ENT PATHOLOGY REPORT *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#: Obtained: 10/27/20XX Received: 10/28/20XX 1234 anywhere NYWHERE, NY (516) DOB: 06/05/19XX 8:36 pm PTIENT: Preliminary Date cct#: 1012 ge: 77 Sex: Female Submitted: 1 vial- ENT PTHOLOGY REPORT *RL;MMR; 1 of 1 10/31/XX 11/01/XX Chart//C#00000 Copy was sent to: DR. JNE DOE 456 SMPLE BLVD DIGNOSIS LT NSOPHRYNGEL DIGNOSIS: FOLLICULR LYMPHOM, GRDE I BC SURGERY CENTER PHYSICIN: JOHN E. SMITH 1234 FIRST VE, Suite: 8 cct # (212) (212) Notes: IHC results are as follows: CD3 few positive T-cells; CD5 few positive T-cells; CD10 positive, lymphoid follicles; CD20 positive lymphoid follicles; CD21 positive lymphoid follicles; BcL2 focally positive; Ki67 positive-20%. This IHC staining pattern supports the diagnosis of follicular lymphoma, Grade I. This case has been reviewed by Dr. Lee of the cupath Hematopathology Division. Microscopic Description: Sections reveal a diffuse lymphocytic neoplasm composed of poorly formed follicles. Preliminary Reasons: CD3, BCL-2 Oncoprotein, KI67, CD5, CD20, CD10, CD21 Grossing Information: Received in 10% formalin is a specimen measuring 10x08x04 mm, color is white, shape is Irregular and submitted in 1 block, 2 pieces. Grossing Comments: largest piece measures see above Clinical Impression: R/O NPC 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 Benign Infectious Inflammatory Suspicious Other typical Photomicrograph of, M.D. : (LT NSOPHRYNGEL) FOLLICULR LYMPHOM, GRDE I See report for notes (516) DOB: 06/05/19XX 10/27/20XX Submitted: 1 vial- : (LT NSOPHRYNGEL) FOLLICULR LYMPHOM, GRDE I See report for notes (516) DOB: 06/05/19XX 10/27/20XX Submitted: 1 vial- 10/27/20XX Page 1 of 1
2 Batch#: Obtained: 10/27/20XX Received: 10/28/20XX 1234 anywhere NYWHERE, NY (516) DOB: 06/05/19XX 8:36 pm PTIENT: Preliminary Date cct#: 1012 ge: 77 Sex: Female Submitted: 1 vial- ENT PTHOLOGY REPORT *RL;MMR; 1 of 1 10/31/XX 11/01/XX Chart//C#00000 Duplicate Report For DR. JNE DOE 456 SMPLE BLVD DIGNOSIS LT NSOPHRYNGEL DIGNOSIS: FOLLICULR LYMPHOM, GRDE I BC SURGERY CENTER PHYSICIN: JOHN E. SMITH 1234 FIRST VE, Suite: 8 cct # (212) Rte (212) Notes: IHC results are as follows: CD3 few positive T-cells; CD5 few positive T-cells; CD10 positive, lymphoid follicles; CD20 positive lymphoid follicles; CD21 positive lymphoid follicles; BcL2 focally positive; Ki67 positive-20%. This IHC staining pattern supports the diagnosis of follicular lymphoma, Grade I. This case has been reviewed by Dr. Lee of the cupath Hematopathology Division. Microscopic Description: Sections reveal a diffuse lymphocytic neoplasm composed of poorly formed follicles. Preliminary Reasons: CD3, BCL-2 Oncoprotein, KI67, CD5, CD20, CD10, CD21 Grossing Information: Received in 10% formalin is a specimen measuring 10x08x04 mm, color is white, shape is Irregular and submitted in 1 block, 2 pieces. Grossing Comments: largest piece measures see above Clinical Impression: R/O NPC 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 Benign Infectious Inflammatory Suspicious Other typical Photomicrograph of, M.D. : (LT NSOPHRYNGEL) FOLLICULR LYMPHOM, GRDE I See report for notes (516) DOB: 06/05/19XX 10/27/20XX Submitted: 1 vial- : (LT NSOPHRYNGEL) FOLLICULR LYMPHOM, GRDE I See report for notes (516) DOB: 06/05/19XX 10/27/20XX Submitted: 1 vial- 10/27/20XX DR. JNE DOE 456 SMPLE BLVD Rte 6 Page 1 of 1
3 BC SURGERY CENTER JOHN E. SMITH, M.D First venue, Ste. 8 New York, NY November 1, 20XX Dr. Jane Doe 456 Sample Blvd New York, NY Re: Betsy J. Jones Dear Dr. Doe: I had the pleasure of treating your patient Betsy J Jones, a 77 year old female, on October 27, 20XX. The specimen was sent for pathologic interpretation to cupath Laboratories, Inc. The histopathologic interpretation of the specimen from the () LT NSOPHRYNGEL revealed follicular lymphoma, Grade I. IHC results are as follows: CD3 few positive T-cells; CD5 few positive T-cells; CD10 positive, lymphoid follicles; CD20 positive lymphoid follicles; CD21 positive lymphoid follicles; BcL2 focally positive; Ki67 positive-20%. This IHC staining pattern supports the diagnosis of follicular lymphoma, Grade I. 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 E. SMITH, M.D.
