". The specimen consists of a
red-brown, trabeculated needle core biopsy, measuring 1.3 x 0.2 x 0.2 cm. The specimen is decalcified and submitted
entirely in cassette 2A. CC/dw 04/19/
Peripheral Smear
CBC Results:
WBC 13.8 K/CMM HI
RBC 3.17 M/CMM LOW
Hgb 8.5 g/dL LOW
Hct 26.2 % LOW
MCV 82.6 fL Normal
MCH 26.9 pg LOW
MCHC 32.6 g/dL Normal
RDW 15.1 % HI
Platelet 670 K/CMM HI
MPV 9.0 fL Normal
Segs 51.2 % Normal
Lymphocytes 32.0 % Normal
Monocytes 13.9 % HI
Eosinophils 1.8 % Normal
Basophils 1.1 %
HI
Segs-Bands
# 7.1 K/CMM Normal
Lymphocytes
# 4.4 K/CMM Normal
Monocytes
# 1.9 K/CMM HI
Eosinophils
# 0.3 K/CMM Normal
Basophils
# 0.2 K/CMM Normal
Retic Auto 0.8 % Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Hypochromic
normocytic anemia with slight polychromasia
White cells: Increased
in number
Granulocytes: Normal number and morphology
Lymphocytes: Normal
number and morphology
Monocytes: Increased
with normal morphology
Platelets: Increased
with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 1
Myelocytes: 4
Metas: 4
Bands & PMN's: 44
Eos: 2
Baso:
1
Monos:
4
Lymphs:
17
Plasma cells: 0
Erythroids:
23
M:E ratio: 2.61
Cellularity: 60%
Megakaryopoiesis:
Marked
increase with clusters of megakaryocytes with variable size and shape
Erythropoiesis: Adequate
with normal maturation
Iron Content (aspirate): Adequate iron stores
Granulopoiesis: Increased with normal maturation, no
increase in blasts
Lymphocytes: Normal
number and morphology
Biopsy and clot section: Marked increase in megakaryocyte; no evidence of
fibrosis
Iron content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT:
88305-GC x 2, 88313-GC x 2, 88311-GC x 1, 85097-GC x 1, 85060-GC
The positive controls and internal negative controls for the
special stains have been reviewed, and appropriate staining is confirmed by the
pathologist whose signature appears above.
_
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report."
++++
57. Plasma cell myeloma with
immature plasma cells
Diagnosis
Peripheral
Blood:
Macrocytic
hypochromic anemia with rouleaux formation
Bone
Marrow:
Plasma
cell myeloma, 60% plasma cells
(most with immature cytological
features)
Reduced
iron stores
04/28/
NDN 05/01/2017 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
- Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-17 -197) shows a T cell
population (about 65% of the cells analyzed) with no aberrant loss or aberrant
expression of T cell markers, a B cell population (about 12% of the cells
analyzed) that is negative for CD5, CD10, and no surface light-chain
restriction. Analysis of cells gated for CD38 positivity shows a large
monoclonal plasma cell population that is positive for cytoplasmic Kappa
light-chain restriction. These plasma cells are positive for CD56 and negative
for CD19. These results, together with the finding of 60% plasma cells in bone
marrow, are consistent with plasma cell myeloma.
- Bone
marrow aspirate was sent for FISH panel for multiple myeloma and cytogenetics.
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure:
bone marrow
Aspiration
site: R post iliac crest
Biopsy site:_R post iliac crest
Histologic
type: _plasma cell myeloma
Immunophenotyping
Immunohistochemistry: not performed,
Flow cytometry: _
Performed, see separate report (HF-17-_)
Cytogenetic studies: Performed, see separate report
Specimen Source
1. Bone marrow
clot
2. Bone
marrow biopsy, decal, touch prep
Bone marrow
was obtained by IR
Clinical Information
71 year old
male with PMH of multiple myeloma, s/p radiotherapy
Gross Description
The
specimen is received in two parts each labeled with the patient's name and
medical record number.
Part 1
received in formalin and labeled with the patient's name and bm clot on the
requisition are two red-brown gelatinous portions of clotted blood measuring
1.2 x 1.2 x 0.9 cm. The clot is serially cross sectioned to reveal
a red-brown gelatinous cut surface. The
specimen is submitted in its entirety in cassettes 1A-1C.
Part 2
received in formalin in a container and labeled with the patient's name and bm
core biopsy on the requisition is a red-brown cylindrical core of bone
measuring 1.2 x 0.2 x 0.2 cm. The
specimen is submitted in toto in cassette 2A after a brief
decalcification. PY/ddw 04/29/
4 blocks, 4
H&E
Peripheral Smear
CBC
Results:
WBC 4.5 K/CMM Normal
RBC 4.17 M/CMM LOW
Hgb 11.5 g/dL LOW
Hct 35.1 % LOW
MCV 84.0 fL Normal
MCH 27.6 pg Normal
MCHC 32.9 g/dL Normal
RDW 16.7 % HI
Platelet 187 K/CMM Normal
MPV 8.5 fL Normal
Segs 64.8 %
Normal
Lymphocytes 23.0 % Normal
Monocytes 8.0 % Normal
Eosinophils 3.8 % Normal
Basophils 0.4 % Normal
Segs-Bands
# 2.9 K/CMM Normal
Lymphocytes
# 1.0 K/CMM
Normal
Monocytes
# 0.4 K/CMM Normal
Eosinophils
# 0.2 K/CMM Normal
Retic
Auto 1.0 % Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Macrocytic
hypochromic anemia with mild polychromasia, rouleaux formation
White cells: Normal
in number
Granulocytes: Normal number and morphology
Lymphocytes: Normal
number and morphology
Monocytes: Normal
number and morphology
Platelets: Normal
number and morphology
Bone marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 0
Myelocytes: 2
Metas: 4
Bands & PMN's: 11
Eos: 1
Baso:
0
Monos:
3
Lymphs:
9
Plasma cells: 60
Erythroids:
10
M:E ratio: 1.6
Cellularity: 65%
Megakaryopoiesis:
Adequate with
normal maturation
Erythropoiesis: Decreased
with normal maturation
Iron Content (aspirate): Decreased iron stores
Granulopoiesis: Decreased with normal maturation
Lymphocytes: Unremarkable
number and morphology
Plasma cells: Marked
increase in plasma cells, most with immature cytology
Biopsy and clot section: Sheets of plasma cells with many immature forms
seen. No granuloma, or fibrosis seen
Iron content (biopsy and clot section): Decrease iron stores
Non Clinical Documentation
CPT:
88305-GC x 2, 88313-GC x 2, 88311-GC x
1, 85097-GC x 1, 85060-GC x 1
The positive controls and internal negative controls for the
special stains have been reviewed, and appropriate staining is confirmed by the
pathologist whose signature appears above.
_
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report."
+++
58. Megakaryocytic Dysplasia,
possible MDS with del 5q
Diagnosis
Peripheral
Blood:
- Microcytic hypochromic anemia
- Thrombocytosis
- No blasts seen
Bone
Marrow:
- Increased number of megakaryocytes with many
mature hypolobated megakaryocytes,
see comment
-
Increased erythropoiesis with mild dyserythropoiesis,
see comment
- Hypercellular for age (70%)
- Decreased iron stores
Comment
- Dysplastic
changes are seen in erythroids and megakaryocytes.
Myelodysplastic syndrome (MDS),
especially MDS with isolated del 5q,
cannot be ruled out
- Bone
marrow aspirate was sent for cytogenetics and FISH panel to rule out MDS
Tumor Summary
_
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
39 year-old female without significant past medical history
presenting with anemia and thrombocytopenia; now with thrombocytosis
Gross Description
The specimen is received in two parts each labeled with the
patient's name and medical record number.
1. Received
in formalin and labeled bone marrow is a red-brown gelatinous portion of clotted
blood measuring 1.1 x 1.0 x 0.8 cm. The
clot is serially cross sectioned to reveal red-brown gelatinous cut
surfaces. The clot is submitted in its
entirety in cassette 1A.
2. Received
in formalin and labeled bone marrow is a red-brown cylindrical core of
measuring 1.3 cm in length red-brown cylindrical core measuring 0.2 cm in
diameter. The specimen is submitted in
toto in cassette 2A after a brief decalcification. PY/myf 10/25/
Peripheral Smear
CBC Results
Date/time:
10/25/2018 at 08:15
CBC Results:
WBC 6.0
K/CMM Normal
RBC 4.42
M/CMM Normal
Hgb 8.9
g/dL LOW
Hct 31.0 % LOW
MCV 70.2 fL LOW
MCH 20.2 pg LOW
MCHC 28.8
g/dL LOW
RDW 43.6
% HI
MPV 8.9 fL Normal
Platelet
Segs 58.3 %
Normal
Lymphocytes 29.4
% Normal
Monocytes 7.7
% Normal
Eosinophils 3.0
% Normal
Basophils 1.6
% HI
Segs-Bands # 3.5
K/CMM Normal
Lymphocytes # 1.8 K/CMM
Normal
Monocytes # 0.5
K/CMM Normal
Eosinophils # 0.2
K/CMM Normal
Basophils # 0.1
K/CMM Normal
Anisocyte 3+
Polychrom Moderate
Hypochrom 1+
Microcyte 2+
Tear Cell
Moderate
Schistocyte
Large Plt Moderate
Retic Auto 1.4
% Normal
Microscopic Description
PERIPHERAL
BLOOD:
Erythrocytes:Microcytic
hypochromic anemia with anisopoikilocytosis including
occasional elliptocytes, mild polychromasia
White
cells: Normal in number
Granulocytes: Normal morphology
Lymphocytes: Normal morphology
Monocytes: Normal morphology
Platelets: Increased number, occasional large
forms seen
BONE
MARROW:
Differential
(%) on aspirate
Myeloblasts:
0
Promyelocytes:
2
Myelocytes:
6
Metas: 13
Bands &
PMN's: 34
Eos: 2
Baso:
1
Monos:
2
Lymphs:
8
Plasma
cells: 0
Erythroids:
32
M:E ratio: 1.8
Cellularity: 70%, hypercellular for age
Megakaryopoiesis:
Increased number of megakaryocytes, many hypolobated
forms with mature cytoplasm.
Erythropoiesis:
Increased with mild dyserythropoiesis
Iron Content (aspirate): Decreased iron stores
Granulopoiesis:
Adequate with normal maturation
Lymphocytes:
Normal number and morphology
Biopsy and
clot section: No evidence of granuloma, fibrosis or abnormal cellular
infiltrates
Iron content
(biopsy and clot section): Decreased iron stores
Intradepartmental
Consultation
_
Non Clinical Documentation
CPT: 88305
x 2, 88313 x 2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
+++++
59.
Monoclonal lymphocytosis vs. Focal involvement with a CD5-positive low grade B
cell lymphoproliferative disorder
Diagnosis
Peripheral
Blood:
- Normocytic normochromic anemia
- Normal lymphocyte count and morphology
Bone
Marrow:
- Normocellular for age (40%)
- Focal involvement by CD5-positive monoclonal
B cells,
see comment
- Adequate iron stores
Comment
-Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-18- 588) shows an abnormal
B cell population (about 69% of the lymphocytes analyzed, or 9% of bone marrow
cells) that is positive for CD5, CD19, CD20 (bright signal), FMC7, and surface
kappa light chain restriction (bright signal). These B cells are negative for
CD10, CD23. These B cells are predominantly small in size (based on
forward-scatter signal). Analysis of CD38-positive cells shows a small abnormal
plasma cell population. These plasma cells are positive for CD56, with
cytoplasmic kappa light-chain restriction. They are negative for CD19. These
results, together with morphological findings in bone marrow, are most
consistent with a CD5-positive monoclonal B cell population.
-Immunohistochemical
stains, with adequate controls, are performed on biopsy for CD3, CD5, CD20,
CD23, CD79a, CD138, cyclin D1. The lymphoid aggregate in biopsy is positive for
CD5, CD20, CD79a, CD23 and negative for cyclin D1, CD3, CD5. Note that there is
a discrepancy between CD23 result by flow cytometry and immunostain,
likely due to different antibody affinity. CD138 shows scattered plasma cells
(<5%)
-Further workup
is suggested to rule out the primary site of a potential B cell lymphoma in
this patient (marginal zone lymphoma or lymphoplasmacytic lymphoma) which is
likely associated with IgG-kappa monoclonal gammopathy
-Bone
marrow aspirate was sent for cytogenetics, FISH panels for myeloma and NHL, PCR
for MYD88
- Findings
are notified to Dr xxx on xxx
Tumor Summary
_
Specimen Source
1. Bone marrow
aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
61 year-old male with acute kidney failure on chronic renal
disease, and IgG-kappa monoclonal gammopathy by serum protein immunofixation
Gross Description
The case is received in 2 parts both labeled with the patient's name and medical record
number.
