John Brown John Brown, M.D.

Transcription

1 Batch#: UROPATHOOGY REPORT IS;R;MMR;STP 1 of 2 Accession: XX Obtained: 09/18/20XX Received: 09/18/20XX 6:07 pm PATIENT: MAIN ST FUSHING, NY (718) DOB: 01/02/19XX Comments: Specimen Preliminary Date Final Report Date A Age: 58 Sex: Male Acct: 1018 B Submitted: 12 vials-a,b,c,d,e,f,g,h,i,j,, C D E F A Copy was sent to: DR. JANE U. DOE 456 SAMPE BVD. NEW YOR, NY 11 ABC SURGERY CENTER PHYSICIAN: JOHN U. SMITH 1234 FIRST AVE Suite: 8A NEW YOR, NY 16 Acct # Rte 6 G H I J (212) (212) DIAGNOSIS & MICROSCOPIC DESCRIPTION C, D, J, : ADENOCARCINOMA OF THE PROSTATE. There is a gland forming neoplasm in prostatic stroma composed of neoplastic epithelial cells with enlarged nuclei and prominent nucleoli. E, F, : ADENOCARCINOMA OF THE PROSTATE WITH FOCA PERINEURA INVASION. Sections reveal a gland forming neoplasm adjacent to a nerve. H: SMA FOCUS OF ADENOCARCINOMA OF THE PROSTATE. There is a gland forming neoplasm in prostatic stroma composed of neoplastic epithelial cells with enlarged nuclei and prominent nucleoli. A: PROSTATIC HYPERPASIA. There is hyperplasia of glands and surrounding fibrous stroma. B, G: PROSTATIC HYPERPASIA WITH ATROPHIC FEATURES. There is focal hyperplasia of glands and surrounding fibrous stroma. Other areas reveal dilated glands with atrophic epithelium. I: FIBROMUSCUAR STROMA ONY. This specimen consists of fibromuscular stroma only. No glandular elements are seen. A B C 10% GEASONS SCORE & % OF BIOPSY REPACED BY CARCINOMA D 5% E F G H 2% I J 90% Continued on next page Color ey Photomicrograph of J RB(G) RM(H) RB(A) RM(B) 2% B(D) B(J) 5% M(E) M() Adenocarcinoma Benign Infectious Inflammatory Suspicious Pin Other No Diag Atypical RA(I) RA(C) A(F) A() 10% 90% John Brown John Brown, M.D. Olga Falkowski, M.D., Medical Director Note: Prostate diagrams and labels indicate disease summaries only. See diagnosis above for details A B C D E F 6(3+3) 6(3+3) 7(3+4) 7(3+4) G H I J 6(3+3) 7(3+4) 7(3+4) 6(3+3) 09/18/20XX RB(G) RB(A) B(D) B(J) A B C D E F 6(3+3) 6(3+3) 7(3+4) 7(3+4) G H I J RM(H) RA(I) RM(B) RA(C) M(E) A(F) M() A() 6(3+3) 7(3+4) 7(3+4) 6(3+3) 09/18/20XX

2 Accession: XX PATIENT: 2 of 2 Plainview,NY Specimen Preliminary Date Final Date A B C NOTES C: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a D: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a E: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a with the Gleason's grade. IHC stain for i67 is negative. IHC stain for S is positive, supporting the diagnosis of perineural invasion. F: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a with the Gleason's grade. IHC stain for i67 is negative. IHC stain for S is positive, supporting the diagnosis of perineural invasion. H: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a J: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a with : eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a with the Gleason's grade. IHC stain for i67 is negative. IHC stain for S is positive, supporting the diagnosis of perineural invasion. : eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a This test was developed and its performance characteristics determined by Acupath aboratories, Inc. It has 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. This test is used for clinical purposes. It should not be regarded as investigational or for research. This laboratory is certified under the Clinical aboratory Improvement Amendments of 1988 (CIA) as qualified to perform high complexity clinical laboratory testing. D E F G H I J GROSSING INFORMATION Site Fixative Color Shape Cassette Piece Measurement(mm) A