Immunophenotyping of cervical lymph node biopsy by flow cytometry shows a T cell population (about 76% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 23% of the cells analyzed) that is negative for CD5, CD10, CD56, no surface light-chain restriction. Impression: no abnormal immunophenotypes are found with flow cytometry.

CPT 88188

2. BM: 1% monoclonal plasma cells

Immunophenotyping of bone marrow aspirate by flow cytometry shows a T cell population with no aberrant loss or aberrant expression of T cell markers, a B cell population that is negative for CD5, CD10, also no surface light-chain restriction. Plasma cells account for about 1% of the cells analyzed and show cytoplasmic kappa light chain restriction. Impression: presence of monoclonal plasma cells (1%) in bone marrow.

CPT 88189

3. BX: 10% polyclonal plasma cells

Immunophenotyping of sinus biopsy by flow cytometry shows a T cell population with no aberrant loss or aberrant expression of T cell markers, a B cell population that is negative for CD5, CD10, also no surface light-chain restriction. Plasma cells account for about 10% of the cells analyzed and show no evidence of cytoplasmic light chain restriction. Impression: no evidence of monoclonal B cells or monoclonal plasma cells by flow cytometry.

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4. PB: normal

Immunophenotyping of peripheral blood lymphocytes by flow cytometry shows a T cell population (about 62% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 35% of the cells analyzed) that is negative for CD5, CD10, CD16, and CD56.

CPT 88187

5. PB: normal

Immunophenotyping of peripheral blood lymphocytes by flow cytometry shows a T cell population (about 58% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 35% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. Impression: no abnormal immunophenotypes are found with flow cytometry.

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6. BM: AML

Immunophenotyping of bone marrow aspirate by flow cytometry shows a predominant myeloblast population that is positive for CD34, CD13, CD33 (partial, and dim signal for CD33), CD4, and HLA-DR. These blasts are negative for CD14, CD16, CD56, CD19, CD10, CD117, and TdT. Impression: these

findings are consistent with acute myeloid leukemia.

CPT 88189

7. PB: normal, no myeoblasts

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a T cell population (about 50% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 45% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. The analyzed cells are negative for CD34, CD13, and CD33. Impression: no abnormal immunophenotypes are found with flow cytometry.

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8. LN: mediastinal B cell lymphoma

Immunophenotyping of supraclavicular lymph node by flow cytometry shows a T cell population (about 25% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 25% of the cells analyzed) that is negative for CD5, CD10, CD23, no expression of surface-light chains (neither kappa nor lambda). These B cells have large nuclear size (based on forward-scatter signal) and are positive for CD19, CD20, CD22, FMC7. The analyzed cells are negative for TdT. Impression: these results are consistent with a B-cell lymphoma, most likely mediastinal (thymic) B cell lymphoma (a subtype of diffuse large B cell lymphoma). Definitive diagnosis would require additional data (morphology and immunoperoxidase stains on the biopsy).

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9. LN: SLL

Immunophenotyping of parotid lymph node by flow cytometry shows a T cell population (about 17% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 88% of the cells analyzed) that is positive for CD5, CD19, CD20, CD22, CD23, surface kappa light chain restriction (dim signal). These B cells are negative for CD10, and CD38. These B cells have small nuclear size (based on forward-scatter signal). Impression: these results are consistent with a B-cell lymphoma, most likely small lymphocytic lymphoma. Definitive diagnosis would be based on correlation with morphology.

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10. PB: B cells markedly decreased (<1%), due to Rituximab treatment

Immunophenotyping of peripheral blood lymphocytes by flow cytometry shows a T cell population (about 80% of the cells analyzed) with low CD4/CD8 ratio (0.25), no aberrant expression of T cell markers. The B cells are markedly decreased (<1%), presumably due to Rituximab treatment in this patient with autoimmune disease.

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11. PB: myeloproliferative disorder

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a T cell population with no aberrant loss or aberrant expression of T cell markers, a B cell population that is negative for CD5, CD10, also no surface light-chain restriction. A small myeloblast population (about 2% of the cells analyzed) is found of which the results are shown in this panel. These blasts are positive for CD34, CD13, and CD33. Review of the peripheral blood smear shows normochromic normocytic RBCs, thrombocytosis (Plt count 545k), marked leukocytosis (WBC 87k) with left shift including 4% blasts. Impression: the immunophenotyping results by flow cytometry, together with morphological findings, are consistent with a myeloproliferative disorder. Further testing for bcr-abl and JAK2 mutations (by PCR using peripheral blood in EDTA tubes) is suggested if clinically indicated.