1. Received in formalin labeled "clot"
1.5 x 1.0 x 1.0 cm portion of clotted blood.
The specimen is trisected and entirely submitted in 1A.
2. Received in formalin labeled "core"
is a 0.8 x 0.2 x 0.2 cm tan-red bony core fragment. The specimen is entirely submitted in 2A,
following decalcification. RC 11/12/
Peripheral Smear
CBC Results
Date/time:
11/12/2018 at 0400
CBC Results:
WBC 7.1
K/CMM Normal
RBC 3.92 M/CMM
LOW
Hgb 12.6
g/dL LOW
Hct 36.1 % LOW
MCV 92.0 fL Normal
MCH 32.0 pg HI
MCHC 34.8
g/dL Normal
RDW 13.7 %
Normal
MPV 7.9 fL Normal
Platelet 204 K/CMM Normal
Segs 57.2 %
Normal
Lymphocytes 30.4
% Normal
Monocytes 9.1
% Normal
Eosinophils 2.1 %
Normal
Basophils 1.2
% HI
Segs-Bands # 4.1 K/CMM Normal
Lymphocytes # 2.2 K/CMM
Normal
Monocytes # 0.6
K/CMM Normal
Eosinophils # 0.1
K/CMM Normal
Basophils # 0.1
K/CMM Normal
Retic Auto 1.7
% HI
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normocytic normochromic anemia with mild polychromasia, a few echinocytes seen;
no rouleaux formation
White
cells: Normal in number
Granulocytes: Normal morphology
Lymphocytes: Normal morphology
Monocytes: Normal morphology
Platelets: Normal number and morphology
Bone marrow
Differential
(%) on aspirate
Myeloblasts:
0
Promyelocytes:
3
Myelocytes:
12
Metas: 10
Bands &
PMN's: 30
Eos: 3
Baso:
0
Monos:
3
Lymphs:
13
Plasma
cells: 3
Erythroids:
23
M:E ratio: 2.6
Cellularity: 40%, normocellular for age
Megakaryopoiesis:
Adequate with normal maturation
Erythropoiesis:
Adequate with normal maturation
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis:
Adequate with normal maturation
Lymphocytes:
Normal number and morphology
Plasma
Cells: Normal number (3%) and morphology
Biopsy and
clot section: No evidence of granuloma, fibrosis or large clusters of plasma
cells. A focal aggregate of small lymphocytes is seen in biopsy (please refer
to immunohistochmical stains in Comment)
Iron
content (biopsy and clot section): Adequate iron stores
Intradepartmental
Consultation
_
Non Clinical Documentation
CPT:88305 x
2, 88313 x 2, 88311, 85097, 85060
The positive
controls and internal negative controls for the special stains have been
reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report."
++++
Peripheral
Blood:
-
Normocytic normochromic anemia
Bone
Marrow, R iliac crest:
- Diffuse
Neuroblastoma involvement in bone marrow, see comment
- Decreased
iron stores
Comment
-Immunohistochemical
stains, with adequate controls, are performed on biopsy for CD45, CD56, CD99, Desmin, Myogenin, and Neurofilement. The tumor cells are positive for CD56 and Neurofilement. They are negative for CD45, CD99, Desmin, Myogenin. The morphology
and immunostain findings are consistent with
neuroblastoma
-Dr Linda
Li was notified of the diagnosis on 11/28/18
Tumor Summary
Specimen:
Right Iliac crest bone marrow
Procedure:
bone marrow (trephine) biopsy
Aspiration
site: Right iliac crest
Biopsy site:Right iliac crest
Histologic
type: Neuroblastoma
Immunophenotyping
Immunohistochemistry:
performed
Flow
cytometry: Not performed
Specimen Source
1. Right
Iliac crest bone marrow aspirate and clot
2. Right
Iliac crest bone marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
3 year old male with retroperitoneal mass suspicious of
Neuroblastoma.
Gross Description
The case is received in 2 parts both labeled with the patient's name and medical record
number.
1. Received in formalin labeled "RT
clot" is a 1.5 x 1.5 x 0.5 cm portion of clotted blood. The specimen is trisected and entirely submitted
in 1A.
2. Received in formalin labeled "RT
core" is a 1.6 x 0.1 x 0.1 cm tan red bony core fragment. The specimen is submitted in toto in 2A,
following decalcification. RC 11/26/
Peripheral Smear
CBC result
(11/26/2018)
WBC 4.4
K/CMM Normal
RBC 2.93
M/CMM Low
Hgb 8.3
g/dL Low
Hct
23.4 % Low
MCV 79.8 fL Normal
MCH 28.2 pg Normal
MCHC 35.3
g/dL Normal
RDW 15.6 %
High
Platelet
168 K/CMM Normal
MPV 7.6 fL Normal
Segs 33.0 %
Normal
Lymphocytes
52.0 % Normal
Monocytes
9.0 % Normal
Basophils
2.0 % High
Eosinophils
3.0 % Normal
Metamyelocytes
1.0%
Segs-Bands
# 1.5 K/CMM Normal
Lymphocytes
# 2.3 K/CMM Normal
Monocytes #
0.4 K/CMM Normal
Eosinophils
# 0.1 K/CMM Normal
Basophils #
0.1 K/CMM Normal
NRBC
2/100WB
Anisocytes
1+
Microcytes
1+
Plt
Morph Normal
Microscopic Description
PERIPHERAL
BLOOD:
Erythrocytes:
Normocytic normochromic anemia with mild polychromasia.
White
cells: Normal in number and morphology
Granulocytes:
Normal in number and morphology
Lymphocytes:
Normal in number and morphology
Monocytes:
Normal in number and morphology
Platelets:
Normal number and morphology
Bone
marrow:
There are
many tumor cells in aspirate and very few hematopoietic cells. Differential
counts are not performed.
Cellularity:
90%, with diffuse tumor infiltration
Megakaryopoiesis:
Decreased with normal maturation
Erythropoiesis:
Decreased with normal maturation
Iron
Content (aspirate): Decreased iron stores
Granulopoiesis:
Decreased with normal maturation
Lymphocytes:
Decreased with normal morphology
Others: Tumor
cells in clumps
Biopsy and
clot section: Diffuse infiltration of tumor cells in rosetting
pattern.
Iron
content (biopsy and clot section): Decreased iron stores
Intradepartmental
Consultation
_
Non Clinical Documentation
CPT:88305 x
2, 88313 x 2, 88311, 85097, 85060, 88342, 88341 x5
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Some of the
immunohistochemical tests in this panel were developed and their performance
characteristics determined by Memorial Hermann Southwest Hospital Laboratory.
They have not been cleared or approved by the U. S. Food and Drug
Administration. The FDA has determined that such clearance or approval is not
necessary. These tests are used for clinical purposes. They should not be
regarded as investigational or for research. This laboratory is regulated under
the Clinical Laboratory Improvement Amendments of the 1988 (CLIA) as qualified
to perform high complexity clinical testing.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report".
++++
61. Chronic myeloid leukemia, in
hematologic remission, hypercellular
Peripheral
Blood:
-
Normochromic hypochromic anemia with moderate polychromasia
Bone
Marrow:
-
Hypercellular for age (90%)
- Chronic
myeloid leukemia, with hematologic remission
see comment
-
Trilineage hematopoiesis with no increase in blasts
- Adequate
iron stores
Comment
-Patient's
peripheral blood shows no morphologic evidence of CML. However, patient's bone
marrow is hypercellular despite a normal M/E ratio.
-Bone
marrow aspirate was sent for cytogenetics, and quantitative PCR for bcr/abl1 to assess cytogenetic and molecular response to
treatment
-Findings
were discussed with Dr Rios on 11/30/18
-Reticulin
and trichrome stains are pending on biopsy. Findings will be reported in Addendum.
Tumor Summary
Specimen:
Peripheral
blood smear
Bone marrow
aspiration
Bone marrow
aspirate clot
Bone marrow
core (trephine) biopsy
Bone marrow
core touch preparation (imprint)
Procedure:
Bone marrow
Aspiration
site: Iliac crest
Biopsy
site: Iliac crest
Histologic
type: Chronic myeloid leukemia, chronic phase
Immunophenotyping
Immunohistochemistry:
not performed
Flow
cytometry:
Not
performed
Cytogenetic
studies: Performed, see separate report
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone marrow
core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
41 y/o male
with CML-accelrated phase (diagnosed in 2/2018,
platelet count <100k while not on treatment); with t(9;22), negative FLT3
mutation, BM with reticulin fibrosis (grade 1/3)
Gross Description
The case is received in 2 parts both labeled with the patient's name and medical record
number.
1. Received in formalin and labeled "bone
marrow clot" on the requisition is a 2.0 x 1.0 x 0.3 cm portion of clotted
blood. The specimen is submitted in toto
in 1A.
2. Received in formalin labeled "bone
marrow core" on the requisition is a 1.5 x 0.2 x 0.2 cm tan-red bony core fragment.
The specimen is submitted in toto in 2A, following decalcification. RC 11/29/
Peripheral Smear
CBC Results
11/29/2018
WBC 10.0
RBC 3.03 L
Hgb 8.0 L
Hct 24.8 L
MCV 82.0
MCH 26.4 L
MCHC 32.2
RDW 18.5 H
Platelet 316
MPV 9.7
Segs 77.2 H
Monocytes 10.3
Lymphocytes 8.2
L
Eosinophils 3.2
Basophils 1.1 H
Segs-Bands
# 7.7
Lymphocytes
# 0.8 L
Monocytes # 1.0
H
Eosinophils
# 0.3
Basophils # 0.1
Retic Auto 7.5 H
Microscopic Description
Erythrocytes:
Normochromic hypochromic anemia with anisopoikilocytosis,
moderate polychromasia
White
cells: Normal in number
Granulocytes:
Normal morphology, no blasts, no eosinophila or
basophilia
Lymphocytes:
Normal morphology
Monocytes:
Normal morphology
Platelets:
Normal number and morphology
Bone marrow
Differential
(%)
Myeloblasts:
2%
Promyelocytes:
3%
Myelocytes:
4%
Metas: 2%
Bands &
PMN's: 46%
Eos: 1%
Baso:
1%
Monos:
1%
Lymphs:
2%
Plasma
cells: 0%
Erythroids:
38%
M:E ratio:
1.6
Cellularity:
90%, hypercellular for age
Megakaryopoiesis:
Increase with many early forms (basophilc cytoplasm
and hypolobated nuclei)
Erythropoiesis:
Increased with normal maturation
Iron
Content (aspirate): Adequate iron stores
Granulopoiesis:
Increased with normal maturation; no increase in blasts
Lymphocytes:
Normal number and morphology
Biopsy and
clot section: Hypercellular with no clusters of blasts
Iron
Content (biopsy/clot): Adequate iron stores
Intradepartmental
Consultation
_
Non Clinical Documentation
CPT:88305 x
2, 88313 x 2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report".
+++
Diagnosis
Peripheral
Blood:
-
Erythrocytosis
-
Leukocytosis and thrombocytosis
Bone
Marrow:
- Hypercellular
for age (60%) with panmyelosis,
supportive of Polycythemia Vera
- Negative
for reticulin fibrosis
- Decreased
iron stores
NDN/RKC 12/10/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping
of bone marrow aspirate by flow cytometry (report HF-18 -635) in Gate 1 shows a
T cell population (about 70% of the cells analyzed) with no aberrant loss or
aberrant expression of T cell markers, a B cell population (about 12% of the
cells analyzed) that is negative for CD5, CD10, no surface light-chain
restriction. The lymphocytes have small nuclear size (based on forward-scatter
signal). Analysis of the cells in the blast area (Gate 4) shows fewer than 2%
blasts (of the bone marrow cells) that are positive for CD13 and CD33. These
results show no abnormal immunophenotypes
with flow cytometry.
- Reticulin
stain, with adequate control, is performed on biopsy. The stain shows no
obvious reticulin fibrosis (only focal areas with thin fibers seen)
-Bone
marrow aspirate was sent for cytogenetics, molecular analysis for JAK2, FISH
panels for MPN and Eosinophilia.
-Dr Apostolidu was notified of the findings on 12/10/18
Tumor Summary
Specimen: _
Peripheral
blood smear
Bone marrow
aspiration
Bone marrow
aspirate clot
Bone marrow
core (trephine) biopsy
Bone marrow
core touch preparation (imprint)
Procedure:
bone marrow
Aspiration
site: R post iliac crest
Biopsy
site: R post iliac crest
Histologic
type: Polycythemia Vera
Immunophenotyping
Immunohistochemistry:
not performed
Flow
cytometry: performed
Cytogenetic
studies: Performed, see separate report
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone
marrow core biopsy, decal, touch prep
3.
