COMMON BONE MARROW REPORT TEMPLATES
Andy Nguyen, M.D. / UT-Medical School at Houston, Pathology


Last Revision on: 7/14/2018

 

 

 

16. Normal Bone Marrow

8.   Aplastic anemia

27. HLH

15. Neg for HLH

14. Neg for B cell Lymphoma-Hypocellular BM

24. SLE with Myelofibrosis

25. Neutropenia with Arrest of Granulocyte Maturation

30. Neutropenia due to arrest of granulocytic maturation

33. Hypocellular bone marrow with cytopenia

45. Acute ITP

 

26. CML, chronic phase

12. CML-Acc phase with Thrombocytopenia-Dry Tap

29. Essential Thrombocythemia

56. Essential Thrombocythemia

42. Myelofibrosis

21. MPN, NOS

23. Myeloproliferative neoplasm, NOS in accelerated phase (12% myeloblasts)

 

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

 

43. AML

49. AML

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

7.   APL s/p Induction

28. APL, in remission

20. AML, 5% residual leukemia

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

10. B ALL-Relapse-Refractory

 

11. CLL

51. CLL

35. Lymphoplasmacytic lymphoma

47. Lymphoplasmacytic Lymphoma

39. CD5-positive low grade B-cell proliferative disorder

52. Follicullar Lymphoma in BM

55. FL/DLBCL in BM

 

 

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

 

38. Plasma cell myeloma

57. Plasma cell myeloma with immature plasma cells

18. Smoldering myeloma-25% monoclonal plasma cells

 

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-18-2) in gate #3 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, no evidence of surface-light chain restriction. Analysis of cells in gate #1 (blast area) shows a small number of normal myeloblasts (2%) with expression of CD13, CD33, CD117, CD34. Analysis of cells in CD45 down-regulated gate (gate #2) shows an abnormal lymphoblast population (1% of bone marrow cells) with marker profile similar to that of diagnostic sample on 11/11/2017 (expression of CD10, CD19, CD38, CD34, TdT, aberrant expression of CD13, and CD33, negative for CD117). These results indicate 1% residual lymphoblastic leukemia by flow cytometry.

 

- 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-18-2)

 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 01/03/2018 14:26

 

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-18-37) shows a T cell population (about 58% 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. Plasma cells account for less than 3% 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.

- 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 02/09/2018 16:59 

 

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."

 

 

+++++

3. Adult B ALL

 

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-18-52) shows predominant a B cell population (about 90% of all the cells analyzed). These B cells have small to imtermediate nuclear size (based on forward-scatter signal) and show expression of CD19, CD38, HLA-DR, and TdT. They are negative for CD20, CD2, CD3, CD4, CD8, CD5, CD7, CD10, CD56, CD34, CD13, CD117, and CD33. Review of peripheral blood smear shows a predominant lymphoblast population. These results, together with morphologic findings in peripheral blood and bone marrow aspirate, are consistent with precursor B lymphoblastic leukemia.

-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-18-52)

 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  01/31/2018 16:23

 

Peripheral Smear

CBC result (1/31/2018 06:25)

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  03/02/2018 21:59

 

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".

 

 

+++++

6. AML Relapse

Diagnosis

Peripheral Blood:

- Hypochromic normocytic anemia and thrombocytopenia

- Numerous circulating blasts

 

Bone Marrow:

- Acute myeloid leukemia relapse, see comment

- Increased iron stores

 

02/13/2018 11:09/ddw 

 

 

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-18-78)

   

 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  02/13/2018 10:30.

 

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."

 

++++

7. APL s/p Induction

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

 

 

02/14/2018 07:55/ddw

 

 

NDN 02/14/2018 Electronic Signature: Nguyen, Nghia Andy D MD

 

Comment

- Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-18-80) shows a normal T cell population with no aberrant loss or aberrant expression of T cell markers, a B cell population with normal marker profile. A small number of normal myeloblasts (<3%) is found. The myeloblasts show normal marker profile (positive for CD13, CD33, CD117, CD34, HLA-DR). These results indicate that no immunophenotype associated with APL is found with flow cytometry.

- 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-18-80)

   

 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  02/13/2018 17:15

 

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."

 

 

+++++

8. Aplastic anemia

 

Diagnosis

Peripheral Blood:

- Pancytopenia

 

Bone Marrow:

- Aplastic anemia, see comment

- Decreased iron stores

 

02/13/2018 10:52/ddw 

 

 

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 02/13/2018 10:13

 

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-18-3) in blast gate (Gate #1) by flow cytometry shows a normal myeloblast population (about 2% of the cells analyzed) with normal marker expression (positive for CD13, CD33, CD34, CD38, and CD117). The analyzed cells are negative for CD10, CD19, and TdT. These results indicate no residual lymphoblastic leukemia with flow cytometry.