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12. (L) Neck mass FNA: T-cell neoplasm

Immunophenotyping of (L) neck mass aspirate by flow cytometry shows a normal subpopulation of small lymphocytes consisting of T cell and B cells (results not shown in panel). A subpopulation of lymphocytes with large nuclear size (based on forward-scatter signal) shows expression of CD2, CD3, CD4, CD5, and CD7. No aberrant expression or aberrant loss of T cell markers is found. These large CD4-pos cells account for about 20% of the cells analyzed. Impression: expression of T cell markers in this lymphocytic population with large nuclei is suggestive of a T cell neoplasm.

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13. PB: premature infant with myeloblasts

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a mixture of T cells and B cells with normal marker profile (results not shown in this panel). A small population of myeloblasts (about 3% of the cells analyzed) is found that is positive for CD13, CD33, and negative for CD34. Impression: a small population of myeloblasts is found with flow cytometry. Review of peripheral blood smear shows 8% blasts in this 6 week-old infant (born at 35 wk gestation) with URI. CPT 88189

14. Lytic lesion FNA: plasmacytoma

Immunophenotyping of lytic lesion by flow cytometry shows a large monoclonal plasma cell population that is positive for CD56, CD38, cytoplasmic Kappa light-chain restriction. These plasma cells are negative for CD19. Impression: these results are consistent with a plasma cell dyscrasia.

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15. PB: CLL

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows an abnormal B cell population (about 95% of the cells analyzed) that is positive for CD5, CD19, CD20, CD22, CD23, surface lambda light chain restriction (dim signal). These B cells are negative for CD10, FMC7, and CD38. These B cells have small nuclear size (based on forward-scatter signal). Impression: these results, together morphological findings in peripheral blood, are consistent with chronic lymphocytic leukemia (CLL).

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16. Spleen: T cell lymphoma, low viability

Immunophenotyping of the spleen biopsy by flow cytometry shows a T cell population with no aberrant loss or aberrant expression of T cell markers, a B cell population that is negative for CD5, CD10, no surface light-chain restriction. Impression: no abnormal immunophenotypes are found with flow cytometry. Note: results are compromised by low viability of the cells analyzed (ranging from 34% to 76%). Please refer to surgical pathology report for final diagnosis.

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17. BM: negative for NK call lymphoma and T-LGL

Immunophenotyping of bone marrow leukocytes by flow cytometry shows a T cell population (about 87% of the cells analyzed) with partial loss of CD7 and low CD4/CD8 ratio (0.5), a small B cell population (about 4% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. No prominent CD2(+)/CD56(+) population is found. Impression: partial loss of CD7 in T cells can be seen in benign conditions (examination of lymphocytes in bone marrow shows normal morphology).

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18. BAL: no evidence of malignancy

Immunophenotyping of BAL specimen by flow cytometry shows a leukocyte population that is negative for B cell and T cell markers. Microscopic examnination of the BAL sample shows that the majority of the cells are macrophages which correspond to these flow cytometry results. The small subpopulations of B cells and T cells show no abnormal immunophenotypes. Impression: no evidence of malignancy with histological and flow cytometric findings.

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19. PB: no evidence of acute leukemia

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a T cell population (about 73% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 25% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. The following markers are negative for the cells analyzed: CD13, CD33, CD34, CD64, TdT, and CD117. Impression: no abnormal immunophenotypes are found with flow cytometry. Especially, no evidence of acute leukemia.

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20. Bone marrow: no residual APL

Immunophenotyping of bone marrow aspirate by flow cytometry shows a T cell population (about 78% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 6% of the cells analyzed) with normal marker profile. A small number of normal myeloblasts (<1%) is found. No residual leukemic cells are detected [pretreatment profile: CD13(+), CD33(+), CD34(-), CD64(+), HLA-DR(-)]. Impression: no residual leukemic population is found with flow cytometry.

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21. PB: CLL with atypical FMC7, bright CD20

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows an abnormal B cell population (about 87% of the cells analyzed) that is positive for CD5, CD19, CD20 (bright signal), CD22, CD23, CD38, FMC7, surface and cytoplasmic lambda light chain restriction (dim signal). These B cells are negative for CD10. These B cells have small nuclear size (based on forward-scatter signal). Impression: these results are most compatible with chronic lymphocytic leukemia (CLL). There are some atypical findings in this case including abundant cytoplasm of the malignant cells as seen in peripheral blood smear, atypical expression of FMC7, and bright signal for CD20. Due to these unusual features, mantle cell lymphoma with leukemic presentation cannot be completely ruled out. Further testing for t(11 ; 14) by FISH is suggested. Peripheral blood sample (green top tube) can be submitted for this test.

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22. LN: non-hematopoietic malignancy (rhabdomyosarcoma)

Immunophenotyping of submandibular lymph node aspirate by flow cytometry shows a T cell population (about 29% of the leukocytes analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 58% of the leukocytes analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Impression: no abnormal immunophenotypes are found in the leukocytes with flow cytometry. However, most of the cells in the sample (>95%) are not leukocytes (negative for CD45) and they do not express any markers in this panel. These cells are also negative for Cytokeratin by flow cytometry. Morphological findings from lymph node aspirate are consistent with malignancy. Further workup on excisional lymph node biopsy is currently pending.