4 Batch#: Obtained: 01/05/20XX Received: 01/05/20XX 05:48 pm PTIENT: 1234 NYWHERE NYWHERE, NY (516) DOB: 06/05/19XX cct#: 1012 ge: 85 Sex: Female CYTOPTHOLOGY REPORT STPL 1 of 2 01/06/XX Chart//C# XXXXXXX Report released on 01/06/20XX 09:28 M Copy was sent to: DR. JNE DOE 456 SMPLE BLVD DIGNOSIS BC SURGERY CENTER PHYSICIN: JOHN G. SMITH 1234 FIRST VE, Suite: 8 cct # (212) RIGHT THYROID DIGNOSIS: POSITIVE FOR MLIGNNCY (BETHESD CTEGORY VI) PPILLRY THYROID CRCINOM (212) Microscopic Description: Cellular specimen composed of syncytial groups and papillary clusters of atypical follicular cells showing enlarged oval nuclei, focally molding, nuclear grooves, and rare intranuclear cytoplasmic pseudoinclusions. Single squamoid cell is present. The background contains ropy colloid. These findings are consistent with papillary thyroid carcinoma. DEQUCY: STISFCTORY FOR EVLUTION. Rec'd 30ml of fixed clear fluid in Thin Prep vial. Prepared 1 Thin Prep slide. Received 3 SP slides. Clinical Impression: 1.5cm CLCIFIED NODULE. The Bethesda System for Reporting Thyroid Cytopathology: Implied Risk of Malignancy and Recommended Clinical Management ^ Diagnostic Category Risk of Malignancy (%) Usual Management * I. Non Diagnostic 1-4 Repeat FN with US guidance II. Benign 0-3 Clinical follow up III. typia of undetermined significance IV. Suspicious for a follicular neoplasm or Suspicious for Hurthle cell neoplasm V. Suspicious for Malignancy Repeat FN Surgical consultation (surgical lobectomy) Surgical consultation (Near-total thyroidectomy or surgical lobectomy) VI. Malignant * ctual management may depend on other factors ( e.g. clinical, sonographic) besides the FN interpretation ^ dapted from Cibas E. ly S - m J Clin Pathol 2009; 132: Photomicrograph: Surgical consultation (Near-total thyroidectomy) Color Key: Cancer Benign Suspicious Other typical Non-Diagnostic No. 2 No. 3 No. 4, M.D. : (RIGHT THYROID) POSITIVE FOR MLIGN...See Report (516) DOB: 06/05/19XX 01/05/20XX Submitted: 1 vial- : (RIGHT THYROID) POSITIVE FOR MLIGN...See Report (516) DOB: 06/05/19XX 01/05/20XX Submitted: 1 vial- 01/05/20XX Page 1 of 1
5 Batch#: Obtained: 01/06/20XX Received: 01/06/20XX 08:14 pm PTIENT: 1234 NYWHERE NYWHERE, NY (516) DOB: 06/05/19XX cct#: 1012 ge: 85 Sex: Female CYTOPTHOLOGY REPORT STPL 1 of 2 01/07/XX B 01/07/XX Chart//C# XXXX Report released on 01/07/20XX 10:14 M Copy was sent to: DR. JNE DOE 456 SMPLE BLVD DIGNOSIS LEFT THYROID DIGNOSIS: BENIGN FINDINGS (BETHESD CTEGORY II) LYMPHOCYTIC (HSHIMOTO'S) THYROIDITIS BC SURGERY CENTER PHYSICIN: JOHN G. SMITH 1234 FIRST VE, Suite: 8 cct # (212) (212) Microscopic Description: Moderately cellular specimen consists of groups of Hurthle cells admixed with a polymorphous population of lymphoid cells. Scattered macrophages are noted. Some colloid identified. The cytomorphology is consistent with lymphocytic (Hashimoto's) thyroiditis, in the