Ordering Physician CLIENT,CLIENT. Collected REVISED REPORT

Transcription

1 HPWET Hematopathology Consultation, MML Embed Client Hematopathology Consult REVISED INAL DIAGNOSIS Interpretation Peripheral blood, bone marrow aspirate and biopsies, bilateral iliac crests: 1. Normocellular bone marrow with morphologically normal trilineage hematopoiesis. Case Number BR No morphologic features of a myelodysplastic syndrome, a myeloproliferative neoplasm, or other primary malignant myeloid neoplasms. 3. No morphologic or immunophenotypic features of involvement by lymphoma. COMMENT The etiology of the patient's mild cytopenia is not evident from this bone marrow examination. Secondary causes such as toxic exposure, medication/drug usage, alcohol consumption, nutrional deficiency, autoimmune disorders, chronic inflammation/infection, should be considered. Correlation with cytogenetic and Next Generation Sequencing findings is suggested. MICROSCOPIC DESCRIPTION Peripheral Blood By report CBC (dated 6/22/17): Hgb 10.6 g/dl; RBC 3.56 X10(12)/L; MCV 86.2 fl; RDW 16.2 %; WBC 3.9 x10(9)/l; PLT 369 x 10(9)/L. NEUTROPHILS 62 MONOCYTES 16 EOSINOPHILS 0 METAMYELOCYTES 0 MYELOCYTES 0 BLASTS 0 OTHER CELLS 0 NRBC 0 Total s: 100 Peripheral smear: Red blood cells: White blood cells: % of Total s BR Page 1 of 6

2 Client Platelets: Bone Marrow Aspirate/Touch Imprint NEUTROPHILS 26 METAMYELOCYTES 7 MYELOCYTES 7 EOSINOPHILS 9 BLASTS 6 NORMOBLASTS 0 PROMONOCYTES 0 MONOCYTES 23 PLASMA CELLS 0 Total s: 100 Quality: ular M:E ratio: 2:3 Erythroid precursors: Normoblastic maturation. Myeloid precursors: Normal maturation without dysplastic features. Blasts not increased. Megakaryocytes: Normal cytology Lymphocytes: Not increased. Bone Marrow Biopsy/Clot Quality: Adequate ularity: Normal; 40%. Erythroid precursors: Relatively slightly increased with normal morphology. % of Total s BR Page 2 of 6

3 Client Myeloid Precursors: Relatively slightly decreased with normal morphology. Blasts not increased. Megakaryocytes: Normal quantity and morphology. Lymphocytes: No lymphoid aggregates. ANCILLARY STUDIES Iron stain, bone marrow aspirate: performed at Mayo Clinic in Rochester, MN: Storage slightly increased. Sideroblasts present. Ring sideroblasts not seen. Cytochemical stain, myeloperoxidase, bone marrow aspirate myeloperoxidase is positive. Cytochemical stain, butyrate esterase/chloroacetate esterase, bone marrow aspirate butyrate esterase is positive and chloroacetate is negative. Immunohistochemical studies, bone marrow biopsy, antibodies to CD30 and Ki67: The cells are negative for CD30 and negative for Ki67. REVISION DESCRIPTION Report reactivated to update Ancillary Studies. In Ancillary Studies the CD30 result was updated from positive to be negative. Gross Description Report electronically signed by ANGELA REESE-DAVIS I verify that I have examined all relevant slides/materials for the specimen(s) and rendered or confirmed the diagnosis. B: Received in formalin labeled with the patient's name, medical record number and "Bone marrow biopsy" is a 1.0 x 0.2 cm core of tissue. The specimen is submitted en toto in cassette #1.C: Received in formalin labeled with the patient's name, medical record number and "Bone marrow clot" is a 1.0 x 0.5 x 0.2 cm aggregate of tissue. The specimen is submitted en toto in cassette #1. Material Received A. BM654: Bone marrow 8 unstained slides B. BM654: biopsy C. BM654: clot Received: 23 Jun :46 Reported: 29 Jun :27 BR Page 3 of 6

4 Client Previously Reported As: Hematopathology Consult Interpretation Previously reported on 26 Jun 2017 at 12:27 as: INAL DIAGNOSIS Peripheral blood, bone marrow aspirate and biopsies, bilateral iliac crests: 1. Normocellular bone marrow with morphologically normal trilineage hematopoiesis. 2. No morphologic features of a myelodysplastic syndrome, a myeloproliferative neoplasm, or other primary malignant myeloid neoplasms. 3. No morphologic or immunophenotypic features of involvement by lymphoma. COMMENT The etiology of the patient's mild cytopenia is not evident from this bone marrow examination. Secondary causes such as toxic exposure, medication/drug usage, alcohol consumption, nutrional deficiency, autoimmune disorders, chronic inflammation/infection, should be considered. Correlation with cytogenetic and Next Generation Sequencing findings is suggested. MICROSCOPIC DESCRIPTION Peripheral Blood By report CBC (dated 6/22/17): Hgb 10.6 g/dl; RBC 3.56 X10(12)/L; MCV 86.2 fl; RDW 16.2 %; WBC 3.9 x10(9)/l; PLT 369 x 10(9)/L. NEUTROPHILS 62 MONOCYTES 16 EOSINOPHILS 0 % of Total s BR Page 4 of 6

5 Client METAMYELOCYTES 0 MYELOCYTES 0 BLASTS 0 OTHER CELLS 0 NRBC 0 Total s: 100 Peripheral smear: Red blood cells: White blood cells: Platelets: Bone Marrow Aspirate/Touch Imprint NEUTROPHILS 26 METAMYELOCYTES 7 MYELOCYTES 7 EOSINOPHILS 9 BLASTS 6 NORMOBLASTS 0 PROMONOCYTES 0 MONOCYTES 23 PLASMA CELLS 0 Total s: 100 Quality: ular M:E ratio: 2:3 % of Total s Erythroid precursors: Normoblastic maturation. BR Page 5 of 6

6 Client Myeloid precursors: Normal maturation without dysplastic features. Blasts not increased. Megakaryocytes: Normal cytology Lymphocytes: Not increased. Bone Marrow Biopsy/Clot Quality: Adequate ularity: Normal; 40%. Erythroid precursors: Relatively slightly increased with normal morphology. Myeloid Precursors: Relatively slightly decreased with normal morphology. Blasts not increased. Megakaryocytes: Normal quantity and morphology. Lymphocytes: No lymphoid aggregates. ANCILLARY STUDIES Iron stain, bone marrow aspirate: performed at Mayo Clinic in Rochester, MN: Storage slightly increased. Sideroblasts present. Ring sideroblasts not seen. Cytochemical stain, myeloperoxidase, bone marrow aspirate myeloperoxidase is positive. Cytochemical stain, butyrate esterase/chloroacetate esterase, bone marrow aspirate butyrate esterase is positive and chloroacetate is negative. Immunohistochemical studies, bone marrow biopsy, antibodies to CD30 and Ki67: The cells are positive for CD30 and negative for Ki67. BR Page 6 of 6