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23. LN: FL / DLBCL

Immunophenotyping of the (R) inguinal lymph node biopsy by flow cytometry shows a T cell population (about 8% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a prominant B cell population (about 92% of the cells analyzed) that is positive for CD19, CD20, CD22, CD10, FMC7, surface lambda light chain restriction. These B cells are negative for CD5, and CD23. These B cells have intermediate-large nuclear size (based on forward-scatter signal). Impression: these results are consistent with a B-cell lymphoma. Please refer to surgical pathology report HS-8-2741 (dated 4/25/08) for full details of final diagnosis [Diffuse large B-cell lymphoma (70%) and follicular lymphoma, grade 3/3 (30%), indicating transformation of follicular lymphoma to diffuse large B-cell lymphoma].

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24. PB: AML-M7

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a myeloblast population that is positive for CD34, CD13, CD33, CD117, HLA-DR, CD41a (86% of the blasts), and CD61 (78% of the blasts). These blasts are negative for CD14, CD16, CD56, CD19, CD20, CD10, CD64, and TdT. Impression: these findings, together with morphological finding of 21% blasts in peripheral blood,

are consistent with acute megakaryoblastic leukemia (AML-M7).

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25. BM: plasma cell myeloma

Immunophenotyping of bone marrow aspirate by flow cytometry in gate 1 shows a T cell population (about 60% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 27% of the cells analyzed) that is negative for CD5, CD10, and no surface light-chain restriction. Analysis of cells gated for CD38 positivity shows a large monoclonal plasma cell population that is positive for cytoplasmic Kappa light-chain restriction. These plasma cells are partially positive for CD56 and negative for CD19. Impression: these results, together with the finding of 30% plasma cells in bone marrow, are consistent with plasma cell myeloma.

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26. BM: FL, grade 1

Immunophenotyping of bone marrow aspirate by flow cytometry shows a T cell population (about 35% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a prominent B cell population (about 57% of the cells analyzed) that is positive for CD19, CD20, CD22, CD10, FMC7, surface kappa light chain restriction. These B cells are negative for CD5, and CD23. These B cells small nuclear size (based on forward-scatter signal). Impression: these results are consistent with follicular B-cell lymphoma.

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27. BAL: partial loss of CD7 in T cells / low cell viability

Immunophenotyping of BAL specimen by flow cytometry shows a T cell population (about 95% of the cells analyzed) with partial loss of CD7 and low CD4/CD8 ratio (0.4), and a small B cell population (less than 1% of the cells analyzed). Only 46% of the cells analyzed are viable. Impression: partial loss of CD7 in T cells can be seen in benign conditions. Accuracy of this study is also compromised by low viability of the sample.

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28. Mediastinal mass: thymoma

Immunophenotyping of mediastinal mass biopsy by flow cytometry shows a predominant T cell population with small nuclear size (based on forward-scatter signal) with co-expression of CD2, CD3, CD4, CD8, CD5, CD7, and TdT. Smear pattern in scattergrams is observed for CD3, CD4, and CD8. The B cells only account for only 2% of the cells analyzed. Impression: The results are most compatible with thymocytes in thymoma.

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29. Pelvic mass: FL, Gr 1

Immunophenotyping of presacral pelvic mass by flow cytometry shows an abnormal B cell population that is positive for CD19, CD20, CD22, CD10, CD22, surface lambda light chain restriction, and also cytoplasmic lambda light chain restriction. These B cells are CD45-down regulated (weaker CD45 signal than normal lymphocytes). Impression: these results are consistent with a B-cell lymphoma. Positivity for CD10 suggests follicular origin.

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30. Pleural fluid: primary effusion lymphoma

Immunophenotyping of pleural fluid by flow cytometry shows a T cell population with no aberrant loss or aberrant expression of T cell markers, a B cell population that is negative for CD5, CD10, also no surface light-chain restriction. An abnormal population of cells (approximately 6% of the cells analyzed) shows positivity for CD38, CD45, and CD56. These cells are negative for T cell markers (CD2, CD3, CD4, CD8, CD5, CD7) and B cell markers (CD19, CD20). They show neither surface nor cytoplasmic light chain restriction. Impression: these results, together with morphological findings, are most compatible with primary effusion (B cell) lymphoma.

