GASTROENTEROLOGY PATHOLOGY REPORT IS;RL;MMR; STPL 1 of 2 11/29/XX 12/01/XX. A Copy was sent to: DR. JANE G. DOE 456 SAMPLE BLVD. NEW YORK, NY 10011
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1 atch#: Tel#: CUPTH ccession: Obtained: 11/28/20XX Received: 11/28/20XX 12:00 am PTIENT: MIN ST FLUSHING,NY (718) DO: 01/02/19XX GSTROENTEROLOGY PTHOLOGY REPORT IS;RL;MMR; STPL 1 of 2 Specimen Preliminary Date Final Report Date cct#: 1018 ge: 55 Sex: Male Submitted: 2 vials-, N/ Chart//C# /01/XX Copy was sent to: DR. JNE G. DOE 456 SMPLE LVD. DIGNOSIS STOMCH DIGNOSIS: MODERTE TO SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI C SURGERY CENTER PHYSICIN: JOHN GI SMITH 1234 FIRST VE, Suite: 8 cct # (212) Rte (212) Microscopic Description: Sections of antral and body types gastric mucosa reveal an infiltrate of neutrophils and, in the lamina propria, an increased number of lymphocytes and plasma cells. The presence of Helicobacter pylori is confirmed by immunohistochemical stain. Grossing Information: Received in 10% formalin is a specimen measuring 03x02x02 mm, color is tan, shape is Irregular and submitted in 1 block, multiple pieces. Grossing Comments: largest piece measures see above Clinical Impression: GSTRIC MUCOS. STOMCH DIGNOSIS: SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI WITH ULCER, PROMINENT RECTIVE LYMPHOID HYPERPLSI ND FOCL INTESTINL METPLSI Notes: Immunohistochemical stains for CD3, CD5 are positive in T-cells. CD20 is positive in -cells, CD10 is negative. cl-2 is positive in T-cells. These findings are most consistent with secondary to ulcer dense lymphocytic infiltrate composed of reactive follicles. This case has been reviewed by Dr. Lee of the cupath Hematopathology Division. Microscopic Description: Sections of antral type gastric mucosa reveal an infiltrate of neutrophils and, in the lamina propria, an increased number of lymphocytes and plasma cells. The presence of Helicobacter pylori is confirmed by immunohistochemical stain. There is detached ulcer membrane and a fragment of mucosa with prominent reactive lymphoid hyperplasia. Preliminary Reasons: CD3, CL-2 Oncoprotein, CD5, CD20, CD10 Grossing Information: Received in 10% formalin is a specimen measuring 03x02x02 mm, color is tan, shape is Irregular, procedure is Cold and submitted in 1 block, multiple pieces. Grossing Comments: largest piece measures see above, hp This SR has been prepared and validated according to manufacturer recommendations and its performance characteristics have been evaluated as to how they contribute to the global clinical applications within cupath s diagnostic services. With the exception of HercepTest, this reagent has not been cleared by The U.S. Food Drug dministration. The FD has determined that such clearance or approval is not necessary. This test is used for clinical applications only. This laboratory is certified under CLI-88 amendments to perform high complexity clinical laboratory testing. Color Key: Cancer Precancer/Dysplasia enign Infectious Inflammatory Suspicious Other typical Photomicrograph of John rown John rown, M.D. Olga Falkowski, M.D., Medical Director : (STOMCH) MODERTE TO SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI : (STOMCH) SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI WITH ULCER, PROMINENT RECTIVE LYMPHOID HYPERPLSI ND FOCL INTESTINL METPLSI (718) DO: 01/02/19XX 11/28/20XX Submitted: 2 vials-, : (STOMCH) MODERTE TO SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI : (STOMCH) SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI WITH ULCER, PROMINENT RECTIVE LYMPHOID HYPERPLSI ND FOCL INTESTINL METPLSI (718) DO: 01/02/19XX 11/28/20XX Submitted: 2 vials-, 11/28/20XX Page 1 of 1
2 Patient: JCK S JONES For Site(s):, Date Obtained: 11/28/20XX Date of irth: 01/02/19XX Doctor: Dr. JOHN GI. SMITH (212) PTIENT FCT SHEET TM CHRONIC CTIVE GSTRITIS Definition: recurring infection of the lining of your stomach. FCTS -Chronic active gastritis is usually the result of an infection by a bacterium called H. pylori in your stomach. -The incidence of chronic active gastritis increases sharply in patients over 50 years of age. SYMPTOMS Chronic active gastritis may present any of the following symptoms, though patients usually show no symptoms at all. -Nausea -Indigestion -Vomiting -bdominal pain -Loss of appetite -Dark stools METHOD OF DIGNOSIS Many clinicians can suspect the diagnosis by gastroscopy. However, the removal of a small sample of your stomach's lining for analysis at a reputable pathology laboratory was required for absolute confirmation of the diagnosis, as other more serious conditions can mimic it clinically. Your sample was studied by a specialized pathologist at cupath Laboratories, Inc. before being conclusively diagnosed as Chronic ctive Gastritis. METHODS OF TRETMENT There are a variety of treatments for chronic active gastritis. Your doctor will decide which treatment is best suited for your specific condition. 