Peripheral blood smear
Bone marrow
procedure was performed by IR
Clinical Information
70 year old male with suspected polycythemia vera.
Gross Description
The case is received in 2 parts both labeled with the patient's name and medical record
number.
1. Received in formalin and labeled
"clot" is a 1.0 x 1.0 x 1.0 cm portion of tan red clotted blood. The specimen is trisected and entirely
submitted in 1A.
2. Received in formalin and labeled
"core" is a 2.0 x 0.2 cm tan-pink bony core fragment. The specimen is submitted in toto in 2A,
following decalcification.
Peripheral Smear
CBC Results
on 12/
WBC 13.0 H
RBC 7.34 H
Hgb 17.4
Hct 56.0 H
MCV 76.3 L
MCH 23.7 L
MCHC 31.1 L
RDW 20.4 H
Platelet 695 H
MPV 8.1
Segs 81.2 H
Monocytes 5.5
Lymphocytes 9.9
L
Eosinophils 2.7
Basophils 0.7
Segs-Bands
# 10.5 H
Lymphocytes
# 1.3
Monocytes # 0.7
Eosinophils
# 0.4
Basophils # 0.1
Anisocyte 1+
Microcyte 1+
Retic Auto 1.0
Microscopic Description
PERIPHERAL
BLOOD:
Erythrocytes:
Increased in number with normal morphology, mild polychromasia
White
cells: Increased in number
Granulocytes:
Increased in PMNs with normal morphology; no blasts seen
Lymphocytes:
Normal morphology
Monocytes:
Normal morphology
Platelets:
Increased in number with normal morphology
Bone marrow
Differential
(%) on aspirate
Myeloblasts:
0
Promyelocytes:
1
Myelocytes:
4
Metas: 6
Bands &
PMN's: 34
Eos: 4
Baso:
0
Monos:
0
Lymphs:
5
Plasma cells:
0
Erythroids:
46
M:E ratio:
1.06
Cellularity:
60%, hypercellular for age
Megakaryopoiesis:
Increased with clustering and pleomorphism including large size, and hyperlobated nuclei
Erythropoiesis:
Increased with normal maturation
Iron
Content (aspirate): Decreased iron stores
Granulopoiesis:
Increased with normal maturation
Lymphocytes:
Normal number and morphology
Biopsy and
clot section: hypercellular; increased megakaryocytes with clustering and hyperlobated nuclei
Iron content
(biopsy and clot section): Decreased iron stores.
Non Clinical Documentation
CPT:88305 x
2, 88313 x 3, 88311, 85097, 85060,
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
++++
Diagnosis
Peripheral Blood:
- Erythrocytosis
- Leukocytosis and
thrombocytosis
Bone Marrow:
- Hypercellular for age
(60%) with panmyelosis,
supportive of Polycythemia Vera
- Negative for
reticulin fibrosis
- Decreased iron stores
NDN/RKC 12/10/2018 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-18 -635) in Gate 1 shows a T
cell population (about 70% of the cells analyzed) with no aberrant loss or
aberrant expression of T cell markers, a B cell population (about 12% of the
cells analyzed) that is negative for CD5, CD10, no surface light-chain
restriction. The lymphocytes have small nuclear size (based on forward-scatter
signal). Analysis of the cells in the blast area (Gate 4) shows fewer than 2%
blasts (of the bone marrow cells) that are positive for CD13 and CD33. These
results show no abnormal immunophenotypes
with flow cytometry.
- Reticulin stain, with
adequate control, is performed on biopsy. The stain shows no obvious reticulin
fibrosis (only focal areas with thin fibers seen)
-Bone marrow aspirate
was sent for cytogenetics, molecular analysis for JAK2, FISH panels for MPN and
Eosinophilia.
-Dr Apostolidu was notified of the findings on 12/10/18
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: bone marrow
Aspiration site: R post
iliac crest
Biopsy site: R post
iliac crest
Histologic type:
Polycythemia Vera
Immunophenotyping
Immunohistochemistry:
not performed
Flow cytometry:
performed
Cytogenetic studies:
Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
70
year old male with suspected polycythemia vera.
Gross Description
The case is
received in 2 parts both labeled "Frisk, Eric Carl" and 33573399.
1. Received in formalin and labeled "clot"
is a 1.0 x 1.0 x 1.0 cm portion of tan red clotted blood. The specimen is trisected and entirely
submitted in 1A.
2. Received in formalin and labeled "core"
is a 2.0 x 0.2 cm tan-pink bony core fragment.
The specimen is submitted in toto in 2A, following decalcification.
Peripheral Smear
CBC Results on 12/
WBC 13.0 H
RBC 7.34 H
Hgb 17.4
Hct 56.0 H
MCV 76.3 L
MCH 23.7 L
MCHC 31.1 L
RDW 20.4 H
Platelet 695 H
MPV 8.1
Segs 81.2 H
Monocytes 5.5
Lymphocytes 9.9
L
Eosinophils 2.7
Basophils 0.7
Segs-Bands # 10.5
H
Lymphocytes # 1.3
Monocytes # 0.7
Eosinophils # 0.4
Basophils # 0.1
Anisocyte 1+
Microcyte 1+
Retic
Auto 1.0
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Increased
in number with normal morphology, mild polychromasia
White cells: Increased
in number
Granulocytes: Increased
in PMNs with normal morphology; no blasts seen
Lymphocytes:
Monocytes:
Platelets: Increased in
number with normal morphology
Bone marrow
Differential (%) on
aspirate
Myeloblasts: 0
Promyelocytes: 1
Myelocytes: 4
Metas: 6
Bands & PMN's: 34
Eos: 4
Baso: 0
Monos: 0
Lymphs: 5
Plasma cells: 0
Erythroids: 46
M:E ratio: 1.06
Cellularity: 60%, hypercellular
for age
Megakaryopoiesis: Increased
with clustering and pleomorphism including large size, and hyperlobated
nuclei
Erythropoiesis:
Increased with normal maturation
Iron Content
(aspirate): Decreased iron stores
Granulopoiesis:
Increased with normal maturation
Lymphocytes:
Biopsy and clot
section: hypercellular; increased megakaryocytes with clustering and hyperlobated nuclei
Iron content (biopsy and
clot section): Decreased iron stores.
Non Clinical Documentation
CPT:88305 x 2, 88313 x
3, 88311, 85097, 85060,
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
++++
64.
Benign Lymphoid Aggregates
Diagnosis
Peripheral
Blood:
- Pancytopenia
Bone Marrow:
- Normocellular for age (30%)
-
Presence of benign lymphoid aggregates in biopsy
- No morphologic or immunophenotypic
evidence of lymphoma or leukemia,
see comment
-
Increased erythropoiesis with mild dyserythropoiesis
- Adequate iron stores
NDN/PSY
02/15/2019 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping
of bone marrow lymphocytes (Gate 1) by flow cytometry (report HF-
These
results indicate no abnormal immunophenotypes with flow cytometry.
-Bone marrow aspirate was sent for cytogenetics, FISH panel for MDS to rule
out myelodysplastic syndrome.
++++++++++++++++++++++++++++++++++++++++++++++++++++++++
65.
Addendum for MDS-SLD with abnormal cytogenetics
Bone marrow:
-Myelodysplastic syndrome, single-lineage
dysplasia (MDS-SLD), see Notes
NOTES:
In light of the abnormal
chromosome findings, deletion 12p and 20q (see below), together with increased
erythropoiesis and dyserythropoiesis as described
previously in original report, this case is most consistent with myelodysplastic
syndrome, single-lineage dysplasia (MDS-SLD).
Dr H. Juneja
was notified of the findings on 2/25/2019
ADDITIONAL TEST RESULTS:
1. Bone marrow aspirate, FISH:
FISH analysis for
5p/5q, 7p11/7q31, chromosome 8, KMT2A (MLL) and 20q:
ABNORMAL results with
20q-. These studies, utilizing probes specific for aberrations commonly
associated with myelodysplastic syndromes (MDS), detect the loss of one copy of
the 20q12-specific signal in 70% (140/200) of nuclei examined. The remaining
probes do not detect aberrations in the 200 nuclei/probe examined.
2. Bone marrow
aspirate, chromosome analysis:
46,XY,del(12)(p11.2p13),del(20)(q11.2q13.1)[16]/46,XY[4]
Chromosome analysis
shows a male karyotype with one ABNORMAL clone(s). The abnormal clone (16/20
cells) shows deletion of 12p and 20q. Deletion of 12p and 20q are recurrent
findings in myeloid neoplasms. In the context of MDS, this finding is
associated with an intermediate prognosis. The remaining cells are
cytogenetically normal.
Comment
The above tests were performed
in Genoptix and dated 2/16 and 2/20/2019.
Non Clinical Documentation
++++++++++++++++++++++
66. Residual leukemic
promyelocytes (5%) by immunophenotyping
Diagnosis
Peripheral Blood:
- Hypochromic
normocytic anemia and leukopenia
- No leukemic promyelocytes
or blasts seen
Bone marrow:
- Normocellular for age
- Small number of
residual leukemic promyelocytes (5%) by immunophenotyping,
see comment
- Increased iron stores
NDN/RKC 04/24/2019 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
aspirate by flow cytometry (report HF-
-Bone marrow aspirate
was sent for cytogenetics, FISH for t(15;17), and quantitative PCR for
t(15;17). Results will be reported in Addendum.
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: Bone marrow
Aspiration site: R ilac crest
Biopsy site: R ilac crest
Histologic type: Acute
promyelocytic leukemia
Immunophenotyping
Immunohistochemistry:
Not performed,
Flow cytometry:
Performed, see separate
report (HF-
Cytogenetic studies:
Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR.
Clinical Information
62
y/o male with diagnosis of APL on 2/11/19. Baseline BM was positive for t(15;17);
negative for the following: FLT3-ITD/TKD, bcr/abl1,
AML-NGS mutation panel. The most recent BM on 3/1/19 still showed positive
t(15;17) by FISH.
Gross Description
The case is received in 2 parts both labeled with the patient's name and medical record
number.
.
1. Received in formalin with no other
designation is a 1.5 x 1.1 x 0.6 cm portion of irregular tan red blood. The specimen is serially cross sectioned and
submitted in its entirety in 1A.
2. Received in formalin with no other designation
is a 2.0 cm in length by 0.3 cm in diameter tan-red bony core fragment. The specimen is submitted in toto in 2A,
following light decalcification. RC
04/22/
Peripheral Smear
CBC on 04/22/2019 at
11:20
WBC 2.5 L (
RBC
3.56 L (
Hgb
11.8 L (Ref. Range 14.0 - 18.0)
Hct 36.0 L (
MCV
101.0 H (
MCH
33.1 H (
MCHC
32.8 (
RDW
19.3 H (
MPV
8.9 (
Platelet
138 (
Segs
36.4 L (
Lymphocytes
46.2 H (
Monocytes
12.4 H (
Eosinophils
3.3 (
Basophils
1.7 H (
Neutrophils
# 0.9 L (
Lymphocytes
# 1.2 (
Monocytes
# 0.3 (
Eosinophils
# 0.1 (
Anisocyte 1+ A (
Macrocyte
1+ A (
Plt Morph
Retic Auto 2.1 H (
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normocytic hypochromic anemia, slight polychromasia
White cells: Decreased
in number
Granulocytes:
Lymphocytes:
Monocytes:
Platelets:
BONE MARROW:
Differential (performed
on aspirate)
Myeloblasts: 0%
Promyelocytes: 5%
Myelocytes: 2%
Metas: 1%
Bands& PMN's: 11%
Eos: 6%
Baso: 1%
Monos: 2%
Lymphs: 16%
Plasma cells: 0%
Erythroids: 56%
M:E ratio: 0.4
Cellularity:
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis: Increased
with rare dyserythropoiesis, including irregular
nuclear contours
Iron Content
(aspirate): Increased iron stores
Granulopoiesis:
Adequate with normal maturation; no increase in blasts
Lymphocytes:
Biopsy and clot
section: No abnormal cellular infiltrates
Iron content (biopsy
and clot section): Increased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
++++++++++++++++
67. AML with 40% residual leukemia
Diagnosis
Peripheral Blood:
- Normochromic
hypochromic anemia
- Leukopenia with
circulating blasts
Bone Marrow:
- Residual acute
myeloid leukemia (40% myeloblasts)
- Adequate iron stores
NDN/KK 04/24/2019 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (HF-
-Bone marrow aspirate
was sent for cytogenetics, AML Molecular Profile, FISH testing for MECOM
3q26.2, t(8;21), and FLT3 mutations by PCR
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: Bone marrow
Aspiration site: R
posterior iliac crest
Biopsy site: R
posterior iliac crest
Histologic type: acute
myeloid leukemia
Immunophenotyping
Immunohistochemistry:
not performed
Flow cytometry: Performed,
see separate report (HF-
Cytogenetic studies:
Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
72
year old male with AML, s/p chemo (diagnosed 3/22/2019). Baseline marrow showed
complex chromosomal abnormalities, FISH showing MECOM rearrangement, 21q+; AML
molecular profile showing abnormal ASXL1, CSF3R, TET2
Gross Description
The specimen is received in two parts, each labeled with the patient's name and
medical record number.