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31. Pleural fluid: atypical CD38&CD56 cells / suboptimal sample

Immunophenotyping of pleural fluid by flow cytometry shows a T cell population (about 60% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 20% of the cells analyzed) that is negative for CD5, CD10, also no surface light-chain restriction. An

atypical population of cells (approximately 6% of the cells analyzed) shows positivity for CD38, and CD56. These cells are negative for T cell markers (CD2, CD3, CD4, CD8, CD5, CD7) and B cell markers (CD19, CD20). They show neither surface nor cytoplasmic light chain restriction. Impression: a small population of cells with atypical marker pattern. A definitive diagnosis cannot be rendered with a margin of error due to the small number of cells detected (6%). Further sample collection for flow cytometry analysis is suggested.

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32. BM: non-diagnostic due to uneven distribution of lymphoma cells (FL, Gr 1)

Immunophenotyping of bone marrow aspirate by flow cytometry shows a T cell population (about 61% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 9% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. Impression: no abnormal immunophenotypes are found with flow cytometry. Note: these findings are not diagnostic since the aspirate does not contain sufficient number of malignant cells due to uneven distribution of lymphoma cells in bone marrow. Please refer to bone marrow report HB-8-70 (6/10/08) for full details.

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33. BM: plasma cell myeloma / false-negative cytoplasmic light-chain restriction

Immunophenotyping of bone marrow aspirate by flow cytometry shows a normal T cell population (about 85% of the lymphocytes analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 10% of the lymphocytes analyzed) that is negative for CD5, CD10, no surface light-chain restriction. An abnormal plasma cell population is detected that is positive for CD38, and CD56. These plasma cells are negative for CD19. The plasma cells do not demonstrate cytoplasmic light-chain restriction. Note that serum protein immunofixation in this patient (6/12/08) shows monoclonal IgG-kappa. This false-negative finding (cytoplasmic light-chain restriction by flow cytometry) is most likely due to background stain artifacts. However, the other marker results (CD38-positive, CD56-positive, CD19-negative) are sufficiently diagnostic of monoclonal plasma cells. Impression: the immunophenotype results, together with morphological findings in bone marrow (report HB-08-71, 6/13/08), are consistent with plasma cell myeloma

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34. BM: normal, 2 gates

Immunophenotyping of bone marrow lymphocytes (Gate 2) by flow cytometry shows a T cell population (about 51% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 14% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Analysis of the cells in the blast area (Gate 1) shows fewer than 2% blasts (of the bone marrow cells) that are positive for CD13 and CD33. Impression: no abnormal immunophenotypes are found with flow cytometry.

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35. BM: hematogones

Immunophenotyping of bone marrow aspirate by flow cytometry shows a lymphocytic population (Gate #1) with normal immunophenotype. A small population of hematogones is found (Gate #2) which express CD45, CD34, CD10, CD19, CD20, and TdT. Scattergrams of these markers show a smear-out pattern indicating a continuum of maturation, consistent with that of hematogones. The hematogones account for approximatedly 2-4% of the bone marrow cells. Note that hematogones may be increased in bone marrow of very young patients. Impression: no evidence of acute leukemia.

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36. BM: no evidence of abnormal mast cells

Immunophenotyping of bone marrow leukocytes by flow cytometry shows a T cell population (about 80% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 11% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. No prominent CD2(+)/CD25(+) or CD2(+)/CD117(+) population is found. Impression: No abnormal immunophenotypes are seen. Particularly, no evidence of abnormal mast cells is found.

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37. BM: chronic LPD of NK cells

Immunophenotyping of bone marrow leukocytes by flow cytometry shows a T cell population (about 42% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 12% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Approximately 50% of the lymphocytes express a marker profile consistent with NK cell lineage (positive for CD2, CD56, CD7; and negative for CD5, CD3, CD57). These NK cells account for about 8-10% of the bone marrow cells. Impression: increased number of NK cells in bone marrow. Please refer to bone marrow report (HB-8-100) for full discussion and correlation.

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38. Chest Wall BX: DLBCL

Immunophenotyping of the left chest wall lesion by flow cytometry shows a small T cell population (about 31% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a predominant B cell population (about 60% of the cells analyzed) that is positive for CD19, CD20, CD22, and surface kappa light-chain restriction. They are negative for CD5, CD10, and CD23. These B cells have large nuclear size (based on forward-scatter signal). Impression: these results are consistent with a B-cell lymphoma. The flow cytometric immunophenotype, morphology, and immunostain findings are consistent with diffuse large B-cell lymphoma (please refer to report HS-8-6344 for details).

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39. CSF- Partial loss of CD7

Immunophenotyping of CSF specimen by flow cytometry shows a T cell population (about 98% of the cells analyzed) with partial loss of CD7, and a small B cell population (less than 1% of the cells analyzed).

Impression: partial loss of CD7 in T cells can be seen in benign conditions. However, a T-cell lymphoproliferative disorder cannot be ruled out. Correlation with morphology is suggested.