Right Base 10% Formalin white Cylindrical x01x01 B Right Mid 10% Formalin white Cylindrical x01x01 C Right Apex 10% Formalin white Cylindrical x01x01 D eft Base 10% Formalin white Cylindrical x01x01 E eft Mid 10% Formalin white Cylindrical x01x01 F eft Apex 10% Formalin white Cylindrical x01x01 G Right ateral Base 10% Formalin white Cylindrical x01x01 H Right ateral Mid 10% Formalin white Cylindrical x01x01 I Right ateral Apex 10% Formalin white Cylindrical x01x01 J eft ateral Base 10% Formalin white Cylindrical x01x01 eft ateral Mid 10% Formalin white Cylindrical x01x01 eft ateral Apex 10% Formalin white Cylindrical x01x01

3 Patient: JAC S JONES Date Obtained: 09/18/20XX Date of Birth: 01/02/19XX Doctor: Dr. JOHN U. SMITH For Site(s): C, D, H, J, (212) PROSTATE ADENOCARCINOMA PATIENT FACT SHEET TM Definition: The most common form of cancer in men. It is a growth that originates in the peripheral cells of the prostate and is malignant, meaning that it can spread to other organs of the body. The prostate is a gland that surrounds the male urethra and secretes a fluid during ejaculation. POSSIBE RIS FACTORS -Age -Prostate cancer is very rarely found in men under 40 years old. -Men over 65 are 40 times more likely to have prostate cancer than are men under 65. -Prostate cancer is the most common cause of death from cancer in men over Prostate Specific Antigen (PSA) levels PSA of up to 4.0 is considered normal. PSA of 4.1 to 10.0 is associated with a 15%-20% risk of prostate adenocarcinoma. PSA of over 10.0 is associated with a risk of prostate adenocarcinoma. -Race -Prostate cancer is most common in black men over age 60. -Prostate cancer is least common in men of Asian (Oriental) decent. -Heredity Patients with a family history of prostate cancer are more likely to develop it than are patients without a family history. STAGES OF PROSTATE CANCER Stage A. The carcinoma is confined to the prostate, and is not palpable (detectable) by Digital Rectal Examination (DRE). Patients usually do not complain about symptoms, and it can only be detected by elevated PSA levels or a biopsy. Stage B. The cancer is confined to the prostate, but is palpable by DRE. There are usually no symptoms. Stage C. In this stage, the carcinoma has spread to regions outside the prostate. Patients usually experience some pain. Stage D. The carcinoma has spread into the spinal column, causing back pain in addition to the pains found in stage C. DIAGNOSIC TESTS -Digital Rectal Examination (DRE) Your doctor inserts a gloved, lubricated finger into the rectum and feels for any abnormalities in the prostate. -Prostate Specific Antigen (PSA) Test PSA is a chemical that is produced only by the prostate. A high PSA level in your blood suggests that your prostate is enlarged. METHOD OF DIAGNOSIS Clinicians can occasionally make the diagnosis by careful observation. However, the removal of a small sample from the affected area for analysis at a reputable pathology laboratory was required for absolute confirmation of the diagnosis, as other conditions can mimic it clinically. Your sample was studied by a specialized pathologist at Acupath aboratories, Inc. before being conclusively diagnosed as Prostate Cancer. METHODS OF TREATMENT Prostate adenocarcinoma usually requires surgery. However, other non-surgical methods are appropriate in some cases. Your doctor will determine which treatment is best suited for your specific case. COMMENTS Provided as a service by Acupath aboratories in cooperation with your doctor. Acupath aboratories, Inc. "For the absolute highest standard in pathology services."