1. Received
in formalin, labeled with the patient's name, MRN number, and "clot,"
is a 1.7 x 1.5 x 1.2 cm blood clot. The specimen is bisected and entirely embedded
in cassette 1A.
2. Received
in formalin, labeled with the patient's name, MRN number, and "core,"
is a 1.1 x 0.2 bone core. The specimen is entirely embedded in cassette 2A for
light decal.
KK 4/23/19
Peripheral Smear
CBC on
4/22/2019:
WBC 0.8 C
RBC 2.64 L
Hgb 8.1 L
Hct 23.2 L
MCV 87.8
MCH 30.8
MCHC 35.1
RDW 17.5 H
Platelet 155
MPV 6.5 L
Segs 17.0 L
Bands 0.0
Lymphocytes 63.0
H
Atypical Lymphs 0.0
Monocytes 1.0 L
Neutrophils # 0.1
L
Lymphocytes # 0.5
L
Monocytes # 0.0
Blasts 19.0 H
Plt Morph
Retic Auto 0.3 L
Microscopic Description
Erythrocytes:
Normocytic hypochromic anemia with anisopoikilocytosis,
mild polychromasia
White cells: Leukopenia
with circulating blasts
Granulocytes: Decreased
in number
Lymphocytes:
Monocytes:
Platelets:
Bone marrow
Differential (%) on
aspirate
Myeloblasts: 40
Promyelocytes: 1
Myelocytes: 3
Metas: 1
Bands & PMN's: 3
Eos: 0
Baso: 2
Monos: 2
Lymphs: 23
Plasma cells: 7
Erythroids: 18
Cellularity: 20%,
normocellular for age
Megakaryopoiesis: Decreased
with normal maturation
Erythropoiesis:
Decreased with normal maturation
Iron Content (aspirate):
Adequate iron stores
Granulopoiesis: Arrest
of maturation with numerous blasts (40%)
Lymphocytes:
Biopsy and clot
section: Clusters of blasts seen
Iron content (biopsy
and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x 2, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report."
++++++++++
Diagnosis
Peripheral Blood:
- Normochromic hypochromic anemia
Bone Marrow:
- Normocellular for age (50%)
- No morphologic evidence of Hodgkin lymphoma
- Increased iron stores
NDN/LZ 04/24/2019 Electronic Signature: Nguyen, Nghia Andy D MD
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core biopsy,
decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
46 y/o female with recent diagnosis of Hodgkin
lymphoma, bone marrow for staging
Gross Description
The case is received in 2 parts both labeled with the patient's name and medical record
number.
1. Received in formalin with no other
designation is a 2.6 x 1.2 x 0.4 cm portion of irregular tan-red clotted
blood. The specimen is submitted in toto
in 1A.
2. Received in formalin with no other
designation is a 1.2 cm in length by 0.3 cm in diameter tan-red bony core
fragment. The specimen is submitted in
toto in 2A, following light decalcification.
RC 04/22/
Peripheral Smear
4/19/2019
CBC
Results:
WBC 4.1 K/CMM
RBC 3.08 M/CMM LOW
Hgb 8.6 g/dL LOW
Hct 26.6 % LOW
MCV 86.4 fL
MCH 27.9 pg
MCHC 32.3 g/dL
RDW 15.5 % HI
MPV 7.8 fL
Platelet 382 K/CMM
Segs 72.9 %
Lymphocytes 13.5 % LOW
Monocytes 9.2 %
Eosinophils 3.0 %
Basophils 1.4 % HI
Neutrophils
# 3.0 K/CMM
Lymphocytes
# 0.5 K/CMM LOW
Monocytes
# 0.4 K/CMM
Eosinophils
# 0.1 K/CMM
Basophils
# 0.1 K/CMM
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normochromic hypochromic anemia with anisopoikilocytosis,
mild polychromasia
White cells:
Granulocytes:
Lymphocytes:
Monocytes:
Platelets:
Bone marrow
Differential (%) on
aspirate
Myeloblasts: 2%
Promyelocytes: 6%
Myelocytes: 13%
Metas: 9%
Bands & PMN's: 27%
Eos: 2%
Baso: 0%
Monos: 4%
Lymphs: 6%
Plasma cells: 0%
Erythroids: 31%
Cellularity: 50%,
normocellular for age
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Increased with mild dyserythropoiesis
Iron Content
(aspirate): Increased iron stores
Granulopoiesis:
Adequate with normal maturation
Lymphocytes:
Biopsy and clot
section: No evidence of granuloma, fibrosis or Hodgkin lymphoma
Iron
content (biopsy and clot section): Increased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x 2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
++++++++++++
69. Low-grade B cell lymphoma in bone marrow of
patient with high-grade B cell lymphoma
Diagnosis
Peripheral Blood:
- Pancytopenia with normocytic hypochromic
RBCs
Bone Marrow:
- Normocellular for age (30%)
- B cell lymphoma involvement in bone marrow
(low-grade cytology), see comment
- Decreased iron stores
NDN/MAV 06/18/2019 Electronic Signature: Nguyen,
Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow lymphocytes (Gate 1) by flow cytometry (report HF- 19- 179) shows a
T cell population (about 50% of the cells analyzed) with no aberrant loss or
aberrant expression of T cell markers, a B cell population (about 19% of the
cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction.
The lymphocytes have small nuclear size (based on forward-scatter signal).
These results indicate no abnormal immunophenotypes with flow cytometry. Note
that these results are likely false-negative due to the very small number of
lymphoma cells in the sample.
-Several foci of
lymphoid infiltrates are seen in biopsy and clot section (paratrabecular
in biopsy). Most lymphocytes have small nuclei with mature cytology; only a
small number of large lymphocytes with prominent nucleoli are seen in the infiltrates.
-Immunohistochemical
stains, with adequate controls, are performed on biopsy for CD79a, bcl2, bcl6, cMYC, and Ki67. The stains show that the lymphocytes in the
aggregates are positive for CD79a, bcl2, bcl6. cMYC
and Ki67 shows positivity in less than 20% of the lymphocytes in the
aggregates.
-The morphologic
findings are consistent with low-grade B cell lymphoma in bone marrow. Note
that this patient has a recent diagnosis of high-grade B cell lymphoma. The
presence of low-grade B cell lymphoma in bone marrow in this case represents
typical findings in discrepancy between lymphoma morphology in the primary site
and in bone marrow.
-Dr A Rios was notified
of the findings on 6/18/2019
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: _
Aspiration site: R post
iliac crest_
Biopsy site:_R post iliac crest_
Histologic type: B cell
lymphoma
Immunophenotyping
Immunohistochemistry:
Performed,
Flow cytometry: _
Performed, see separate
report (HF-19-179)
Cytogenetic studies: not
performed
Specimen Source
1. Bone
marrow aspirate and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood smear
Bone marrow procedure
was performed by IR
Clinical Information
70yo female with past medical history of NASH
cirrhosis, DM2, hypothyroidism with a recent diagnosis of high grade B-cell
lymphoma. Abdominal and pleural fluids were both positive.
Cytology of abdominal fluid (CN19-1097) revealed B-cells
positive for CD45, CD20, CD79a, BCL2, BCL6, MUM1 (focal), cMYC,
and negative for CD30, CD68, CD138, TdT, cyclin D1,
ALK-1, HHV8 and EBER. Flow cytometry (MF19-4533) revealed CD19/20/22 positive B lymphocytes that
express CD10 and FMC7 and show lambda light chain predominance.
Pleural fluid flow cytometry (MF19-561) showed monoclonal
B-cell population, expressing CD45, CD19, CD20, CD22, CD10, FMC 7 and
restricted light chain lambda. FISH was ordered for BCL2, BCL6, and cMyc rearrangement at MHH-Memorial City.
Gross Description
The specimen is received in 2 parts each labeled with the patient's name and
medical record number.
1: Received
in formalin and labeled clot is a red-brown gelatinous portion of clotted blood
measuring 1.3 x 1.1 x 0.8 cm. The clot
is serially cross sectioned to reveal a red-brown gelatinous cut surface. The specimen is submitted in its entirety in
cassette 1A.
2: Received
in formalin and labeled BM is a red-brown cylindrical core of bone measuring
0.8 cm in length and 0.2 cm in diameter.
The specimen is submitted in toto in cassette 2A after a brief
decalcification. PSY 06/13/2019 15:00
Peripheral Smear
Erythrocytes:
Normocytic hypochromic anemia with anisopoikilocytosis,
mild polychromasia
White cells: Decreased
in number
Granulocytes: Normal morphology
Lymphocytes: Normal morphology
Monocytes: Normal morphology
Platelets: Decrease in number with normal
morphology
Microscopic Description
CBC Results
Date/time:
06/13/2019 06:29
WBC
2.6 L (Ref. Range 3.7 - 10.4)
RBC
2.66 L (Ref. Range 4.20 - 5.40)
Hgb
7.1 L (Ref. Range 12.0 - 16.0)
Hct 22.6 L (Ref. Range 36.0 - 48.0)
MCV
85.1 (Ref. Range 80.0 - 98.0)
MCH
26.8 L (Ref. Range 27.0 - 31.0)
MCHC
31.5 L (Ref. Range 32.0 - 36.0)
RDW
20.3 H (Ref. Range 11.5 - 14.5)
MPV
9.0 (Ref. Range 7.4 - 10.4)
Platelet
53 L (Ref. Range 133 - 450)
Segs
82.4 H (Ref. Range 45.0 - 75.0)
Lymphocytes
3.4 L (Ref. Range 20.0 - 40.0)
Monocytes
11.7 (Ref. Range 2.0 - 12.0)
Eosinophils
1.4 (Ref. Range 0.0 - 4.0)
Basophils
1.1 H (Ref. Range 0.0 - 1.0)
Neutrophils
# 2.2 (Ref. Range 1.5 - 8.1)
Lymphocytes
# 0.1 L (Ref. Range 1.0 - 5.5)
Monocytes
# 0.3 (Ref. Range 0.0 - 0.8)
Anisocyte 1+ A (Ref. Range None Seen - )
Microcyte
1+ A (Ref. Range None Seen - )
Retic
Auto 2.7 H (Ref. Range 0.5 - 1.5)
BONE MARROW:
Differential (%) on aspirate
Myeloblasts: 0
Promyelocytes: 2
Myelocytes: 13
Metas: 5
Bands & PMN's: 20
Eos: 3
Baso: 0
Monos: 1
Lymphs: 11
Plasma cells: 0
Erythroids: 45
M:E ratio 0.8
Cellularity: 30%, normocellular for age
Megakaryopoiesis: Adequate with
normal maturation
Erythropoiesis:
Increased with normal maturation
Iron Content (aspirate): Decreased
iron stores
Granulopoiesis:
Decreased with normal maturation
Lymphocytes: Normal in
number
Biopsy and clot section:
Several foci of lymphoid infiltrates are seen in biopsy and clot section. Most
lymphocytes have small nuclei with mature cytology; only a small number of
large lymphocytes with prominent nucleoli are seen in the infiltrates
Iron content (biopsy and
clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060, 88342, 88341 x4,
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Some of the
immunohistochemical tests in this panel were developed and their performance
characteristics determined by Memorial Hermann Southwest Hospital Laboratory.
They have not been cleared or approved by the U. S. Food and Drug
Administration. The FDA has determined that such clearance or approval is not
necessary. These tests are used for clinical purposes. They should not be
regarded as investigational or for research. This laboratory is regulated under
the Clinical Laboratory Improvement Amendments of the 1988 (CLIA) as qualified
to perform high complexity clinical testing.
+++++
70. Rule out MDS with Cytopenia
Diagnosis
Peripheral Blood:
- Macrocytic
normochromic anemia
- Mild eosinophilia
Bone Marrow:
- Normocellular for age
(20%)
- Increased
erythropoiesis with normal maturation, see comment
- Decreased iron stores
with no increase in ring-sideroblasts
NDN/RKC 01/27/2020 Electronic Signature: Nguyen,
Nghia Andy D MD
Comment
No definitive
morphologic evidence of myelodysplastic syndrome (MDS) is found in bone marrow
Bone marrow aspirate
was sent for cytogenetics, FISH panel for MDS, and Myeloid Molecular Profile to
rule out MDS
Specimen Source
1. Bone marrow clot
2. Bone marrow core
biopsy, decal, touch prep
Peripheral blood smear
Bone marrow was
obtained by IR
Clinical Information
Clinical
history: 84-year-old male with suspected MDS
Patient
with progressive macrocytic anemia despite folate and B12 therapy, in the absence
of liver and thyroid disease.