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40. CHEST WALL MASS: DLBCL with no light-chain restriction due to necrosis

Immunophenotyping of left chest wall mass by flow cytometry (in gate#2) shows a small T cell population (about 3% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a predominent B cell population (about 91% of the cells in gate#2) that is negative for CD5, CD10, and CD23, These B cells are positive for CD20, CD22, and CD19. The ratio of surface light chains (kappa/lambda) is 2:1. The ratio of cytoplasmic kappa/lambda is also 2:1

41. LEFT SCAPULAR NODULE FNA: DLBCL with lack of KAPPA/LAMBDA

Immunophenotyping of the left scapular nodule FNA by flow cytometry (in gate#2) shows a small T cell population (about 5% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a predominant B cell population (about 86% of the cells in gate#2) that is negative for CD5, CD10, CD23, and TdT. These B cells are positive for CD20, CD22, and CD19. These B cells do not express surface kappa nor lambda light chains. The size of the malignant cells is large based on forward-scatter signal. Lymphocytes in gate#1 show immunophenotypic profile consistent with normal B cells and T cells. The ratio of CD4/CD8 is low (0.1). Impression: with lack of both surface kappa and lambda light chains in a B cell population in the sample, the flow cytometric findings are consistent with a B-cell lymphoma. The current results (flow cytometry and morphology in FNA smears) are consistent with recent diagnosis of diffuse large B-cell lymphoma (left chest wall biopsy, report HS-8-6707, issued on 10/7/08).

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42. PERIPHERAL BLOOD: NORMAL (SW)

Flow cytometric immunophenotyping of peripheral blood, selectively gated using CD45 versus side scatter, discloses a CD45 bright lymphoid population dominated by phenotypically normal T lymphocytes (67%) and CD16/56 positive NK-like cells (13%). The B lymphocytes (20%) show no discernible aberrant coexpression; light chain expression is polytypic. Selective gating of the CD45 intermediate "blast" region of the histogram (data not shown) reveals a heterogeneous myeloid population, comprising 2% of analyzed events. CD34 positive cells within this gate comprise less than 1% of events. There is no diagnostic immunophenotypic evidence of a lymphoproliferative disorder or abnormal myeloblast proliferation in this specimen. Clinical and morphologic correlation is required for definitive evaluation.

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43. LUNG MASS (ASPIRATE): MALT

Immunophenotyping of lung mass aspirate by flow cytometry shows a small T cell population (about 20% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers. An abnormal B cell population (about 79% of the cells analyzed) is found that is positive for CD19, CD20, CD22, surface kappa light chain restriction. These B cells are negative for CD5, CD10, and CD23. These B cells have small nuclear size (based on forward-scatter signal). Impression: these results, together morphological findings in lung mass aspirate and biopsy, are most consistent with MALT lymphoma.

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44. PB, 2 GATES, normal

Immunophenotyping of peripheral blood leukocytes by flow cytometry in gate #1 shows a T cell population (about 78% of the cells analyzed) with low CD4/CD8 ratio (0.1), no aberrant loss or aberrant expression of T cell markers, a B cell population (about 6% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. Immunophenotyping cells in gate #2 shows a T cell population (about 17% of the cells analyzed) with low CD4/CD8 ratio (0.3), no aberrant loss or aberrant expression of T cell markers, a B cell population (about 80% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. Impression: no abnormal immunophenotypes are found with flow cytometry

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45. BAL: low cell count and low viability

Immunophenotyping of the BAL sample by flow cytometry shows a T cell population (about 73% of the cells analyzed) with normal CD4/CD8 ratio (1.2), a small B cell population (about 3% of the cells analyzed). Lymphocytes account for only 1% of the cells in the sample. Impression: results are not diagnostic due to the low number of lymphocytes in the sample, also low viability of the cells analyzed (45%).

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46. BM: negative for Mast Cells and Blasts

Immunophenotyping of bone marrow aspirate cells (in gate #1) by flow cytometry shows a T cell population (about 35% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 31% of the cells analyzed) with normal marker profile. Analysis of cells in the blast area (gate #2) shows less than 3% blasts (positive for CD13, CD33, and CD117). Analysis of cells with high side-scatter signal (granulocytes in gate #3) shows no evidence of abnormal mast cells (with expression for CD2, CD25, and CD117). Impression: no evidence of acute myeloid leukemia or mastocytosis.

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47: Lung Mass: normal flow results with cHL

Immunophenotyping of right lung mass biopsy by flow cytometry shows a T cell population (about 76% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 26% of the cells analyzed) that is negative for CD5, CD10, CD23, no surface light-chain restriction.

Impression: no abnormal immunophenotypes are found with flow cytometry. Note that classical Hodgkin lymphoma cannot be ruled out with flow cytometry testing. Please refer to surgical pathology report (HS-8-7588, issued on 11/10/08) for full details.

