PODIATRIC PATHOLOGY REPORT IS;RL;MMR; 1 of 1. A Copy was sent to: DR. JANE DOE 456 SAMPLE BLVD NEW YORK, NY DIAGNOSIS

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1 Batch#: Tel#: CUPTH ccession: Obtained: Received: 12:02 pm PTIENT: JCK JONES MIN ST FLUSHING, NY (718) DOB: 01/02/19XX Specimen Final Report Date cct#: 1018 ge: 57 Sex: Male PODITRIC PTHOLOGY REPORT IS;RL;MMR; 1 of 1 Submitted: 1 vial- RT GRET TOE DIGNOSIS: ONYCHOMYCOSIS 07/19/XX Copy was sent to: DR. JNE DOE 456 SMPLE BLVD DIGNOSIS BC SURGERY CENTER PHYSICIN: JOHN SMITH 1234 FIRST VE, Suite: 8 cct # (212) (212) Notes: PS reveals fungal elements Microscopic Description: Sections show fragments of nail plate with hyperkeratosis and fungal hyphae Grossing Information: Received in 10% Formalin is a specimen measuring 10X03X01 mm, color is tan, shape is Irregular, procedure is Snip and submitted in 1 block, 3 pieces. Grossing Comments: Largest piece measured - see above. PS stain performed Clinical Impression: Color Key: Cancer Precancer/Dysplasia Benign Infectious Inflammatory Suspicious Other typical Photomicrograph of John Brown John Brown, M.D. Board Certified Dermatopathologist Olga Falkowski, M.D., Medical Director : (RT GRET TOE) ONYCHOMYCOSIS JCK JONES JCK JONES Submitted: 1 vial- : (RT GRET TOE) ONYCHOMYCOSIS JCK JONES Submitted: 1 vial- JCK JONES Page 1 of 1

2 Patient: JCK S JONES Date Obtained: Date of Birth: 01/02/19XX Doctor: Dr. JOHN SMITH For Site(s): (212) PTIENT FCT SHEET TM NIL FUNGUS / ONYCHOMYCOSIS / MYCOTIC NILS Definition: fungal infection of the fingernail or toenail. CUSE -Nail fungus is caused by the introduction of a fungus around your nail. -It can enter through: - Cuts in your skin - separation of your nail from the skin around and beneath it SYMPTOMS Your nail may: -Thicken -Turn yellowish or brownish in color -Become foul-smelling, with moist debris around the nail -Become painful, often made worse by pressure METHOD OF DIGNOSIS Many clinicians can diagnose nail fungus 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 cupath Laboratories, Inc. before being conclusively diagnosed as Onychomycosis. METHODS OF TRETMENT There are a variety of treatments for nail fungi, which include topical creams, oral medications, and surgery. Your doctor will discuss with you which treatment is best in your specific case. COMMENTS Provided as a service by cupath Laboratories in cooperation with your doctor. cupath Laboratories, Inc. "For the absolute highest standard in pathology services."

3 Batch#: Tel#: CUPTH ccession: Obtained: Received: 12:02 pm PTIENT: JCK JONES MIN ST FLUSHING, NY (718) DOB: 01/02/19XX Specimen Final Report Date cct#: 1018 ge: 57 Sex: Male PODITRIC PTHOLOGY REPORT IS;RL;MMR; 1 of 1 Submitted: 1 vial- RT GRET TOE DIGNOSIS: ONYCHOMYCOSIS 07/19/XX Duplicate Report For DR. JNE DOE 456 SMPLE BLVD DIGNOSIS BC SURGERY CENTER PHYSICIN: JOHN SMITH 1234 FIRST VE, Suite: 8 cct # (212) Rte (212) Notes: PS reveals fungal elements Microscopic Description: Sections show fragments of nail plate with hyperkeratosis and fungal hyphae Grossing Information: Received in 10% Formalin is a specimen measuring 10X03X01 mm, color is tan, shape is Irregular, procedure is Snip and submitted in 1 block, 3 pieces. Grossing Comments: Largest piece measured - see above. PS stain performed Clinical Impression: Color Key: Cancer Precancer/Dysplasia Benign Infectious Inflammatory Suspicious Other typical Photomicrograph of John Brown John Brown, M.D. Board Certified Dermatopathologist Olga Falkowski, M.D., Medical Director : (RT GRET TOE) ONYCHOMYCOSIS JCK JONES JCK JONES Submitted: 1 vial- : (RT GRET TOE) ONYCHOMYCOSIS JCK JONES Submitted: 1 vial- JCK JONES DR. JNE DOE 456 SMPLE BLVD Rte 6 Page 1 of 1

4 BC SURGERY CENTER JOHN SMITH, D.P.M First venue New York, NY July 19, 20XX Dr. Jane Doe 456 Sample Blvd New York, NY Re: Jack S. Jones Dear Dr. Doe: I had the pleasure of treating your patient Jack S Jones, a 57 year old male, on July 18, 20XX. The specimen was sent for pathologic interpretation to cupath Laboratories, Inc. The histopathologic interpretation of the specimen from the () RT GRET TOE revealed onychomycosis. PS reveals fungal elements. 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 SMITH, D.P.M.