proper clinical setting. DEQUCY:STISFCTORY FOR EVLUTION. Rec'd 30ml of fixed clear fluid in Thin Prep vial. Prepared 1 Thin Prep slide. Received 2 SP slides. Clinical Impression: 1.2cm NODULE. B RIGHT THYROID MID TO UPPER POLE DIGNOSIS: BENIGN FINDINGS (BETHESD CTEGORY II) COLLOID NODULE Microscopic Description: is composed predominantly of abundant watery colloid. Rare small groups of follicular cells present. These findings are consistent with a colloid nodule. DEQUCY: STISFCTORY FOR EVLUTION. Received 10ml of clear fluid in Formalin Jar. Prepared 2 Cytospin slides. Received 2 SP slides. Prepared cell block. Clinical Impression: 1.1cm NODULE. Photomicrograph: Continued on next page No.2 B, M.D. : (LEFT THYROID) BENIGN FINDINGS (BE...See Report B: (RIGHT THYROID MID TO UPPER POLE) B...See Report (516) DOB: 06/05/19XX 01/06/20XX Submitted: 2 vials-,b : (LEFT THYROID) BENIGN FINDINGS (BE...See Report B: (RIGHT THYROID MID TO UPPER POLE) B...See Report (516) DOB: 06/05/19XX 01/06/20XX Submitted: 2 vials-,b 01/06/20XX Page 1 of 2
6 PTIENT: STPL 2 of 2 Final Date 01/07/XX 01/07/XX DIGNOSIS The Bethesda System for Reporting Thyroid Cytopathology: Implied Risk of Malignancy and Recommended Clinical Management ^ Diagnostic Category Risk of Malignancy (%) Usual Management * I. Non Diagnostic 1-4 Repeat FN with US guidance II. Benign 0-3 Clinical follow up III. typia of undetermined significance IV. Suspicious for a follicular neoplasm or Suspicious for Hurthle cell neoplasm V. Suspicious for Malignancy Repeat FN Surgical consultation (surgical lobectomy) Surgical consultation (Near-total thyroidectomy or surgical lobectomy) VI. Malignant * ctual management may depend on other factors ( e.g. clinical, sonographic) besides the FN interpretation ^ dapted from Cibas E. ly S - m J Clin Pathol 2009; 132: Surgical consultation (Near-total thyroidectomy) Color Key: Cancer Benign Suspicious Other typical Non-Diagnostic Photomicrograph: No.2 B, M.D. : (LEFT THYROID) BENIGN FINDINGS (BE...See Report B: (RIGHT THYROID MID TO UPPER POLE) B...See Report (516) DOB: 06/05/19XX 01/06/20XX Submitted: 2 vials-,b : (LEFT THYROID) BENIGN FINDINGS (BE...See Report B: (RIGHT THYROID MID TO UPPER POLE) B...See Report (516) DOB: 06/05/19XX 01/06/20XX Submitted: 2 vials-,b 01/06/20XX Page 2 of 2
7 MOLECULR ISH REPORT RL;MMR; Page 1 of 1 CCESSION: Obtained: 01/30/20XX Received: PRCTICE: PHYSICIN: 01/31/20XX 1 2:00 am BC SURGERY CENTER JOHN D. SMITH 1234 FIRST VE Suite: 8 ccount # Rte 6 Indications: LESION Source of Tissue: Nose Date Reported: 02/03/20XX 3:34PM (212) (212) Copy was sent to: DR. JNE DOE 456 SMPLE BLVD PTIENT: JCK S. JONES MIN ST FLUSHING, NY Phone #: (718) Chart//C#23XXX4 ge: 63 DOB: 01/02/19XX Sex: Male cct: 1018 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 ISH WIDESCREEN HPV ISH 6/11 Electronically signed by:, 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.