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48. Non Clinical Documentation

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Immunophenotyping performed and interpreted at Memorial Hermann Hospital. Some of the tests in this panel were developed and their performance characteristics determined by Memorial Hermann Hospital Laboratory. They have 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. These tests are used for clinical purposes. They should not be regarded as investigational or for research. This laboratory is regulated under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) as qualified to perform highly-complexity clinical testing.

Teaching Physician Statement

"I have personally reviewed the resident's preliminary interpretation and all specimen preparations and have personally issued this report".

CPT:88189

Immunophenotyping performed at Memorial Hermann Hospital Southwest and interpreted at Memorial Hermann Hospital-TMC.

Some of the tests in this panel were developed and their performance characteristics determined by Memorial Hermann Southwest Hospital Laboratory. They have 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. These tests are used for clinical purposes. They should not be regarded as investigational or for research. This laboratory is regulated under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) as qualified to perform highly-complexity clinical testing.

Teaching Physician Statement

"I have personally reviewed the resident's preliminary interpretation and all specimen preparations and have personally issued this report".

49. Aortic wall: SLL, no surface light chains, cytoplasmic lambda light-chain restriction.

Immunophenotyping of the aortic wall biopsy by flow cytometry shows a T cell population (about 31% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 73% of the cells analyzed) that is negative for CD10, CD11c, no expression of surface light chains (neither kappa nor lambda). These B cells have small nuclear size (based on forward-scatter signal) and are positive for CD5, CD19, CD20, CD22, and CD23, also positive for cytoplasmic lambda light-chain restriction. Impression: these results are most consistent small lymphocytic lymphoma.

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50. QNS for flow analysis

Flow cytometry analysis shows less than 2% of the cells from the sample expressing lymphocytic markers (CD45, and CD5 or CD20).

The flow cytometry results are non-diagnostic due to the lack of sufficient cells from the sample for analysis.

51. Pleural fluid: PRECURSOR T LYMPHOMA

Immunophenotyping of pleural fluid by flow cytometry shows predominant a T cell population (about 95% of all the cells analyzed). These T cells have small nuclear size (based on forward-scatter signal) and show expression of CD2, CD5, CD7, CD10, CD38, TdT, co-expression of CD4 and CD8. They are negative for CD3. The analyzed cells are negative for CD19, CD20, CD34, CD13, CD117, and CD33. Review of pleural fluid smear shows a predominant lymphoblast population. Impression: the immunophenotype results and morphology are consistent with precursor T lymphoma.

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52. Mediastinal mass: NECROSIS, NON-DIAGNOSTIC

Cell Surface Marker Results

99,000 events were obtained, from which only 206 were CD45-positive (leukocytes)

Interpretation

Immunophenotyping of mediastinal mass by flow cytometry is not diagnostic due to failure to obtain intact lymphocytes for analysis, most likely due to necrosis (see surgical pathology report HS-09-871 for details).

53. PB: PRECURSOR B LYMPHOBLASTIC LEUKEMIA

Immunophenotyping of peripheral blood by flow cytometry shows predominant a B cell population (about 80% of all the cells analyzed). These B cells have small nuclear size (based on forward-scatter signal) and show expression of CD10, CD19, CD38, HLA-DR, and TdT. They are partially positive for CD20 and negative for CD2, CD3, CD4, CD8, CD5, CD7, CD56, CD34, CD13, CD117, and CD33. Review of peripheral blood smear shows a predominant lymphoblast population. Impression: the immunophenotype results and morphology are consistent with precursor B lymphoblastic leukemia. Dr. Rodriguez was notified of the findings on 2/11/09.

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54. LUNG MASS: less than 1% LYMPHOCYTES, CANNOT R/O CA (keratin-pos)

Flow cytometry analysis shows less than 1% of the cells from the lung biopsy sample expressing leukocytic markers (CD45). These cells are mostly T cells (positive for CD3 and CD5) accounting for about 70% of the lymphocytes. A smaller number of lymphocytes (18%) are B cells (positive for CD20). The lymphocytes are negative for CD16 and CD56. Up to 19% of all the non-leukocyte cells are positive for cytokeratin. Impression: the flow cytometry results show no evidence of lymphoma. Carcinoma cannot be ruled out with the presence of cytokeratin-positive cells. Morphological correlation is needed.

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55. LN: non-diagnostic due to low cell viability

Immunophenotyping of lymph node biopsy by flow cytometry shows a T cell population (about 32% of the cells analyzed), and B cell population (60% of the cells analyzed). Only 12% of the cells analyzed are viable.

Impression: non-diagnostic results due to low viability of the sample.