4 Patient: JAC S JONES Date Obtained: 09/18/20XX Date of Birth: 01/02/19XX Doctor: Dr. JOHN U. SMITH For Site(s): A, B, G (212) PATIENT FACT SHEET TM PROSTATIC HYPERPASIA (BPH) Definition: A non-cancerous enlargement of the prostate that often begins around age 45 and can continue indefinitely. The prostate is a gland that surrounds the male urethra and secretes a fluid during ejaculation. As the prostate grows, it begins to pinch the urethra, causing the symptoms associated with BPH. There are many causes of an enlarged prostate, and it is important that BPH be distinguished from prostate cancer. FACTS -BHP may be the result of the hormone dihydrotestosterone (DHT), which triggers the enlargement of the prostate. -BHP affects of men age 60 or older, and 90% of men age 85 or older. -Most cases of an enlarged prostate are BPH, not cancer. SYMPTOMS -Frequent urination -Weak or interrupted urinary stream -Feeling that bladder will not empty completely -Feeling of delay or hesitation when you begin to urinate -Feeling that you cannot postpone urination -Pain in lower back, pelvis, and/or upper thigh -Burning pain during urination sometimes indicates that an infection is present DIAGNOSIC TESTS -Digital Rectal Examination (DRE) Your doctor inserts a gloved, lubricated finger into your rectum and feels for an enlargement of the prostate. METHOD OF DIAGNOSIS Clinicians can occasionally make the diagnosis by careful observation. However, the removal of small samples from the affected area for analysis at a reputable pathology laboratory is required for absolute confirmation of the diagnosis, as other more serious conditions can mimic it clinically. Your sample is studied by a specialized pathologist at Acupath aboratories, Inc. before being conclusively diagnosed as a Benign Prostatic Hyperplasia. METHODS OF TREATMENT There are various surgical and non-surgical methods of treating BPH, including several technologically advanced methods. Each method is applicable for certain specific cases, and your doctor will determine which method is best suited for you. COMMENTS Provided as a service by Acupath aboratories in cooperation with your doctor. Acupath aboratories, Inc. "For the absolute highest standard in pathology services."

5 Batch#: UROPATHOOGY REPORT IS;R;MMR;STP 1 of 2 Accession: XX Obtained: 09/18/20XX Received: 09/18/20XX 6:07 pm PATIENT: MAIN ST FUSHING, NY (718) DOB: 01/02/19XX Comments: Specimen Preliminary Date Final Report Date A Age: 58 Sex: Male Acct: 1018 B Submitted: 12 vials-a,b,c,d,e,f,g,h,i,j,, C D E F Duplicate Report For: DR. JANE U. DOE 456 SAMPE BVD. NEW YOR, NY 11 ABC SURGERY CENTER PHYSICIAN: JOHN U. SMITH 1234 FIRST AVE Suite: 8A NEW YOR, NY 16 Acct # Rte 6 G H I J (212) (212) DIAGNOSIS & MICROSCOPIC DESCRIPTION C, D, J, : ADENOCARCINOMA OF THE PROSTATE. There is a gland forming neoplasm in prostatic stroma composed of neoplastic epithelial cells with enlarged nuclei and prominent nucleoli. E, F, : ADENOCARCINOMA OF THE PROSTATE WITH FOCA PERINEURA INVASION. Sections reveal a gland forming neoplasm adjacent to a nerve. H: SMA FOCUS OF ADENOCARCINOMA OF THE PROSTATE. There is a gland forming neoplasm in prostatic stroma composed of neoplastic epithelial cells with enlarged nuclei and prominent nucleoli. A: PROSTATIC HYPERPASIA. There is hyperplasia of glands and surrounding fibrous stroma. B, G: PROSTATIC HYPERPASIA WITH ATROPHIC FEATURES. There is focal hyperplasia of glands and surrounding fibrous stroma. Other areas reveal dilated glands with atrophic epithelium. I: FIBROMUSCUAR STROMA ONY. This specimen consists of fibromuscular stroma only. No glandular elements are seen. A B C 10% GEASONS SCORE & % OF BIOPSY