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 atch#: Tel#: CUPTH ccession: Obtained: 11/28/20XX Received: 11/28/20XX 12:00 am PTIENT: MIN ST FLUSHING,NY (718) DO: 01/02/19XX GSTROENTEROLOGY PTHOLOGY REPORT IS;RL;MMR; STPL 1 of 2 Specimen Preliminary Date Final Report Date cct#: 1018 ge: 55 Sex: Male Submitted: 2 vials-, N/ Chart//C# /01/XX Duplicate Report For DR. JNE G. DOE 456 SMPLE LVD. DIGNOSIS STOMCH DIGNOSIS: MODERTE TO SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI C SURGERY CENTER PHYSICIN: JOHN GI SMITH 1234 FIRST VE, Suite: 8 cct # (212) Rte (212) Microscopic Description: Sections of antral and body types gastric mucosa reveal an infiltrate of neutrophils and, in the lamina propria, an increased number of lymphocytes and plasma cells. The presence of Helicobacter pylori is confirmed by immunohistochemical stain. Grossing Information: Received in 10% formalin is a specimen measuring 03x02x02 mm, color is tan, shape is Irregular and submitted in 1 block, multiple pieces. Grossing Comments: largest piece measures see above Clinical Impression: GSTRIC MUCOS. STOMCH DIGNOSIS: SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI WITH ULCER, PROMINENT RECTIVE LYMPHOID HYPERPLSI ND FOCL INTESTINL METPLSI Notes: Immunohistochemical stains for CD3, CD5 are positive in T-cells. CD20 is positive in -cells, CD10 is negative. cl-2 is positive in T-cells. These findings are most consistent with secondary to ulcer dense lymphocytic infiltrate composed of reactive follicles. This case has been reviewed by Dr. Lee of the cupath Hematopathology Division. Microscopic Description: Sections of antral type gastric mucosa reveal an infiltrate of neutrophils and, in the lamina propria, an increased number of lymphocytes and plasma cells. The presence of Helicobacter pylori is confirmed by immunohistochemical stain. There is detached ulcer membrane and a fragment of mucosa with prominent reactive lymphoid hyperplasia. Preliminary Reasons: CD3, CL-2 Oncoprotein, CD5, CD20, CD10 Grossing Information: Received in 10% formalin is a specimen measuring 03x02x02 mm, color is tan, shape is Irregular, procedure is Cold and submitted in 1 block, multiple pieces. Grossing Comments: largest piece measures see above, hp This SR has been prepared and validated according to manufacturer recommendations and its performance characteristics have been evaluated as to how they contribute to the global clinical applications within cupath s diagnostic services. With the exception of HercepTest, this reagent has not been cleared by The U.S. Food Drug dministration. The FD has determined that such clearance or approval is not necessary. This test is used for clinical applications only. This laboratory is certified under CLI-88 amendments to perform high complexity clinical laboratory testing. Color Key: Cancer Precancer/Dysplasia enign Infectious Inflammatory Suspicious Other typical Photomicrograph of John rown John rown, M.D. Olga Falkowski, M.D., Medical Director : (STOMCH) MODERTE TO SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI : (STOMCH) SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI WITH ULCER, PROMINENT RECTIVE LYMPHOID HYPERPLSI ND FOCL INTESTINL METPLSI (718) DO: 01/02/19XX 11/28/20XX Submitted: 2 vials-, : (STOMCH) MODERTE TO SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI : (STOMCH) SEVERE CHRONIC CTIVE GSTRITIS WITH H PYLORI WITH ULCER, PROMINENT RECTIVE LYMPHOID HYPERPLSI ND FOCL INTESTINL METPLSI (718) DO: 01/02/19XX 11/28/20XX Submitted: 2 vials-, 11/28/20XX DR. JNE G. DOE 456 SMPLE LVD. Rte 6 Page 1 of 1
4 C SURGERY CENTER JOHN GI SMITH, M.D First venue New York, NY December 1, 20XX Dr. Jane G. Doe 456 Sample lvd. New York, NY Re: Jack S. Jones Dear Dr. G. Doe: I had the pleasure of treating your patient Jack S Jones, a 55 year old male, on November 28, 20XX. The specimens were sent for pathologic interpretation to cupath Laboratories, Inc. The histopathologic interpretation of the specimen from the () STOMCH revealed moderate to severe chronic active gastritis with h pylori.the histopathologic interpretation of the specimen from the () STOMCH revealed severe chronic active gastritis with h pylori with ulcer, prominent reactive lymphoid hyperplasia and focal intestinal metaplasia. Immunohistochemical stains for CD3, CD5 are positive in T-cells. CD20 is positive in -cells, CD10 is negative. cl-2 is positive in T-cells. These findings are most consistent with secondary to ulcer dense lymphocytic infiltrate composed of reactive follicles. This case has been reviewed by Dr. Lee of the cupath Hematopathology Division. 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 GI SMITH, M.D.