-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  01/03/2018 14:29

 

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."

 

 

++++

10. B ALL-Relapse-Refractory

Diagnosis

Peripheral Blood:                            

- Normochromic normocytic anemia

- Leukopenia

 

Bone Marrow:

- Residual leukemia (B cell lymphoblastic leukemia), 61% lymphoblasts, s/p chemotherapy

- Adequate iron stores

 

02/13/2018 10:57/ddw

 

 

NDN 02/13/2018 Electronic Signature: Nguyen, Nghia Andy D MD

 

Comment

- Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-18-77) shows a predominant B lymphoblast population. These B cells have intermediate nuclear size (based on forward-scatter signal) and show expression of CD10, CD19, CD38, HLA-DR, CD13, CD33, CD34, and TdT. They are negative for CD20, CD2, CD3, CD4, CD8, CD5, CD7, CD56, CD117, MPO. This profile is similar to that of the diagnostic sample prior to treatment. The immunophenotype results and morphology are consistent with residual B cell lymphoblastic leukemia.

- 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-18-77)

   

 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  02/13/2018 10:37

 

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.

 

 

++++

11. CLL

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-18-7) shows an abnormal B cell population (about 92% of the cells in lymphocytic gate or 68% of bone marrow cells) that is positive for CD5, CD19, CD20, and CD23. Surface kappa and lambda light chain is negative. However, the B cells do show cytoplasmic kappa light chain restriction. These B cells are negative for CD10, FMC7, and CD38. These B cells have small nuclear size (based on forward-scatter signal).

 -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-18-7)

 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  01/03/2018 17:37

 

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

 

 

02/12/2018 09:36/ddw

 

 

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  02/09/2018 16:59

 

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."

 

 

++++++

13. MGUS

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-18-5) 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 cytoplasmic kappa light chain restriction. They are positive for CD56 and negative for CD19. These results indicate presence of monoclonal plasma cells in bone marrow.

 

-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  01/03/2018 14:01

 

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 (HS18-2704). Patient has a h/o orthotopic liver transplant in 1/2016 secondary to Budd Chiari.  He also carries history of antiphospholipid syndrome, factor V Leiden, biliary obstruction status post stent placement, hypothyroidism and seizures.

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 03/09/2018 19:20

 

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".

 

 

++++

15. Neg for HLH

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  01/29/2018 19:17

 

Peripheral Smear

CBC result (1/29/2018 02:26)

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".

 

++++

16. Normal Bone Marrow

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.

 

 

++++

17. Pediatric B ALL

Diagnosis

Peripheral Blood:

- Pancytopenia 

 

Bone Marrow:

- B cell lymphoblastic leukemia, see comment

- Decreased iron stores          

 

02/13/2018 11:20/ddw

 

 

NDN 02/13/2018 Electronic Signature: Nguyen, Nghia Andy D MD

 

Comment

- Immunophenotyping of bone marrow aspirate by flow cytometry (report HF-18-76) shows a predominant B lymphoblast population. These B cells have intermediate nuclear size (based on forward-scatter signal) and show expression of CD10, CD19, CD20, CD38, CD34, CD22, HLA-DR, and TdT. They are negative for CD2, CD3, CD4, CD8, CD5, CD7, CD56, CD13, CD117, MPO, and CD33. These results and morphology are consistent with B cell lymphoblastic leukemia (B ALL).

- 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-18-76)

   

 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  02/13/2018 10:34

 

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-17-397)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 13% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. A monoclonal plasma cell population is found with plasma cells that are positive for CD38, cytoplasmic Kappa light-chain restriction. These plasma cells are negative for CD19 and positive for CD56. Patient's bone marrow shows 25% plasma cells. The immunophenotype results indicate the presence of monoclonal plasama cells in bone marrow.

-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-17-397)

 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  08/22/2017 18:34

 

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."

 

 

+++

19. MDS EB-1

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".

 

++++

20. AML, 5% residual leukemia

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".

 

+++++

 

 

21. MPN, NOS

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  04/09/2018 17:20

 

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-18-179) in gate #1 (blast gate) shows a predominant blast population that is positive for CD5 (aberrant), CD13, CD33 (partial), CD34, CD117, CD38, HLA-DR. They are negative for CD2, CD3, CD4, CD8, CD10, CD19, CD20, CD56, MPO, TdT.

-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-18-179)

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  04/10/2018 21:40

 

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