5 MELNOM FISH NLYSIS REPORT IS;RL;MMR; Page 1 of 1 Tel#: CUPTH Source of Tissue: Indications: Date Reported FISH: Skin Biopsy Left Foot; R/O Melanoma 05/16/20XX CCESSION: Obtained: 05/11/20XX Received: 05/12/20XX PRCTICE: BC SURGERY CENTER PHYSICIN: JOHN D. SMITH 1234 FIRST VE, SUITE: 8 ccount # Rte 9 (212) (212) PTIENT: BETSY J. JONES 1234 NYWHERE NYWHERE, NY Phone #: (516) Chart//C#00000 ge: 78 Sex: Female cct: DOB: 06/05/19XX FINL DIGNOSIS: BNORML, 90% OF CELLS EXHIBIT RELTIVE GINS OF RREB1/CEP 6 ND 53.3% OF CELLS EXHIBIT GINS OF CCND1 FISH NLYSIS DT ssay # Probe Region Chromosome or Locus Normal Percentage Normal Reference Range No. of Cells Scored FISH CCND1 (11q13.3) 46.6% validation in progress 60 D6Z1 (6p11.1-q11) 10% validation in progress 60 MYB (6q23.3) 28.3% validation in progress 60 RREB1 (6p24.3-p25) 0% validation in progress 60 ISCN RESULT: nuc ish(rreb1x3~8)[60],(d6z1x3~5)[54/60],(mybx3~5)[43/60],(ccnd1x3~4)[32/60] INTERPRETTION: Interphase fluorescence in situ hybridization (FISH) was completed on the submitted formalin fixed paraffin embedded left foot biopsy using a panel of four locus specific identifier probes for the following loci: CCND1 (11q13), MYB (6q23), RREB1 (6p25) (Empire Genomics, Buffalo NY), and D6Z1 (CEP 6) (bbott Molecular, Des Plains IL). FISH results were as follows: 54/60 cells (90%) were identified to have relative gains of both the RREB1 and CEP 6 loci. This finding satisfies the abnormal criteria of >55% of the cells having relative gains of these loci (Morey et al. Pathology 2009, pp ). Relative gains of RREB1/CEP6 have been observed in patients with melanocytic tumors (Morey et al. Pathology 2009, pp ). In addition, there were 32/60 cells (53.3%) identified to have 3~4 copies of the CCND1 locus. Gains of the CCND1 locus in >38% of the tissue have been observed in patients with melanoma (Gerami et al. m J Surg Path 2009 pp ). MYB appeared to be present in normal copy number relative to the centromere of chromosome 6. These are BNORML results. These four loci have been identified to have variations in copy number, and can be associated with malignant melanoma (Morey et al. Pathology 2009, pp ). In this case, two of the established abnormal criteria have been satisfied for deeming the case abnormal. These findings should be interpreted in association with other clinical and laboratory findings. Process and limitations of use: 1. The malignant melanoma FISH assay is not an FD-approved FISH test designed to aid in the detection of chromosomal abnormalities related to the development of malignant melanoma. 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. positive result by the malignant melanoma FISH assay requires analysis of a minimum of 30 interphase cells that fit the criteria of being morphologically abnormal under a counterstain and that these cells show gains of CCND1 in >38%, or gains of RREB1 in >29%, or relative gains of RREB1/CEP6 in >55%, or relative loss of MYB/CEP6 in >40% of the interphase cells examined. 3. This FISH test was developed and its performance determined by the cupath Cytogenetics Laboratory. lthough it has not been cleared or approved by the U.S. Food and Drug dministration, the FD has determined that such clearance or approval is not necessary. Pursuant to the requirements of CLI '88, however, this laboratory has established and verified the test's accuracy and precision, therefore, this test is used for clinical purposes. 4. The Spitz Nevus FISH assay is not an FD-approved FISH test designed to aid in the detection of chromosomal abnormalities related to the development of Spitz Nevi. This FISH assay is intended for use as an adjunct to traditional diagnostic procedures and should not be used as the sole basis for diagnosis. 5. positive result for the Spitz Nevus FISH assay requires 30% of the tissue to exhibit greater than three-fold the normal diploid copy number for the HRS locus. Increases in HRS locus have been observed in specimens that were diagnosed as Spitz nevus. Electronically signed by: John Brown, M.D. Olga Falkowski, M.D., Medical Director