REPACED BY CARCINOMA D 5% E F G H 2% I J 90% Continued on next page Color ey Photomicrograph of J RB(G) RM(H) RB(A) RM(B) 2% B(D) B(J) 5% M(E) M() Adenocarcinoma Benign Infectious Inflammatory Suspicious Pin Other No Diag Atypical RA(I) RA(C) A(F) A() 10% 90% John Brown John Brown, M.D. Olga Falkowski, M.D., Medical Director Note: Prostate diagrams and labels indicate disease summaries only. See diagnosis above for details A B C D E F 6(3+3) 6(3+3) 7(3+4) 7(3+4) G H I J 6(3+3) 7(3+4) 7(3+4) 6(3+3) 09/18/20XX RB(G) RB(A) B(D) B(J) A B C D E F 6(3+3) 6(3+3) 7(3+4) 7(3+4) G H I J 6(3+3) 7(3+4) 7(3+4) 6(3+3) RM(H) RA(I) RM(B) RA(C) M(E) A(F) M() A() DR. JANE U. DOE 456 SAMPE BVD. NEW YOR, NY 11 09/18/20XX

6 Accession: XX PATIENT: 2 of 2 Plainview,NY Specimen Preliminary Date Final Date A B C NOTES C: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a D: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a E: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a with the Gleason's grade. IHC stain for i67 is negative. IHC stain for S is positive, supporting the diagnosis of perineural invasion. F: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a with the Gleason's grade. IHC stain for i67 is negative. IHC stain for S is positive, supporting the diagnosis of perineural invasion. H: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a J: eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a with : eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a with the Gleason's grade. IHC stain for i67 is negative. IHC stain for S is positive, supporting the diagnosis of perineural invasion. : eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a This test was developed and its performance characteristics determined by Acupath aboratories, Inc. It has 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. This test is used for clinical purposes. It should not be regarded as investigational or for research. This laboratory is certified under the Clinical aboratory Improvement Amendments of 1988 (CIA) as qualified to perform high complexity clinical laboratory testing. D E F G H I J GROSSING INFORMATION Site Fixative Color Shape Cassette Piece Measurement(mm) A Right Base 10% Formalin white Cylindrical x01x01 B Right Mid 10% Formalin white Cylindrical x01x01 C Right Apex 10% Formalin white Cylindrical x01x01 D eft Base 10% Formalin white Cylindrical x01x01 E eft Mid 10% Formalin white Cylindrical x01x01 F eft Apex 10% Formalin white Cylindrical x01x01 G Right ateral Base 10% Formalin white Cylindrical x01x01 H Right ateral Mid 10% Formalin white Cylindrical x01x01 I Right ateral Apex 10% Formalin white Cylindrical x01x01 J eft ateral Base 10% Formalin white Cylindrical x01x01 eft ateral Mid 10% Formalin white Cylindrical x01x01 eft ateral Apex 10% Formalin white Cylindrical x01x01

7 ABC SURGERY CENTER JOHN U. SMITH, M.D First Avenue New York, NY September 22, 20XX Dr. Jane U. Doe 456 Sample Blvd. New York, NY 11 Re: Jack S. Jones Dear Dr. U. Doe: I had the pleasure of treating your patient Jack S Jones, a 58 year old male, on September 18, 20XX. The specimens were sent for pathologic interpretation to Acupath aboratories, Inc. The histopathologic interpretation of the specimen from the (A) Right Base revealed benign prostatic hyperplasia. The histopathologic interpretation of the specimen from the (B) Right Mid revealed benign prostatic hyperplasia with atrophic features. The histopathologic interpretation of the specimen from the (C) Right Apex revealed adenocarcinoma of the prostate. eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a diagnosis of adenocarcinoma. IHC stain for P504S is positive, supporting the diagnosis