Gross Description
The case is received in 2 parts both labeled with the patient's name and medical record
number.
1. Received in formalin and labeled
"clot" is a 2.0 x 2.0 x 0.3 cm aggregate of red-brown clotted
blood. The specimen is submitted in toto
in 1A.
2. Received in formalin and labeled
"core" is a 0.7 x 0.2 cm tan-red bony core fragment. The specimen is submitted in toto in 2A,
following light decalcification. rc 01/24/2020 11:24
Peripheral Smear
CBC Results: 01/24/2020 at 9:37AM
CBC Results:
WBC 6.1 K/CMM Normal
RBC 3.56 M/CMM LOW
Hgb 12.7 g/dL LOW
Hct 37.2 % LOW
MCV 104.5 fL HI
MCH 35.8 pg
HI
MCHC 34.2 g/dL Normal
RDW 12.8 % Normal
MPV 9.1 fL Normal
Platelet 149 K/CMM Normal
Segs 40.1 % LOW
Lymphocytes 36.2 % Normal
Monocytes 10.9 % Normal
Eosinophils 11.9 % HI
Basophils 0.9 % Normal
Neutrophils # 2.5 K/CMM Normal
Lymphocytes # 2.2 K/CMM Normal
Monocytes # 0.7 K/CMM
Normal
Eosinophils # 0.7 K/CMM HI
Basophils # 0.1 K/CMM Normal
Macrocyte 1+
Retic Auto 0.9 % Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes: Macrocytic
normochromic anemia, mild polychromasia
White cells: Normal in
number
Granulocytes: Normal in
number and morphology, mild eosinophilia
Lymphocytes: Normal in
number with normal morphology
Monocytes: Normal in
number with normal morphology
Platelets: Normal
number and morphology
Bone marrow
Differential (%) on
aspirate
Myeloblasts: 1
Promyelocytes: 8
Myelocytes: 6
Metas: 9
Bands & PMN's: 22
Eos: 5
Baso: 1
Monos: 1
Lymphs: 5
Plasma cells: 3
Erythroids: 39
M:E ratio 1.35
Cellularity: 20%,
normocellular for age
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Increased with normal maturation, only rare dysplastic RBCs seen
Iron Content
(aspirate): Decreased iron stores
Granulopoiesis:
Adequate with normal maturation; no increase in myeloblasts
Lymphocytes: Normal
number and morphology
Plasma Cells: Normal
number and morphology
Biopsy and clot
section: No increase in myeloblasts
Iron content (biopsy
and clot section): No granuloma, fibrosis or abnormal cellular infiltrates seen
Non Clinical Documentation
CPT 88305 x 2, 88313 x
3, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen preparations
and have personally issued this report."
++++++
71. Plasma cell myeloma, s/p chemo with no
residual disease
Diagnosis
Peripheral
Blood:
-
Normocytic hypochromic anemia with no rouleaux formation
Bone
Marrow:
-
Trilineage hematopoiesis
-
Normocellular marrow for age (50%) with increased megakaryocytes
-
Presence of 6% polyclonal plasma cells, see comment
-
Adequate iron stores
NDN/RKC 08/12/2020 Electronic Signature: Nguyen,
Nghia Andy D MD
Comment
- Immunophenotyping of bone
marrow aspirate by flow cytometry (report HF-20-428) for plasma cells gated
using CD38 are positive for CD19, CD45, CD138; negative for CD117, CD56, CD20
and show no evidence of cytoplasmic light chain restriction. These results indicate
no evidence of monoclonal plasma cells by flow cytometry.
- Bone marrow aspirate was
sent for cytogenetics, and FISH panel for myeloma
Specimen Source
1. Bone marrow aspirate and
clot
2. Bone marrow core biopsy,
decal, touch prep
3. Peripheral blood smear
Bone marrow procedure was
performed by IR
Clinical Information
Per
medical record, the patient is a 47-year-old female with history of plasma cell
myeloma status post treatment. Initial bone marrow (HB-17-48 & HF-17-95, 02/22/17)
showed CD38 positive plasma cells with cytoplasmic kappa light chain
restriction, CD 56 positive, CD19 negative and FISH positive for +5 and 11q+.
Her last bone marrow (HB-20-82 & HF-20-138, 03/26/20) showed 0.4%
polyclonal plasma cells with normal FISH and chromosomal analysis.
Gross Description
Two specimens are received,
both labeled with the patient's name and medical record number.
1. Received in formalin and
labeled "clot" is a 1.2 x 1.0 x 0.3 cm irregular portion of red-brown
clotted blood. The specimen is trisected and submitted in its entirety in 1A.
2. Received in formalin and
labeled "core" is a 0.5 cm in length by 0.2 cm in diameter tan-red
bony core fragment. The specimen is submitted in toto in 2A, following light
decalcification. RC 08/10/2020 12:44_
Peripheral Smear
CBC
Results
Date/time: 8/10/2020
at 10:25 AM
CBC
Results:
WBC 6.6 K/CMM
RBC 4.30 M/CMM
Hgb 11.7 g/dL LOW
Hct 36.2 %
MCV 84.2 fL
MCH 27.1 pg
MCHC 32.2 g/dL
RDW 14.8 % High
MPV 8.1 fL
Platelet 298 K/CMM LOW
Segs 59.7 %
Lymphocytes 32.1 %
Monocyte 7.0 %
Eosinophil 0.5%
Basophil 0.7%
Neutrophils # 4 K/CMM
Lymphocytes # 2.1 K/CMM
Monocytes # 0.5 K/CMM
Eosinophil # 0.0 K/CMM
Basiogul # 0.0 K/CMM
NRBC # 0.01 K/CMM
Retic Auto 0.97 %
Erythrocytes: Normocytic hypochromic
anemia with mild polychromasia, no rouleaux formation
White cells: Normal in number
Granulocytes: Normal morphology
Lymphocytes: Normal morphology
Monocytes: Normal morphology
Platelets: Normal number and morphology
Microscopic Description
Bone
marrow
NOTE: The differential was performed on bone
marrow aspirate.
Differential (%)
Myeloblasts: 0
Promyelocytes: 4
Myelocytes: 1
Metas: 2
Bands & PMN's: 33
Eos: 2
Baso: 0
Monos: 0
Lymphs: 6
Plasma cells: 6
Erythroids: 41
M:E ratio 0.91
Cellularity: 50%,
normocellular for age
Megakaryopoiesis: Increased with normal maturation
Erythropoiesis: Increased
with normal maturation
Iron Content (aspirate):
Adequate iron stores
Granulopoiesis: Adequate
with normal maturation
Lymphocytes: Mild increase
(6%) with normal morphology
Plasma cells: Slight
increase (3%) with unremarkable morphology
Biopsy and clot section: No
clusters of plasma cells seen
Iron content (biopsy and
clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x 2,
88311, 85097, 85060
The positive controls and
internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I
have personally reviewed the resident's preliminary interpretation and all
specimen preparations and have personally issued this report".
+++++
72. Plasma cell myeloma, s/p chemo with
residual disease
Diagnosis
Peripheral
blood:
- Normochromic normocytic anemia
Bone marrow:
- Presence of 0.5% monoclonal plasma cells in
bone marrow,
consistent with residual plasma cell myeloma, see comment
- Adequate iron stores
Comment
- Immunophenotyping of bone
marrow aspirate by flow cytometry (report HF-20-433) gated using CD38 shows
plasma cells (1.30% of total population) including a subset of monoclonal
plasma cells (0.54% of total population) that are positive for CD56 and CD117
and show cytoplasmic Kappa light chain restriction. These cells are negative
for CD19, CD20, and CD45.
- Bone marrow aspirate was
sent for cytogenetics, and myeloma FISH panel.
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine)
biopsy
Bone marrow core touch
preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior
iliac crest
Biopsy site: R posterior
iliac crest
Histologic type: plasma cell
myeloma
Immunophenotyping
Immunohistochemistry:
performed
Flow cytometry:
Performed, see separate
report (HF-20-433)
Specimen Source
1. Bone marrow clot
2. Bone marrow core biopsy,
decal, touch prep
Peripheral blood smear
Bone marrow was obtained by
IR
Clinical Information
Clinical
history: 92 y/o male myeloma (diagnosed on 4/1/2020), s/p chemotherapy
Gross Description
_Two specimens are received
both labeled with the patient's name and medical record number.
1. Received in formalin and
labeled "clot" is a 1.8 x 1.3 x 0.8 cm portion of red-brown clotted
blood. The specimen is serially cross-sectioned and submitted in its entirety
in 1A.
2. Received in formalin and
labeled "core" are 2 tan-red bony core fragments measuring 0.3 cm in
length by 0.2 cm in diameter each. The specimen is submitted in toto in 2A,
following light decalcification. RC 08/12/2020 14:27
Peripheral Smear
CBC on 8-12-2020;
WBC 6.3
RBC 4.13 L
Hgb 11.7 L
Hct 36.4 L
MCV 88.0
MCH 28.3
MCHC 32.2
RDW 18.5 H
Platelet 193
Microscopic Description
PERIPHERAL
BLOOD:
Erythrocytes: Normochromic
normocytic anemia with mild polychromasia; no rouleaux formation
White cells: Normal in number
Granulocytes: Normal number and morphology
Lymphocytes: Normal number and morphology
Monocytes: Mild increase with normal morphology
Platelets: Normal in number, with rare clumps
seen
Bone marrow aspirate:
Differential (%)
MYELOBLASTS: 0%
PROMYELOCYTES 4%
MYELOCYTES: 5%
METAMYELOCYTES: 5%
BANDS/NEUTROPHILS: 42%
EOSINOPHILS: 3%
BASOPHILS: 0%
MONOCYTES: 0%
LYMPHOCYTES: 17%
PLASMA CELLS: 2%
ERYTHROIDS: 22%
Myeloid to erythroid ratio: 3.1
Cellularity: 20%, normocellular for age
Megakaryopoiesis: Adequate with normal maturation
Erythropoiesis: Adequate with normal maturation
Iron Content (aspirate): Adequate iron stores
Granulopoiesis: Adequate with normal maturation
Lymphocytes: Normal number and morphology
Plasma cells: Normal number (2%) with mature
cytology
Biopsy and clot section: No clusters of plasma
cells are seen
Iron content (biopsy and clot section): Adequate
iron stores
Intradepartmental Consultation
_
Non Clinical Documentation
CPT 88305 x 2, 88313 x 3,
88311, 85097, 85060
The positive controls and
internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report".
++++
73. Monoclonal B cell lymphocytosis vs.
metastasis of small lymphocytic lymphoma
Diagnosis
Peripheral Blood:
- Normochromic hypochromic anemia
- Normal leukocyte count and lymphocyte count
Bone Marrow:
- Normocellular for age (30%)
- A small number of monoclonal B cell lymphocytes (8% of bone marrow cells)
- Adequate iron stores
NDN/AMM 04/13/2021 Electronic Signature: Nguyen, Nghia
Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-21-000225) shows a T cell population (about 42% of the lymphocytes gated) with no aberrant loss or aberrant expression
of T cell markers, and a B cell population (49% of the lymphocytes gated). A small subpopulation of B cells (8% of all the bone marrow cells
gated) is positive for CD5, CD19, CD20, CD23 and surface kappa light-chain restriction. They are negative for CD10,
and CD38. These results indicate the presence of a small number of monoclonal B cell
lymphocytes (8% of bone marrow cells) that are positive
for CD5, CD19, CD20, CD23 and
surface kappa light-chain restriction.
They are negative for CD10, and CD38.
-The findings
of a few small lymphoid aggregates in bone marrow, together with flow cytometry
results, are consistent with either (a) monoclonal B cell lymphocytosis, or (b)
metastasis of small lymphocytic lymphoma, especially in light of patient's
lymphadenopathy and splenomegaly. Further workup is suggested to rule out the
primary site (lymph nodes) of a potential B cell lymphoma in this patient. Note
that patient's CBC and peripheral blood do not support chronic lymphocytic
leukemia.
-Bone marrow aspirate
was sent for cytogenetics, FISH panel for CLL/SLL.