5 FISH NLYSIS REPORT *NHC;PO; Page 1 of 1 Tel#: CUPTH CCESSION: XXXXXX-20XX Obtained: 08/02/20XX Received: 08/02/20XX PRCTICE: C SURGERY CENTER PHYSICIN: JOHN SMITH 123 FIRST VE, SUITE: 8 ccount # XXXX-XXX-1 Rte 7 (212) (212) PTIENT: JOHN DOE 1234 NYWHERE STREET NEW YORK, NY ge: 53 Sex: Male Phone #: (212) Chart//C# 123XX DO: 07/02/19XX cct: XXXXXX Indications: reast Cancer; R/O Esophageal Ca.; ; ; ; ; Source of Tissue: Date Reported FISH: Esophagus 08/05/20XX 12:53 PM FISH NLYSIS DT ssay # 1 Probe Region: HER2 amplification No. of Cells Scored: 50 Process and limitations of use: This test is approved by the U.S. Food and Drug dministration for use in conjunction with, and not in lieu of, current standard diagnostic procedures. Performance characteristics have been verified by cupath Laboratories. Chromosome or Locus: Modal signals per cell: HER-2 20 cep17 2 TEST RESULT: PTIENT SMPLE: nuc ish(d17z1x2~4,her2x10~44)[50] mplification ratio is 9.4. POSITIVE for HER-2 amplification. POSITIVE CONTROL: nuc ish(d17z1x2,her2x30~45)[25] mplification ratio is INTERPRETTION: Fluorescence in situ hybridization (FISH) with DN probes (bbott Molecular Inc., Des Plaines, IL) for the HER2 locus and the centromere of chromosome 17 was performed on the Formalin Fixed Paraffin Embedded Esophagus iopsy. The observed HER2:CEP17 gave an MPLIFICTION ratio of 9.4. This is POSITIVE for HER2 amplification. Reportable ranges of HER2:CEP17 ratio are: <1.8 - Negative, no amplification Equivocal >2.2 - Positive for HER2 amplification FISH Electronically signed by: John rown, MD Olga Falkowski, M.D., Medical Director
6 MOLECULR ISH REPORT IS;RL;MMR; Page 1 of 1 CCESSION: Obtained: 12/30/20XX Received: PRCTICE: PHYSICIN: Tel#: CUPTH 01/02/20XX 12:00 am C SURGERY CENTER JOHN G. SMITH 1234 FIRST VE Suite: 8 ccount # Rte 6 Indications: R/O Condyloma Source of Tissue: Perianal Date Reported: 01/14/20XX (212) (212) Copy was sent to: DR. JNE DOE 456 SMPLE LVD 3:18PM PTIENT: ETSY JONES 1234 NYWHERE NYWHERE, NY Phone #: (516) ge: 80 DO: 06/05/19XX Sex: Female cct: 1012 TEST RESULT ISH/Probe Marker For Results HPV WS Wide Screen HPV Positive HPV 6/11 HPV Types 6/11 Positive HPV 16/18 HPV Types 16/18 Negative HPV 31/33 HPV Types 31/33 Negative INTERPRETTION: 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 DN 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 Low-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 HPV 6/11 HPV 16/18 HPV 31/33 Electronically signed by: John rown, M.D. This test was developed and its performance characteristics determined by cupath Laboratories, Inc. 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. This test is used for clinical purposes. Pursuant to the requirements of CLI 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.
7 Patient: JCK S JONES Date Obtained: 12/30/20XX Date of irth: 01/02/19XX Doctor: Dr. JOHN G. SMITH For Site(s): (212) PTIENT FCT SHEET TM CONDYLOM CUMINT Definition: Commonly known as genital warts, Condyloma cuminata 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. FCTS/RISK FCTORS 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 lthough 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 DIGNOSIS 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 cupath Laboratories, Inc. before being conclusively diagnosed as Condyloma cuminata. METHODS OF TRETMENT 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 cupath Laboratories in cooperation with your doctor. cupath Laboratories, Inc. "For the absolute highest standard in pathology services."
GASTROENTEROLOGY PATHOLOGY REPORT IS;RL;MMR; STPL 1 of 1 11/29/XX 12/01/XX. A Copy was sent to: DR. JANE G. DOE 456 SAMPLE BLVD. NEW YORK, NY 10011
atch#: 11893 28 South Terminal Drive Plainview, NY 11803 Tel#: 1-888-CUPTH Fax#: 1-516-326-3452 www.acupath.com ccession: Obtained: 11/28/20XX Received: 11/28/20XX 12:00 am PTIENT: 12548 MIN ST FLUSHING,NY
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