of adenocarcinoma. IHC stain for CPP32 reveals weak staining consistent with the Gleason's grade. IHC stain for i67 is negative. IHC stain for S reveals no evidence of perineural invasion. The histopathologic interpretation of the specimen from the (D) eft Base revealed adenocarcinoma of the prostate. eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a diagnosis of adenocarcinoma. IHC stain for P504S is positive, supporting the diagnosis of adenocarcinoma. IHC stain for CPP32 reveals weak staining consistent with the Gleason's grade. IHC stain for i67 is negative. IHC stain for S reveals no evidence of perineural invasion. The histopathologic interpretation of the specimen from the (E) eft Mid revealed adenocarcinoma of the prostate with focal perineural invasion. eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a diagnosis of adenocarcinoma. IHC stain for P504S is positive, supporting the diagnosis of adenocarcinoma. IHC stain for CPP32 reveals moderate staining consistent with the Gleason's grade. IHC stain for i67 is negative. IHC stain for S is positive, supporting the diagnosis of perineural invasion. The histopathologic interpretation of the specimen from the (F) eft Apex revealed adenocarcinoma of the prostate with focal perineural invasion. eratin 903 is absent from glandular basal cells, supporting the diagnosis of carcinoma. IHC stain for P63 reveals no evidence of basal myoepithelial cells favoring a diagnosis of adenocarcinoma. IHC stain for P504S is positive, supporting the diagnosis of adenocarcinoma. IHC stain for CPP32 reveals moderate staining consistent with the Gleason's grade. IHC stain for i67 is negative. IHC stain for S is positive, supporting the diagnosis of perineural invasion. See report for more. I would like to personally thank you for your kind referral. If you have any additional questions, please do not hesitate to contact me at Sincerely, JOHN U. SMITH, M.D.

8 Batch#: Accession: XX Obtained: 04/02/20XX Received: 04/02/20XX 10:24 pm PATIENT: MAIN ST FUSHING, NY (718) DOB: 01/02/19XX Client Comments: A Urine Cytology Specimen Final Report Date Acct#: 1018 Age: 59 Sex: Male CYTOPATHOOGY REPORT *R;MMR; 1 of 1 A 04/03/XX Duplicate Report was faxed to: DR. JANE U. DOE 456 SAMPE BVD. NEW YOR, NY 11 DIAGNOSIS ABC SURGERY CENTER PHYSICIAN: JOHN U. SMITH 1234 FIRST AVE, Suite: 8A NEW YOR, NY 16 Acct # (212) Rte (212) DIAGNOSIS: POSITIVE FOR MAIGNANT CES, CONSISTENT WITH HIGH GRADE UROTHEIA CARCINOMA Microscopic Description: Thin prep slide reveals single urothelial cells with high N/C ratio and hyperchromatic nucleus. ADEQUACY: SATISFACTORY FOR EVAUATION. Rec'd 10ml of fixed clear urine in Thin Prep vial. Prepared 1 Thin Prep slide. Color ey Cancer Benign Suspicious Other Atypical Non-Diagnostic Photomicrograph of A Diagram not indicated John Brown JOHN BROWN, M.D. Olga Falkowski, M.D., Medical Director A: (Urine Cytology) POSITIVE FOR MAIGNANT CES, CONSISTE...See Report XX (718) DOB: 01/02/19XX 04/02/20XX Submitted: 1 vial-a A: (Urine Cytology) POSITIVE FOR MAIGNANT CES, CONSISTE...See Report XX (718) DOB: 01/02/19XX 04/02/20XX Submitted: 1 vial-a 04/02/20XX XX Page 1 of 1