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: monoclonal B cells
Immunophenotyping
Immunohistochemistry: Performed
Flow cytometry:
Performed, see separate report (HF-21-225)
Cytogenetic
studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
74 y/o male
with lymphadenopathy, mediastinal and axillary lymphadenopathy, splenomegaly,
chest pain and night sweat; r/o lymphoma
Gross Description
The specimen
is received in 2 containers: Wetzel, Eugene and 55474079
1. The specimen is received in formalin labeled
with the patient's name, MRN, and " bone marrow clot." It consists of a 2.6 x 1.3 x 0.7 cm aggregate
of red-purple clotted blood which is submitted in toto in cassette 1A.
2. The specimen is received in formalin labeled
with the patient's name, MRN, and " bone marrow biopsy." It consists of a 1.8 x 0.2 cm firm, tan-pink,
cylindrical core of bone which is entirely submitted in cassette 2A following
light decalcification.
DJD
04/12/2021 14:28
Peripheral Smear
CBC Results
Date/time:
4/12/2021
CBC Results:
WBC 9.0 K/CMM Normal
RBC 4.19 M/CMM LOW
Hgb 12.1 g/dL LOW
Hct 35.9 % LOW
MCV 85.6 fL Normal
MCH 28.9 pg Normal
MCHC 33.7 g/dL Normal
RDW 15.1 % HI
MPV 8.1 fL Normal
Platelet 326 K/CMM Normal
Segs 43.0 % LOW
Lymphocytes 43.3 %
HI
Monocytes 8.8 % Normal
Eosinophils 4.0 % Normal
Basophils 0.9 % Normal
Neutrophils # 3.9 K/CMM Normal
Lymphocytes # 3.9 K/CMM Normal
Monocytes # 0.8 K/CMM
Normal
Eosinophils # 0.4 K/CMM Normal
Basophils # 0.1 K/CMM Normal
Retic Auto 1.2 % Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normochromic hypochromic anemia with anisopoikilocytosis,
mild polychromasia
White cells: Normal in
number
Granulocytes: Normal morphology
Lymphocytes: Normal morphology
Monocytes: Normal morphology
Platelets: Normal number and morphology
Bone marrow
Differential (%)
Myeloblasts: 0
Promyelocytes: 4
Myelocytes: 7
Metas: 5
Bands & PMN's: 39
Eos: 3
Baso: 0
Monos: 0
Lymphs: 10
Plasma cells: 1
Erythroids: 31
Cellularity: 30%, normocellular for age
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Adequate with normal maturation
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis:
Adequate with normal maturation
Lymphocytes: Normal
number and morphology
Plasma Cells: Normal
number and morphology
Biopsy and clot
section: No evidence of granuloma, fibrosis. A few small lymphoid aggregates
are seen in biopsy and clot. The lymphocytes are small with mature cytology.
Iron content (biopsy
and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally reviewed the resident's preliminary
interpretation and all specimen preparations and have personally issued this
report".
+++++
74. Chronic neutropenia with arrest of
granulocytic maturation
Diagnosis
Peripheral Blood:
- Mild normochromic hypochromic anemia
- Leukopenia with neutropenia
- No leukemic cells seen
Bone Marrow:
- Arrest of maturation of granulocytes
- Normocellular for age (30%)
- No morphologic or immunophenotypic evidence
of leukemia or lymphoma
- Adequate iron stores
NDN/AMM 04/13/2021 Electronic Signature: Nguyen,
Nghia Andy D MD
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-21-000227) shows a T cell population (about 65% of the cells analyzed) with no aberrant loss or
aberrant expression of T cell markers, a B cell population (about 24% of the cells analyzed) that is negative for CD5,
CD10, no surface light-chain restriction. The lymphocytes have small nuclear
size (based on forward-scatter signal). Analysis of the cells in the blast area
(CD45-dim) shows 3% normal myeloblasts (of the bone marrow cells) that are positive
for CD13, CD33,
CD34, CD117. These
results indicate no evidence of non-Hodgkin lymphoma or leukemia.
-Arrest of granulocyte
maturation is seen in bone marrow which is likely the cause of neutropenia in
this patient. Etiologies may include medication effect, congenital neutropenia,
among others. Clinical correlation is suggested
-Bone marrow aspirate
was sent for cytogenetics
Tumor Summary
N/A
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
87 y/o male
with 10 year-history of leukopenia.
Gross Description
The
specimen is received in 2 containers: Ekelmans,
Albertus and 40876736
1. The specimen is received in formalin labeled
with the patient's name, MRN, and " bone marrow clot." It consists of a 2.1 x 1.3 x 0.5 cm aggregate
of red-purple clotted blood which is submitted in toto in cassette 1A.
2. The specimen is received in formalin labeled
with the patient's name, MRN, and " bone marrow core biopsy." It consists of a 0.5 x 0.3 cm firm, tan-pink,
cylindrical core of bone which is entirely submitted in cassette 2A following
light decalcification.
DJD
04/12/2021 14:44
Peripheral Smear
Erythrocytes: Normochromic
hypochromic anemia with anisopoikilocytosis, mild
polychromasia
White cells: Markedly
decreased in number; no blasts seen
Granulocytes: Normal morphology
Lymphocytes: Normal morphology
Monocytes: Normal morphology
Platelets: Normal number and morphology
Microscopic Description
CBC Results
Date/time: 04/08/2021,
10:23
WBC 0.9 K/CMM CRIT
RBC 4.46 M/CMM LOW
Hgb 14.2 g/dL Normal
Hct 42.7 % Normal
MCV 95.7 fL HI
MCH 31.7 pg HI
MCHC 33.1 g/dL Normal
RDW 13.9 % Normal
MPV 8.0 fL Normal
Platelet 175 K/CMM Normal
Segs 10.0 % LOW
Bands 4.0 % Normal
Lymphocytes 36.0 % Normal
Atypical Lymphs 0.0
% Normal
Monocytes 50.0 % HI
Neutrophils
# 0.1 K/CMM LOW
Lymphocytes
# 0.3 K/CMM LOW
Monocytes # 0.4 K/CMM Normal
Bone marrow
Differential (%)
Myeloblasts: 3
Promyelocytes: 4
Myelocytes: 13
Metas: 10
Bands & PMN's: 2
Eos: 0
Baso: 1
Monos: 1
Lymphs: 37
Plasma cells: 3
Erythroids: 26
M:E ratio: 1.4:1
Cellularity: 30%, normocellular for age
Megakaryopoiesis: Adequate
with normal maturation
Erythropoiesis:
Adequate with normal maturation
Iron Content (aspirate): Adequate
iron stores
Granulopoiesis:
Adequate with marked arrest in maturation; no increase in blasts seen
Lymphocytes: Increased
in number with normal morphology
Plasma Cells: Normal
number and morphology
Biopsy and clot
section: No evidence of granuloma, fibrosis or abnormal cellular infiltrates
Iron content (biopsy
and clot section): Adequate iron stores
Intradepartmental Consultation
N/A
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The
positive controls and internal negative controls for the special stains have
been reviewed, and appropriate staining is confirmed by the pathologist whose
signature appears above.
Teaching Physician Statement
"I have personally
reviewed the resident's preliminary interpretation and all specimen
preparations and have personally issued this report".
++++
75. AML,
NOS-Dry tap with DX made on BX and IHCs
Diagnosis
Peripheral blood:
- Normocytic hypochromic anemia with a few
NRBCs
- Marked thrombocytopenia
- Rare blasts seen
Bone marrow:
-Acute myeloid leukemia (30% blasts), NOS
-Diffuse reticulin fibrosis (grade 1 out of
3)
-Increased iron stores without increase in
ring-sideroblasts
NDN/HLF 05/10/2021 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-No immunophenotyping with flow cytometry,
cytogenetics or molecular studies were performed due to dry tap with no aspirate
(most likely secondary to reticulin fibrosis).
-Reticulin stain on biopsy shows diffuse
myelofibrosis (grade 1 out of 3).
-Bone marrow biopsy is hypercellular at 95%
and shows diffuse distribution of immature hematopoietic precursors, admixed
with increased plasma cells with mature cytology, mildly increased and
dysplastic megakaryocytes (small and hypolobated
nuclei). Granulocytes show lack of maturation with rare PMNs and bands. Touch
prep shows many immature bone marrow cells with crush artifacts.
-Immunohistochemical stains, with adequate
controls, are performed on biopsy (block 1A) for CD34, CD117, CD61, CD79a, CD4,
CD8, TdT, CD138, E-cadherin, CD43, MPO, pankeratin. The stains show numerous erythroid precursors
(about 60% of bone marrow cells, positive for Ecadherin),
increased myeloblasts (about 30%, positive for CD34, with subset positive for
MPO). Megakaryocytes are mildly increased with expression of CD61. Scattered
positive cells are shown with CD117, CD4, CD8, CD79a. The following stains are
negative: Pan-keratin, and TdT. CD43 shows many
positive cells (non-specific stain for erythroids,
granulocytes, megakarycytes). CD138 shows many plasma
cells.
-The morphology of peripheral blood, bone
marrow biopsy and immunophenotypic findings are most consistent with acute
myeloid leukemia, NOS. The findings of increased erythroids,
myelofibrosis, dysplastic megakaryocytes are not specific, but are suggestive
of transformation from a previous myelodysplastic syndrome phase.
-Findings were notified to Dr. Apostolidou on 5/10/2021
Tumor Summary
Specimen:
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest (dry
tap)
Biopsy site: R posterior iliac crest
Histologic type: acute myeloid leukemia, NOS
Immunophenotyping
Immunohistochemistry: performed
Flow cytometry: not performed (dry tap)
Cytogenetic studies: Not performed (dry tap)
Specimen Source
1. Bone marrow core biopsy, decal, touch prep
2. Peripheral blood smear
Bone marrow procedure was performed by IR
Clinical Information
58 old female with history of chronic anemia,
complicated by chronic thrombocytopenia dating back to 10/2020. Bone marrow is
performed to rule out leukemia and MDS-EB.
Gross Description
The case is received in 1 part labeled:
Allen, Christie and 37914868
1. The specimen is received in formalin
labeled with the patients name, MRN, and "bone marrow core biopsy."
It consists of 3 tan-red cylindrical bone cores which measure 0.5 x 0.3 cm, 1.0
x 0.3 cm, and 2.0 x 0.3 cm. The specimen is submitted entirely following
decalcification in cassette 1A.
HLF 05/06/2021 10:29
Peripheral Smear
05/06/2021 03:37
WBC 5.2
RBC 2.26 L
Hgb 6.8 * C
Hct 19.8 * C
MCV 87.5
MCH 30.1
MCHC 34.4
RDW 16.1 H
MPV 8.3
Platelet 10 * C
Segs 38.5 L
Lymphocytes 40.3 H
Monocytes 19.3 H
Eosinophils 0.2
Basophils 1.7 H
Neutrophils # 2.0
Lymphocytes # 2.1
Monocytes # 1.0 H
Basophils # 0.1
Erythrocytes: Normocytic hypochromic anemia,
with anisopoikilocytosis, presence of a few target
cells, nucleated RBCs, and slight polychromasia
White cells: Normal in number with rare
blasts seen
Granulocytes: Normal in number
Lymphocytes: Normal in number and morphology
Monocytes: Normal morphology
Platelets: marked thrombocytopenia
Microscopic Description
Bone marrow: Dry tap
with no aspirate. Differential was not performed on touch prep due to crushed
artifacts..
Cellularity: 95%, hypercellular for age
Megakaryopoiesis:
Mildly increased with small and hypolobated forms
Erythropoiesis: Markedly increased
Granulopoiesis: Arrest of maturation with many myeloblasts
Lymphocytes: Markedly reduced
Plasma Cells: Increased with normal morphology
Biopsy: Diffuse distribution of immature cells.
Iron content (biopsy) : Increased iron stores with no increase in
ring-sideroblasts
Intradepartmental Consultation
Dr. J. Baalwa
Non Clinical Documentation
CPT:88305 x 1-GC, 88313 x 2-GC, 88311-GC,
85060-GC, 88342-CG, 88341x11.
The positive controls and internal
negative controls for the special stains have been reviewed, and appropriate
staining is confirmed by the pathologist whose signature appears above.
Teaching Physician Statement
"I have personally reviewed the
resident's preliminary interpretation and have personally issued this
report".
++++
76. A small number of monoclonal B cell lymphocytes (1.3% of bone marrow cells)
Diagnosis
Peripheral Blood:
- Normochromic hypochromic anemia, with mild polychromasia
- Normal leukocyte count with no lymphocytosis
Bone Marrow:
- Normocellular for age
- A small number of monoclonal B cell lymphocytes
(1.3% of bone
marrow cells),
see comment
- Decreased iron stores
NDN/AMM
05/10/2021 Electronic Signature: Nguyen, Nghia Andy D MD
Comment
-Immunophenotyping of bone marrow aspirate by flow cytometry (report
HF-21-283) in lymphocytic gate shows a T cell population
(about 50% of the lymphocytes gated) with no aberrant loss
or aberrant expression of T cell markers, an NK cell population (33% of the
lymphocytes), and an atyical B cell population (13% of the lymphocytes gated, or 1.3% of all bone marrow leukocytes) that is
positive for CD19, CD20 and surface kappa
light-chain restriction. They are negative for CD5, CD10, and CD23. These results indicate a small number of
monoclonal B cell lymphocytes (1.3%
of bone marrow cells).