56. Aortic mass: normal profile, accuracy is compromised by low viability

Immunophenotyping of aortic mass biopsy in gate #1 by flow cytometry shows a T cell population (about 80% of the cells analyzed), and B cell population (12% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Only 29% of the cells analyzed are viable. Gating of CD38-positive cells show no evince of cytoplasmic light-chain restriction. Immunophenotyping of CD45-negative cells in gate#2 shows no B cells or T cells. Impression: No abnormal immunophenotypes are found with flow cytometry. However, accuracy of this study is compromised by low viability of the sample.

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57. BM: AML-M6

Immunophenotyping of bone marrow leukocytes by flow cytometry in gate #1 shows a T cell population (about 76% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 7% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. Immunophenotyping cells in gate #2 (blast area) shows a predominant population of myeloblasts (positive for CD13, and CD33, and CD117). These blasts also show partial aberrant expression of CD7 and CD19. They are negative for CD34, CD14, CD41, and CD61.

Impression: these findings are consistent with acute myeloid leukemia. Please refer to bone marrow report HB-9-28 (issued on 3/2/09) for full details.

CPT 88189

58. LN: non-hematopoietic tumor (small cell carcinoma)

Cell Surface Marker Results

6,450 events were obtained, from which only 684 were CD45-positive (leukocytes)

Interpretation

Immunophenotyping of lymph node sample by flow cytometry is not diagnostic due to failure to obtain adequate number of lymphocytes for analysis. This could be due to: (a) lack of intact lymphocytes (due to degeneration) or (b) the lymph node sample contains mostly non-lymphoid tissue. Morphological correlation is needed.

59. BM: PLASMA CELL MYELOMA

Immunophenotyping of bone marrow aspirate by flow cytometry shows a T cell population (about 69% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 18% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. A monoclonal plasma cell population is found with plasma cells that are positive for CD38, cytoplasmic Kappa light-chain restriction. These plasma cells are negative for CD19 and positive for CD56. Patient's bone marrow shows 11% plasma cells, some with immature cytological features. The immunophenotype results, together with the findings of multiple lytic lesions, are consistent with plasma cell myeloma. Impression: plasma cell myeloma

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60. BM: Splenic MZL

Immunophenotyping of bone marrow aspirate by flow cytometry shows a T cell population (about 46% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, an abnormal B cell population (about 48% of the cells analyzed) that is positive for CD19, CD20, CD22, surface kappa light-chain restriction. These B cells are negative for CD5, CD10, CD11c, CD25, and CD103. These B cells have small nuclear size (based on forward-scatter signal). Impression: these results, together morphological findings in bone marrow, are most consistent with marginal-zone lymphoma (see bone marrow report HB-9-32 for full details). Not that hairy cell leukemia is ruled out with negative expression for CD11c, CD25, and CD103.

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61. PB: precursor B lymphoblastic leukemia, 2 gates, no evidence of AML-M7

Immunophenotyping of peripheral blood leukocytes by flow cytometry in gate #1shows an abnormal B cell population (about 30% of all the cells analyzed). These B cells have small-intermediate nuclear size (based on forward-scatter signal) and show expression of CD10, CD19, CD38, HLA-DR, and TdT. They are partially positive for CD20 and negative for CD2, CD3, CD4, CD8, CD5, CD7, CD56, CD34, CD13, CD117, CD33, CD41 and CD61. Negative findings for CD41 and CD61 rule out acute megakaryoblastic leukemia. Review of peripheral blood smear shows an abnormal blast population.

Immunophenotyping of the cells in gate #2 shows a normal lymphocytic population consisting of B cell and T cells with normal marker profile. Impression: the immunophenotype results and morphology are consistent with precursor B lymphoblastic leukemia. Dr. D. Brown was notified of the findings on 4/2/09.

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62. BM: APL

Immunophenotyping of bone marrow aspirate by flow cytometry shows a predominant leukemic cell population in gate#1 that is positive for CD13, CD33. They show partial expression for CD117, CD38, and CD2. They are negative for CD34, HLA-DR, and TdT. These cells have intermediate granularity (based on side-scatter signal). Immunophenotyping of the cells in gate #2 shows a normal lymphocytic population consisting of B cell and T cells with normal marker profile. Impression: these results, together with morphological findings in bone marrow, are consistent with acute promyelocytic leukemia.

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63. PB: PLL vs. MCL

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows an abnormal B cell population (about 90% of the cells analyzed) that is positive for CD5, CD19, CD20 (bright signal), CD11c, CD22, FMC7, surface lambda light-chain restriction (bright signal). These B cells are negative for CD10, CD23, and CD38. These B cells have small-intermediate nuclear size (based on forward-scatter signal).

Impression: these results, together with morphology in peripheral blood smear, suggest prolymphocytic leukemia vs. mantle cell lymphoma with leukemic presentation. Patient has been scheduled for bone marrow procedure. Further testing for cyclin-D1 by immunohistochemical stain and t(11 ; 14) by FISH are planned for bone marrow for a definitive diagnosis. Findings were discussed with Dr. Quesada on 4/24/09.