9 FISH ANAYSIS REPORT R;MMR; Page 1 of 1 ACCESSION: XX Obtained: 12/12/20XX Received: 12/13/20XX A Copy was sent to: DR. JANE U. DOE 456 SAMPE BVD. NEW YOR, NY 11 PRACTICE: ABC SURGERY CENTER PHYSICIAN: JOHN U. SMITH 1234 FIRST AVE Suite: 8A NEW YOR, NY 16 Account # Rte 6 (212) (212) PATIENT: Phone #: BETSY JONES 1234 ANYWHERE ANYWHERE, NY (516) Age: 80 DOB: 06/05/19XX Sex: Female Acct: 1012 Indications: Bladder Cancer Source of Tissue: Date Reported FISH: Urine 12/14/20XX 12:48 PM FISH ANAYSIS DATA Assay # 1 Probe Region: Chromosomes 3, 7, 17 and 9p21 No. of Cells Scored: 25 Process and limitations of use: This test was developed and its performance characteristics determined by Acupath aboratories. It has not been cleared or approved by the U.S. Food and Drug Administration. TEST RESUT: Abnormal- Positive Aneuploidy of chromosomes 3, 7, 17 and/or 9p21 locus. A positive control had all 25 cells with an abnormal hybridization pattern. INTERPRETATION: The Vysis UroVysion Bladder Cancer FISH assay was performed on the analyzable cells from the patient s voided urine. A minimum of twenty-five morphologically abnormal cells were analyzed. Of these cells, 25 of 25 (%) were determined to have an abnormal profile. A review of the entire specimen slide revealed ten cells which were aneuploid for chromosomes 3, 7, 17 and/or the 9p21 locus. Aneuploidy of these chromosomes is associated with urothelial carcinoma progression. In addition, sixty other cells were observed which were tetraploidy/ near tetraploidy for chromosomes 3,7,17, and/or the 9p21 locus. This is greater than the 10 cells needed to consider the specimen abnormal by tertaploidy/ near tetraploidy (Bubendorf et al., Am J Clin Pathol 2001; 116:79-86). These results should be correlated with other clinical and laboratory tests. FISH Electronically signed by: John Brown, MD, Director of Genetics Olga Falkowski, M.D., Medical Director

10 PROSTATE FISH ANAYSIS REPORT IS;R; STP Page 1 of 2 Source of Tissue: Prostate Biopsy Indications: Adenocarcinoma; PTEN FISH: ERG FISH Date Reported FISH: 08/09/20XX 3:16 PM ACCESSION: XX Obtained: 08/01/20XX Received: 08/06/20XX PRACTICE: ABC UROOGY PHYSICIAN: JOHN SMITH 123 ANY STREET Suite: ANYWHERE, NY 00 Account # Rte 2 (212) (212) PATIENT: Phone #: JOHN DOE 123 STATE STREET ANYWHERE, NY 00 (212) Age: 69 DOB: 08/17/19XX Sex: Male Acct: FINA DIAGNOSIS: ABNORMA: OSS OF HMGN1 AND DSCAM, RESUTING IN ERG REARRANGEMENTS IN 33% OF THE CES: HETEROZYGOUS OSS OF THE PTEN, FAS AND WAPA OCI IN 28% OF THE CES ANAYZED. FISH ANAYSIS DATA Assay # Probe Region Chromosome or ocus Normal Normal Percentage Reference Range No. of Cells Scored 1 ERG:TMPRSS2 Panel DSCAM (21q22.2) 67% 90-% 1 ERG:TMPRSS2 Panel ERG (21q22.2) 67% 90-% 1 ERG:TMPRSS2 Panel HMGN1 (21q22.2) 67% 90-% 1 ERG:TMPRSS2 Panel TMPRSS2 (21q22.2) 67% 90-% 2 PTEN-del-TECT Panel CEP10 (10p11.1-q11.1) % Hetero. > 79%, Homo. > 69% 2 PTEN-del-TECT Panel FAS (10q23.31) 72% Hetero. > 79%, Homo. > 69% 2 PTEN-del-TECT Panel PTEN (10q23.31) 72% Hetero. > 79%, Homo. > 69% 2 PTEN-del-TECT Panel WAPA (10q23.31) 72% Hetero. > 79%, Homo. > 69% ISCN RESUT: nuc ish(ergx2,hmgn1x1,dscamx1,tmprss2x1~2)[33/],(cep10x2,wapax1,ptenx1,fasx1)[28/] INTERPRETATION: Interphase fluorescence in situ hybridization (FISH) was completed on the submitted formalin fixed paraffin embedded lower prostate biopsy (part I), using a panel of four locus specific identifier probes for the following loci: ERG (centromeric), HMGN1, DSCAM, and TMPRSS2 (telomeric), all located in the long arm of chromosome 21 (21q22.2). One hundred non overlapping cells were identified, of which 33/ (33%) showed a heterozygous loss of both the HMGN1 and DSCAM, and TMPRSS loci resulting in the ERG locus rearranging with an unknown fusion partner. This is greater than the 10% of the tissue needed with an ERG rearrangement to consider the specimen abnormal. These are ABNORMA results. Patients with ERG rearrangements and with loss of PTEN are associated with a poor prognosis (Reid et al. British Journal of Cancer (2010) 102, ). In addition, FISH was also completed using a panel of three locus specific identifier probes and one chromosome enumeration probe for the following loci: CEP10 (10p11.1-q11.1), telomeric FAS (10q23.31), PTEN (10q23.31), and centromeric WAPA (10q23.31). A minimum of one hundred non overlapping cells were identified. Of these, 28/ cells showed a heterozygous loss of the PTEN locus as well as a heterozygous loss of the WAPA and FAS loci - showing the deletion is more likely the whole arm. This is greater than the 20% of the tissue needing to have the heterozygous loss of the PTEN locus to consider the specimen abnormal. The heterozygous PTEN deletion is associated with a much earlier onset of biochemical recurrence (Yoshimoto M, et al. Br J Cancer (2007) p ). FISH Process and limitations of use: Electronically signed by: John Brown, M.D. Olga Falkowski, M.D., Medical Director

11 PROSTATE FISH ANAYSIS REPORT STP Page 2 of 2 Source of Tissue: Prostate Biopsy Indications: Adenocarcinoma; PTEN FISH: ERG FISH Date Reported FISH: 08/09/20XX 3:16 PM ACCESSION: XX Obtained: 08/01/20XX Received: 08/06/20XX PRACTICE: ABC UROOGY PHYSICIAN: JOHN SMITH 123 ANY STREET Suite: ANYWHERE, NY 00 Account # Rte 2 (212) (212) PATIENT: Phone #: JOHN DOE 123 STATE STREET ANYWHERE, NY 00 (212) Age: 69 DOB: 08/17/19XX Sex: Male Acct: The PTEN FISH assay is not an FDA-approved FISH test. It is designed to aid in the detection of chromosomal abnormalities related to patients with Adenocarcinoma of the prostate. This FISH assay is intended for use as an adjunct to traditional diagnostic procedures and should not be used as the sole basis for the diagnosis of new cancers or for the surveillance of tumor recurrence. 2. A positive result by the PTEN FISH assay requires that a total of non overlapping interphase cells be evaluated and that these cells show at least two copies of the CEP10 locus, homozygous loss of PTEN in >30% of the tissue, or heterozygous loss of PTEN in >20% of the tissue. oss of FAS or WAPA are included to determine the size of the deletion, and to prevent truncation artifact reporting. 3. This PTEN FISH assay was developed and its performance characteristics determined by the Acupath Cytogenetics aboratory. Although it has 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. Pursuant to the requirements of CIA 88, however, this laboratory has established and verified the test s accuracy and precision, and is therefore used for clinical purposes. 4. The ERG:TMPRSS2 FISH assay is not an FDA-approved FISH test. It is designed to aid in the detection of chromosomal abnormalities related to patients with Adenocarcinoma of the prostate. This FISH assay is intended for use as an adjunct to traditional diagnostic procedures and should not be used as the sole basis for the diagnosis of new cancers or for the surveillance of tumor recurrence. 5. A positive result by ERG:TMPRSS2 FISH assay requires that a total of non overlapping interphase cells be evaluated and that these cells show at least two copies of at least three of the four loci tested to prevent truncation artifact reporting. Specific cut-off values have been established at Acupath aboratories, Inc. 6. The ERG:TMPRSS2 FISH assay was developed and its performance characteristics determined by the Acupath Cytogenetics aboratory. Although it has 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. Pursuant to the requirements of CIA 88, however, this laboratory has established and verified the test s accuracy and precision, and is therefore used for clinical purposes. Electronically signed by: John Brown, M.D. Olga Falkowski, M.D., Medical Director