-The
findings of a small number (1.3%) of monoclonal B cells in bone marrow with flow
cytometry results in this patient, are of unknown clinical significance. No
lymphoid aggregates are found in biopsy and clot. Metastasis of a small B cell
lymphoma to bone marrow cannot be completely ruled out. Review of EMR did not
reveal obvious LAD or splenomegaly in physical exam. No imaging study is
available to check for LAD. If clinically indicated, further workup is
suggested to rule out the primary site (lymph nodes) of a potential B cell
lymphoma in this patient. Note that patient's CBC and peripheral blood do not
support chronic lymphocytic leukemia.
-Bone
marrow aspirate was sent for cytogenetics, FISH panel for MDS, FISH panel for
low-grade small B cell lymphoma.
Specimen
Source
1. Bone marrow aspirate and clot
2. Bone marrow core biopsy, decal, touch prep
3. Peripheral blood smear
Bone marrow procedure was performed by IR
Clinical
Information
70 year old
female with history of HTN, Crohns,
PSC/cirrhosis, celiac disease, iron deficiency anemia. Bone marrow to work up persistent
anemia
Gross
Description
Specimen is received in 2 parts labeled: Bobo, Jackie and 45045559
1. The specimen is received in formalin labeled with the patients name,
MRN, and "bone marrow clot." It consists of a 1.5 x 1.5 x 0.5 cm
piece of dark red clotted blood which is submitted in toto in cassettes 1A.
2. The specimen is received in formalin labeled with the patients name,
MRN, and "bone marrow biopsy." It consists of 3 tan cylindrical bone
cores which measure 0.3 x 0.2 cm, 0.5 x 0.2 cm, and 1.5 x 0.2 cm. The specimen
is submitted entirely following decalcification in cassette 2A.
HLF 05/07/2021 15:13
Peripheral
Smear
CBC Results
05/07/2021
WBC 9.8
Hgb 9.0
MCV 84
Plt
265
Differential
Seg 76.3%
Lymph 12.1%
Mono 9.5%
Eosin 0.5%
Baso 1.6%
Microscopic
Description
PERIPHERAL BLOOD:
Erythrocytes:
Hypochromic normocytic anemia, with mild polychromasia
White
cells: Normal number and morphology
Granulocytes:
Relatively increased with normal morphology
Lymphocytes:
Relatively decreased with normal morphology
Monocytes:
Normal morphology
Platelets:
Normal number and morphology
Bone marrow
Differential (%)
Myeloblasts:
0
Promyelocytes:
5
Myelocytes:
9
Metas: 10
Bands &
PMN's: 34
Eos: 1
Baso:
0
Monos:
0
Lymphs:
7
Plasma
cells: 1
Erythroids:
33
M:E ratio:
1.78
Cellularity:
30% (normocellular for age)
Megakaryopoiesis:
Adequate with a few hypolobated forms
Erythropoiesis:
Adequate with normal maturation
Granulopoiesis:
Adequate with normal maturation, no increase in blasts
Lymphocytes:
Decreased with normal morphology
Iron
content (aspirate): Decreased iron stores
Biopsy and
clot: No lymphoid aggregates are found in biopsy and clot.
Iron
content (biopsy): Decreased iron stores
Intradepartmental
Consultation
None.
Non
Clinical Documentation
CPT: 88305 x 2, 88313 x 2, 88311, 85097, 85060
The positive controls and internal negative controls for the special stains
have been reviewed, and appropriate staining is confirmed by the pathologist
whose signature appears above.
Teaching
Physician Statement
"I have personally reviewed the resident's
preliminary interpretation and have personally issued this report".
++++
77. T cell large granular lymphocytic leukemia
(T cell LGL)
Diagnosis
Peripheral
Blood:
- Hypochromic microcytic anemia with many
elliptocytes.
- Leukopenia with neutropenia
- Relative lymphocytosis (58%) with large
granular lymphocytes
- Thrombocytopenia
Bone Marrow:
- T cell large granular lymphocytic leukemia
(T cell LGL), see comment
-
Monoclonal gammopathy of undetermined significance (MGUS)
- Adequate iron stores
Comment
-Immunophenotyping of
bone marrow aspirate by flow cytometry (report HF-21-428) shows a predominant T
cell population (83% of lymphocytes, or 50% of bone marrow cells) with high CD8/CD4 ratio (8:1), positive for CD2, CD3,
CD5, CD7, TCR alpha/beta, CD16 and CD57, negative for CD56, TCR
gamma/delta. A small B cell population
is seen that is negative for CD5, CD10, also no surface light-chain
restriction. The lymphocytes have small nuclear size base on forward-scatter signal.
Analysis of cells in CD45-dim (blast) gate shows 1% of normal myeloblasts with
expression of CD34, CD117, CD13, CD33. NK cells (positive for CD56, negative
for sCD3) account for only 7% of bone marrow leukocytes. Plasma cells account
for about 0.6% of the cells analyzed and show cytoplasmic kappa light chain
restriction. They are positive for CD138, CD38 and negative for CD56, CD117.
Impression:
(1) presence of monoclonal plasma cells (0.6% of bone marrow cells) in bone marrow.
(2) presence of small T cells (50% of bone
marrow cells) with high CD8/CD4 ratio (8:1), positive for TCR
alpha/beta, CD16 and CD57,
negative for CD56, TCR gamma/delta.
-It is noted from her
EMR that patient had lung transplant in 1/2021 and no past history of bone
marrow/stem cell transplant; also no history of autoimmune disease.
-Despite absolute
lymphopenia and no documented finding of splenomegaly, the findings in
peripheral blood and bone marrow (around 50% lymphocytes with cytoplasmic large granules, high
CD8/CD4 ratio, positive for TCR alpha/beta, CD16 and CD57) are most supportive
of T cell large granular lymphocytic leukemia (T cell LGL). Additionally, 1% of
monoclonal plasma cells are detected in bone marrow, consistent with monoclonal
gammopathy of undetermined significance (MGUS)
-Bone marrow aspirate
was sent for cytogenetics, FISH panel for MDS, myeloma and T cell clonality
(beta and gamma) by PCR.
-
Dr Idowu was notified of the findings on 7/10/2021
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest_
Histologic type: TCLGLL
Immunophenotyping
Immunohistochemistry: not performed,
Flow cytometry: _
Performed, see separate report (HF-21-428)
Cytogenetic studies: Performed, see
separate report
Specimen Source
1. Bone marrow aspirate
and clot
2. Bone marrow core
biopsy, decal, touch prep
3. Peripheral blood
smear
Bone marrow procedure
was performed by IR
Clinical Information
63 y/o
female with neutropenia, thrombocytopenia, s/p lung transplant in 1/2021.
Gross Description
This case is received in two parts labeled Battles, Deborah
Pleasant
1. The specimen is received
in formalin labeled with the patient's name, MRN, and " bone marrow
clot." It consists of a 1.2 x 1.0 x
0.6 cm aggregate of red-purple clotted blood which is submitted in its entirety
in cassette 1A.
2. The specimen is received
in formalin labeled with the patient's name, MRN, and " bone marrow core
biopsy." It consists of four
fragments ranging from 0.4 - 1.2 cm
firm, tan-pink, cylindrical core of bone which is entirely submitted in
cassette 2A following light decalcification.
JMG 07/08/2021 11:38
Peripheral Smear
CBC Results:
WBC 1.4 C
RBC 3.90 L
Hgb 9.8 L
Hct 30.8 L
MCV 78.9 L
MCH 25.1 L
MCHC 31.8 L
RDW 23.9 H
Platelet 167
MPV 9.8
Retic Perf Yes
Retic Auto 5.1 H
Segs 16.0 L
Bands 0.0
Lymphocytes 58.0
H
Atypical Lymphs 0.0
Monocytes 22.0 H
Neutrophils # 0.2
L
Lymphocytes # 0.8
L
Monocytes # 0.3
Metamyelocytes 4.0
H
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Hypochromic microcytic anemia, mild polychromasia
White cells: Decreased
in number
Granulocytes: Decreased
in number, normal morphology
Lymphocytes: Relatively
increased (58%), many large granular lymphocytes seen
Monocytes: Normal
morphology
Platelets: Decreased in
number, normal morphology
Bone marrow
Differential (%) from
aspirate
Myeloblasts: 1
Promyelocytes: 2
Myelocytes: 2
Metas: 1
Bands & PMN's: 20
Eos: 0
Baso: 0
Monos: 0
Lymphs: 50
Plasma cells: 0
Erythroids: 24
Cellularity: 40%,
normocellular for age
Megakaryopoiesis: Decreased
with normal maturation
Erythropoiesis:
Adequate with normal maturation; no dysplasia seen
Iron Content
(aspirate): Adequate iron stores
Granulopoiesis:
Decreased in number, no increase in blasts
Lymphocytes: Increased
(60% of bone marrow cells), presence of large granular forms
Biopsy and clot
section: Increase in lymphocytes; no evidence of granuloma, fibrosis
Iron content (biopsy
and clot section): Adequate iron stores
Intradepartmental Consultation
_
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I have personally reviewed the resident's preliminary
interpretation and all specimen preparations and have personally issued this
report".
++++++++++++++
78. CMML-0 with Reticulin Myelofibrosis
Diagnosis
Peripheral Blood:
- Leukocytosis with monocytosis,
a few blasts (2%)
- Normocytic normochromic anemia
- Severe thrombocytopenia
Bone Marrow:
- Chronic myelomonocytic leukemia (CMML-0)
- Hypercellular for age (95%)
-
Reticulin stain shows myelofibrosis (grade 2 out of 3)
- Adequate iron stores
NDN/BM 08/04/2021 Electronic Signature: Nguyen,
Nghia Andy D MD
Comment
-Due to insufficient bone marrow aspirate, peripheral blood
samples were obtained for further testing (flow cytometry, FISH and Mutation
tests).
-Immunophenotyping of peripheral blood leukocytes by flow
cytometry shows a small lymphocytic population consisting of normal B
lymphocytes and T lymphocytes. Analysis of cells in the monocytic area shows a
mature monocytic population (49% of leukocytes) with aberrant expression of CD56.
Analysis of the cells in the blast area (CD45-dim gate) shows 2% myeloblasts
(of the leukocytes) that are positive for CD13, CD33, CD34, MPO, and CD117.
They show aberrant CD7 expression and are negative for TdT,
CD10, CD19, CD3. These immunophenotype results, together with morphological
findings in peripheral blood and bone marrow, are supportive of chronic
myelomonocytic leukemia type 0 (CMML-0).
-Peripheral blood
samples were sent for cytogenetics, FISH panel for MDS and MPN, and molecular
studies for MPN by PCR.
-Immunohistochemical
stains, with appropriate controls, were performed on the bone marrow core
biopsy for CD34, CD7, CD117, CD3, MPO, E-cadherin, CD56, and CD4. Stains CD34
and CD117 highlight rare immature precursor cells comprising <5% of the
total cells. Stains CD3 and CD7 stain the scattered T-cells, a subset of which
are positive for CD4. E-cadherin highlights erythroid cells (10%) in clusters.
MPO is suboptimal and stains approximately 30% of the total cells. Stain CD56
is negative.
-Reticulin
stain on the biopsy shows diffuse reticulin fibrosis, grade 2 out of 3.
-Dr A Rios
was notified of the results on 8/4/2021
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure:
Aspiration and Biopsy site: (R) Posterior iliac crest
Histologic type: CMML-0
Immunophenotyping
Immunohistochemistry: CD3, CD4, CD7, CD34,
CD56, CD117, E-cadherin, myeloperoxidase (MPO), reticulin
Flow cytometry: Performed, see separate
report (HF-21-503)
Cytogenetic
studies: Performed, see addendum report
Specimen Source
1. Bone marrow aspirate and clot
2. Bone marrow core biopsy, decal, touch prep
3. Peripheral blood smear
Bone marrow procedure was performed by Heme-Onc
Clinical Information
52 y/o
male with leukocytosis, anemia, and thrombocytopenia. Bone marrow to r/o
leukemia
Gross Description
The case is
received in 2 parts labeled: Lindstrom, Paul and 55512991
1. The specimen is received in formalin labeled
with the patients name, MRN, and "bone marrow clot." It consists of a 1.0 x 1.0 x 0.3 cm dark red
aggregate of clotted blood which is submitted in toto in cassette 1A.