8 Patient: JCK S. JONES Date Obtained: 01/30/20XX Date of Birth: 01/02/19XX Doctor: Dr. JOHN D. 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."
9 Batch#: FLOW CYTOMETRY NLYSIS REPORT RL;MMR; Page 1 of 1 CCESSION: Plainview,NY HP Obtained: 04/20/20XX Received: 04/20/20XX 10:14 am Copy was sent to: DR. JNE DOE 456 SMPLE BLVD 04/21/20XX 12:50 PM PRCTICE: BC SURGERY CENTER PHYSICIN: JOHN E. SMITH 1234 FIRST VE Suite: 8 ccount # Rte 6 (212) (212) PTIENT: Phone #: JCK JONES MIN ST FLUSHING,NY (718) ge: 60 DOB: 01/02/19XX Sex: Male cct: 1018 Clinical Information: 66 year-old man with Right Neck Mass Lymph Node. R/O lymphoma. Source of Tissue: RIGHT NECK LYMPH NODE Date Processed: 4/20/20XX 2:40:00PM Test Results B-Cells CD10 Negative CD19 Positive CD20 Positive CD22 Positive CD23 Moderate S.Lambda Negative S.Kappa Moderate Myeloid CD11c Negative CD13 Negative CD14 Negative CD33 Negative CD117 Negative T-Cells CD2 Negative CD3 Negative CD4 Negative CD5 Positive CD7 Positive CD8 Negative Miscellaneous CD34 Negative CD25 Negative CD38 Positive CD45 Bright CD56 Negative HL-DR Negative CD103 Negative Immunophenotypic analysis Interpretation: The phenotype and cytospin morphology are consistent with small lymphocytic lymphoma/chronic lymphocytic leukemia. See separate biopsy report for surgical pathology diagnosis. Description: RIGHT NECK MSS LYMPH NODE. cytospin preparation is examined. Viability and nalysis: The specimen has a viability of 70%. The above data were generated on a population of cells which cytometrically correspond to lymphoid cells. The gated population comprise 91% of the sample. The specimen appears cellular and examination of cytospin preparation confirms this impression. The cells fall within the standard lymphoid gate. The histogram does not suggest that a separate and distinct blast population is present. Phenotype: The B cells are a major population. They express the pan B-cell markers CD19, CD20 and CD22 and coexpress CD5 and CD23. CD38 is also positive. The B cells are monoclonal with kappa light chain restriction. The T-cell population expresses pan-t cell antigens (CD2, CD3, CD5 and CD7) in a non-aberrant fashion. The CD4/CD8 ratio is normal. Electronically signed by: JOHN BROWN, M.D. This assay has not been approved by the FD (Food and Drug dministration). This test was developed and its performance characteristics were determined by the Flow Cytometry department of cupath Lab.Inc. and was approved by New York State DOH. This report include one or more staining results that use analyte specific reagents (SR). The assay is for clinical use and should not be viewed as experimental or for research use only.
ENT PATHOLOGY REPORT *RL;MMR; 1 of 1. A Copy was sent to: DR. JANE DOE 456 SAMPLE BLVD NEW YORK, NY DIAGNOSIS
Batch#: 11662 ccession: Obtained: 10/27/20XX Received: 10/28/20XX 1234 anywhere NYWHERE, NY 11554 (516) 123-4567 DOB: 06/05/19XX 8:36 pm PTIENT: Specimen Preliminary Date cct#: 1012 ge: 77 Sex: Female
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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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