12 MOECUAR ISH REPORT IS;R;MMR; Page 1 of 1 ACCESSION: Obtained: 11/03/20XX Received: PRACTICE: PHYSICIAN: XX 11/05/20XX 12:00 am ABC SURGERY CENTER JOHN U. SMITH 1234 FIRST AVE Suite: 8A NEW YOR, NY 16 Account # Rte 6 Indications: R/O Condyloma Source of Tissue: Penis Date Reported: 11/13/20XX (212) (212) A Copy was sent to: DR. JANE DOE 456 SAMPE BVD NEW YOR, NY 11 2:45PM PATIENT: MAIN ST FUSHING, NY Phone #: (718) Age: 58 DOB: 01/02/19XX Sex: Male Acct: 1018 TEST RESUT ISH/Probe Marker For Results HPV WS Wide Screen HPV Positive (BOC B) HPV 6/11 HPV Types 6/11 Positive (BOC B) HPV 16/18 HPV Types 16/18 Negative (BOC B) HPV 31/33 HPV Types 31/33 Negative (BOC B) INTERPRETATION: Positive for one or more of the following strains of HPV: 6/11/16/18/31/33/35/45/51/52. The HPV Wide Spectrum is used to detect HPV DNA by In Situ Hybridization (ISH) in biopsies; it does not discriminate between the HPV subtype. The HPV Wide Spectrum detects subtypes 6, 11, 16, 18, 30, 31, 33, 35, 45, 51, and 52. The absence of hybridization with HPV subtypes 6, 11, 16, 18, 31, and 33 may indicate other subtypes that were not analyzed in this study. Positive for ow-risk HPV strains 6/11. Negative for High-Risk HPV strains 16/18. Negative for High-Risk HPV strains 31/33. This analysis is an adjunct to the evaluation of the referring physician and does not represent a final diagnosis. Photomicrographs: HPV WideScreen-Block B HPV 6/11-Block B HPV 16/18 HPV 31/33 Electronically signed by: John Brown, M.D. This test was developed and its performance characteristics determined by Acupath aboratories, Inc. It has 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. This test is used for clinical purposes. Pursuant to the requirements of CIA 88, this laboratory has established the test s accuracy and precision. This test has been approved by New York State as a laboratory specific assay. This test cannot be used as sole evidence for or against cancer and has to be interpreted in the context of all available clinical and pathological information.

13 Patient: JAC S JONES Date Obtained: 11/03/20XX Date of Birth: 01/02/19XX Doctor: Dr. JOHN U. SMITH For Site(s): B (212) PATIENT FACT SHEET TM CONDYOMA ACUMINATA Definition: Commonly known as genital warts, Condyloma Acuminata is a sexually transmitted disease caused by the Human Papilloma Virus (HPV). It is characterized by wart-like growths on the penis, vagina, vulva, and/or rectum. In rarer cases HPV may cause warts on the throat, tongue, and mouth. FACTS/RIS FACTORS Over 50 different types of HPV have been identified. Some lead to rough raised warts, while others to soft flat ones. Several types have been associated with abnormal pap smears in women, which may indicate an increased risk for cervical cancer. Unsafe sexual practices such as multiple/unknown sexual partners and lack of condom use increase the risk of contracting HPV. SYMPTOMS Although many patients display no symptoms at all, infection by HPV may cause: - warts/lesions in the genital and/or anal areas - cauliflower-like growths around the genitals and/or anus - dampness - itching METHOD OF DIAGNOSIS Many clinicians can diagnose Condyloma by careful observation. However, the removal of a small sample from the affected area for analysis at a reputable pathology laboratory is required for absolute confirmation of the diagnosis, as other conditions can mimic it clinically. Your sample is studied by a specialized pathologist at Acupath aboratories, Inc. before being conclusively diagnosed as Condyloma Acuminata. METHODS OF TREATMENT Methods of treatment include both topical medications and minor surgical procedures. Your doctor will decide which type of therapy is best suited for you. COMMENTS Provided as a service by Acupath aboratories in cooperation with your doctor. Acupath aboratories, Inc. "For the absolute highest standard in pathology services."