2. The specimen is received in formalin labeled
with the patients name, MRN, and "bone marrow core." It consists of a 1.5 x 0.2 cm tan cylindrical
bone core which is submitted entirely following light decalcification in
cassette 2A.
HLF 08/02/2021 14:16
Peripheral Smear
CBC Results 8/2/21
WBC 16.6 H
RBC 2.88 L
Hgb 8.5 L
Hct 24.8 L
MCV 86.1
MCH 29.4
MCHC 34.1
RDW 15.6 H
Platelet 9 C
MPV 11.5 H
Retic Perf Yes
Retic Auto 0.4 L
PERIPHERAL BLOOD:
Erythrocytes:
Normochromic normochromic anemia with anisopoikilocytosis, mild polychromasia
White cells: Increased
in number with increase in monocytes (49%), a few blasts (2%)
Granulocytes: Normal
morphology
Lymphocytes: Normal
morphology
Monocytes: Normal
morphology
Platelets: Markedly
decreased number with normal morphology
Microscopic Description
Bone marrow
Differential (%) (performed
on touch prep as the aspirate was suboptimal)
Myeloblasts: 4
Promyelocytes: 2
Myelocytes: 8
Metas: 6
Bands & PMN's: 18
Eos: 1
Baso: 0
Monos: 37
Lymphs: 14
Plasma cells: 0
Erythroids: 10
M:E ratio 7.6
Cellularity: 95%, hypercellular
for age
Megakaryopoiesis: Severely
reduced with normal maturation
Erythropoiesis: Reduced
with normal maturation
Iron Content
(aspirate): Adequate iron stores
Granulopoiesis:
Increased with predominant monocytes (37%), myeloblasts at 4%
Lymphocytes: Normal
number and morphology
Biopsy section:
Hypercellular with high M/E ratio
Clot section:
Suboptimal with few bone marrow cells
Iron content (biopsy
and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060, 88313, 88342-GCx1, 88341-GCx7
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
Teaching Physician Statement
"I have personally reviewed the resident's preliminary
interpretation and all specimen preparations and have personally issued this
report".
++++++
79. Acute Promyelocytic Leukemia
Diagnosis
Peripheral
Blood:
-Acute promyelocytic leukemia
Bone Marrow:
-Acute promyelocytic leukemia, see comment
-Decreased iron stores
NDN/DJD 09/10/2021 Electronic Signature: Nguyen,
Nghia Andy D MD
Comment
-Immunophenotyping of
concurrent peripheral blood sample by flow cytometry (report HF-21-577) shows a
T cell population (about 75% of the lymphocytes analyzed) with no aberrant loss
or aberrant expression of T cell markers, a B cell population (about 5% of the
lymphocytes analyzed) that is negative for CD5, CD10, no surface light-chain
restriction. The lymphocytes have small nuclear size (based on forward-scatter
signal). Analysis of the cells in the blast area shows 70% leukemic cells (of
the leukocytes) with expression of CD13 (heterogeneous), CD33 (homogeneous), cMPO, and CD117. They are negative for: CD34, CD3, CD7,
CD10, CD14, CD16, CD20, CD22, CD38, CD56, CD79a, CD123, HLA-DR, TdT. These results are consistent with acute promyelocytic
leukemia. Many leukemic cells are seen in the area with intermediate
side-scatter signal.
-STAT FISH
testing for PML/RARA is positive, consistent with acute promyelocytic leukemia
- Bone marrow aspirate
was sent for cytogenetics, Rapid AML therapeutic panel, and PCR for bcr/ab
-Oncology team (Dr
Rios) was notified of the diagnosis on 9/10/2021
Tumor Summary
Specimen: _
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate
clot
Bone marrow core
(trephine) biopsy
Bone marrow core touch
preparation (imprint)
Procedure: bone marrow
Aspiration site: R post
iliac crest
Biopsy site:_R post iliac crest
Histologic type: _acute
promyelocytic leukemia
Immunophenotyping
Immunohistochemistry:
not performed,
Flow cytometry: _
Performed, see separate
report (HF-21-577) on peripheral blood
Cytogenetic studies:
Performed, see separate report
Specimen Source
1. Bone marrow clot
2. Bone marrow biopsy,
decal, touch prep
3. Peripheral blood
Bone marrow was
obtained by IR
Clinical Information
39 y/o
male with new-onset acute leukemia
Gross Description
The
specimen is received in 2 containers: Edwards, James and 46429228
1. The specimen is received in formalin labeled
with the patient's name, MRN, and " bone marrow clot." It consists of a 1.7 x 1.5 x 0.2 cm aggregate
of red-purple clotted blood which is submitted in toto in cassette 1A.
2. The specimen is received in formalin labeled
with the patient's name, MRN, and " bone marrow core biopsy." It consists of a 1.1 x 0.2 cm firm, tan-pink,
cylindrical core of bone which is entirely submitted in cassette 2A following
light decalcification.
DJD
09/09/2021 15:24
Peripheral Smear
CBC Results:
WBC 3.7 K/CMM Normal
RBC 3.29 M/CMM LOW
Hgb 9.3 g/dL LOW
Hct 26.2 % LOW
MCV 79.5 fL LOW
MCH 28.2 pg Normal
MCHC 35.4 g/dL Normal
RDW 14.0 % Normal
MPV 7.1 fL LOW
Platelet 20 K/CMM CRIT
Segs 25.0 % LOW
Bands 0.0 %
Normal
Lymphocytes 18.0 % LOW
Atypical Lymphs 0.0 % Normal
Monocytes 7.0 % Normal
Myelocytes 1.0 % HI
Blasts 49.0 %
HI
Neutrophils # 0.9 K/CMM LOW
Lymphocytes # 0.7 K/CMM LOW
Monocytes # 0.3 K/CMM Normal
Microcyte 1+
Plt Morph Normal
Microscopic Description
PERIPHERAL BLOOD:
Erythrocytes:
Normochromic normocytic anemia with slight polychromasia
White cells: Normal in
number
Granulocytes: Many
leukemic cells (49%) present, some with bilobed nuclei and small eosinophilic
granules
Lymphocytes: Normal
morphology
Monocytes: Normal
morphology
Platelets: Markedly
decreased in number with normal morphology
Bone marrow
Differential (%)
Myeloblasts: 87%
Promyelocytes: 0
Myelocytes: 1
Metas: 1
Bands & PMN's: 3
Eos: 0
Baso: 0
Monos: 1
Lymphs: 2
Plasma cells: 0
Erythroids: 5
Cellularity: 95%
Megakaryopoiesis: Decreased
with normal maturation
Erythropoiesis:
Decreased with normal maturation
Iron Content
(aspirate): Decreased iron stores
Granulopoiesis: Marked
decreased in mature granulocytes, numerous leukemic cells (87%)
with many bilobed nuclei forms, some with multiple
auer rods
Lymphocytes: Normal
morphology
Biopsy and clot
section: Hypercellular with diffuse distribution of leukemic cells
Iron
content (biopsy and clot section): Decreased iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x
2, 88311, 85097, 85060
The positive controls
and internal negative controls for the special stains have been reviewed, and
appropriate staining is confirmed by the pathologist whose signature appears
above.
+++++
80. T lymphoblastic leukemia/lymphoma (T cell ALL/LBL)
Diagnosis
Peripheral Blood:
-
Microcytic hypochromic anemia and thrombocytopenia
-
Circulating lymphoblasts (3%)
Bone Marrow:
- T lymphoblastic leukemia/lymphoma (T cell ALL/LBL),
see
comment
- Adequate
iron stores
NDN/NDN 09/20/2022 Electronic Signature: Nguyen,
Nghia Andy D MD
Comment
-Immunophenotyping of bone marrow aspirate by flow cytometry
(report HF-22-744) shows 9% normal lymphocytes with mature B cells and T
cells. Analysis of cells in CD45-dim gate shows a predominant T cell precursor
population (about 71% of all the cells analyzed). These T cells have small nuclear size (based
on forward-scatter signal) and show expression of CD2, CD3, CD5, CD7,
co-expression of CD4/CD8, CD38. They are negative for CD34, CD117, HLA-DR,
CD13, CD33, CD16, CD10, CD19, CD64, CD14, CD56.
-The immunophenotype results and
morphology are most consistent with T lymphoblastic leukemia/lymphoma (T cell
ALL/LBL)
-Bone marrow aspirate was sent for cytogenetics, FISH panel for
ALL (pediatric)
-The diagnosis was notified to Dr. xxx on 9/20/2022
Tumor Summary
Specimen:
Peripheral blood smear
Bone marrow aspiration
Bone marrow aspirate clot
Bone marrow core (trephine) biopsy
Bone marrow core touch preparation (imprint)
Procedure: Bone marrow
Aspiration site: R posterior iliac crest
Biopsy site: R posterior iliac crest
Histologic type: T lymphoblastic leukemia/lymphoma
Immunophenotyping
Immunohistochemistry: not performed
Flow cytometry:
Performed, see separate report (HF-22-xxx)
Cytogenetic
studies: Performed, see separate report
Specimen Source
1. Bone marrow aspirate and clot
2. Bone marrow core biopsy, decal, touch prep
3. Peripheral blood smear
Bone marrow procedure was performed by IR
Clinical Information
The patient
is a 10 y/o male presenting with cough, fever, fatigue, night sweats, and
weight loss. He was found to have thrombocytopenia, anemia, elevated uric
acid/LDH. CT scans show anterior mediastinal mass, bulky right paratracheal
lymphadenopathy, bilateral supraclavicular, axillary, and hilar
lymphadenopathy, hepatosplenomegaly with mesenteric, retroperitoneum, and
bilateral iliac chain lymphadenopathy.
Gross Description
The case is
received in 2 parts labeled: xxx
1. Received in formalin, labeled with the
patient's name, MRN, "bone marrow clot" and consists of a single
irregular bone marrow clot measuring 2.5 x 2.0 x 0.2 cm which is submitted in
toto in cassette 1A.
2. Received in formalin, labeled with the
patient's name, MRN, "bone marrow core" and consists of a single
tan-red hemorrhagic cylindrical bone marrow core measuring 1.5 cm in length by
0.2 cm in diameter which is submitted in toto in cassette 2A, post light
decalcification.
hr
09/19/2022 14:45
Peripheral Smear
Date/time: 09/19/2022,17:05
CBC Results:
WBC 9.1 K/CMM Normal
RBC 3.71 M/CMM LOW
Hgb 8.5 g/dL LOW
Hct 25.9 % LOW
MCV 69.9 fL LOW
MCH 23.1 pg LOW
MCHC 33.0 g/dL Normal
RDW 15.7 % HI
MPV 8.5 fL Normal
Platelet 41 K/CMM LOW
Segs 37.0 % Normal
Bands 2.0 % Normal
Lymphocytes 50.0 % HI
Atypical Lymphs 0.0 % Normal
Monocytes 5.0 % Normal
Metamyelocytes 5.0 % HI
Myelocytes 1.0 % HI
Neutrophils # 3.5 K/CMM Normal
Lymphocytes # 4.6 K/CMM Normal
Monocytes # 0.5 K/CMM Normal
NRBC 12 /100WB NA
PERIPHERAL BLOOD:
Erythrocytes: Decreased in number; microcytic, hypochromic;
mild polychromasia; schistocytes not increased; nucleated RBCs present;
intracellular organisms absent
White cells: Normal in number; presence of a few
blasts (3%)
Platelets: Decreased in number; unremarkable morphology; platelet
clumps absent
Microscopic Description
Bone marrow
Differential (%) on aspirate
Lymphoblasts: 77
Promyelocytes: 1
Myelocytes:
1
Metas:
1
Bands &
PMN's: 5
Eos: 0
Baso: 0
Monos: 0
Lymphs: 10
Plasma
cells: 0
Erythroids: 5
Cellularity: 95%
Megakaryopoiesis: Decreased
Erythropoiesis: Markedly
decreased
Iron
Content (aspirate): Adequate iron stores
Granulopoiesis: Markedly
decreased
Lymphocytes: Decreased
Others: Numerous lymphoblasts are present (77%)
Biopsy and clot
section: Diffuse
distribution of lymphoblasts
Iron content (biopsy and clot section): Adequate iron stores
Non Clinical Documentation
CPT:88305 x 2, 88313 x 2, 88311, 85097, 85060
The positive controls and internal negative controls for the
special stains have been reviewed, and appropriate staining is confirmed by the
pathologist whose signature appears above.
Teaching Physician Statement
"I have personally reviewed the resident's preliminary
interpretation and all specimen preparations and have personally issued this
report".
++++