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64. PB: PRECURSOR B LYMPHOBLASTIC LEUKEMIA WITH sKAPPA RESTRICTION

Immunophenotyping of peripheral blood leukocytes by flow cytometry (in gate#1) shows a predominant B cell population (about 30% of all the cells analyzed). These B cells have small nuclear size (based on forward-scatter signal) and show expression of CD10, CD19, CD20, CD38, HLA-DR, CD34, surface Kappa light-chain restriction, and TdT. They are negative for CD2, CD3, CD4, CD8, CD5, CD7, CD56, CD13, CD117, and CD33. Review of peripheral blood smear shows a large blast population (30% of leukocytes). Lymphocytes in gate#2 show an immunophenotypic profile consistent with normal B cells and T cells. Impression: the immunophenotype results and morphology are consistent with B lymphoblastic leukemia. Dr. Juneja was notified of the findings on 6/11/09.

Note: the finding of surface light-chain restriction is rare in B lymphoblastic leukemia but does not exclude such diagnosis.

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65. CSF: QNS

Specimen Source: CSF

Clinical Information: 74 y/o male

Cell Surface Marker Results: Flow cytometry analysis shows less than 1% of the cells from the sample expressing leukocyte marker (CD45). Interpretation: The flow cytometry results are non-diagnostic (for lymphoma/leukemia) due to the lack of sufficient cells from the sample for analysis.

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66. PB: SS in patient with MF

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a predominant T cell population (about 95% of the cells analyzed) with aberrant loss of CD7. They are positive for CD2, CD3, CD4, and CD5. Less than 1% of the T cells are positive for CD8. A very small B cell population (less than 1% of the cells analyzed) is found. Impression: These immunophenotypic results, together with morphological findings of atypical lymphocytes in the peripheral blood of this patient with history of mycosis fungoides, are consistent with Sezary cells in peripheral blood (Sezary Syndrome)

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67. PB: AML, 2 gates

Immunophenotyping of peripheral blood leukocytes by flow cytometry in gate#2 shows a T cell population (about 62% of the cells in gate#2) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 17% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. A predominant myeloblast population is seen in gate #1(approximatedly 80% of all the cells analyzed). They are positive for CD34, CD13, CD33, CD117, CD4, CD19, CD38, and HLA-DR. These blasts are negative for CD14, CD16, CD56, CD10, and TdT. Impression: these findings, together with the presence of numerous blasts with auer rods in the peripheral blood, are consistent with acute myeloid leukemia.

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68. BM: DLBCL ,S/P chemotherapy with decreased B cells

Immunophenotyping of bone marrow lymphocytes by flow cytometry shows a T cell population (about 91% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (less than 1% of the cells analyzed) that is negative for CD5, and CD10. The lymphocytes have small nuclear size (based on forward-scatter signal). Impression: no abnormal immunophenotypes are found with flow cytometry. The decrease in bone marrow B cells is most likely due to recent chemotherapy.

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69. PB: CLL with negative CD20

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows an abnormal B cell population (about 88% of the cells analyzed) that is positive for CD5, CD19, CD22, CD23, surface lambda light chain restriction (dim signal), and cytoplasmic lambda light chain restriction (dim signal). These B cells are negative for CD10, CD20, FMC7, and CD38. These B cells have small nuclear size (based on forward-scatter signal). Impression: these results are consistent with chronic lymphocytic leukemia (CLL). Note that negativity for CD20 in the leukemic cells may be secondary to: (a) aberrant loss of CD20, or (b) effect of Rituximab if patient had been treated with such therapy. Clinical correlation is suggested.

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70. PB: PLL vs. MCL

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a T cell population (about 31% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, an abnormal B cell population (about 66% of the cells analyzed) that is positive for CD5, CD19, CD20 (bright signal), CD11c (partial and dim expression), CD22, FMC7, surface kappa light-chain restriction (bright signal). These B cells are negative for CD10, and CD23. These B cells have small-intermediate nuclear size (based on forward-scatter signal). Impression: these results, together with morphology in peripheral blood smear, are consistent with B-cell lymphoma / leukemia. Differential diagnosis includes prolymphocytic leukemia vs. mantle cell lymphoma with leukemic presentation. Bone marrow and lymph node biopsy (if patient has lymphadenopathy) would be needed for definitive diagnosis. Further testing for cyclin-D1 and t(11 ; 14) may be performed on bone marrow and/or lymph node biopsy.

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71. BM: NK/T LYMPHOMA

Immunophenotyping of bone marrow leukocytes by flow cytometry shows a T cell population (about 40% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers. Approximately 41% of the lymphocytes express a marker profile consistent with NK cell lineage (positive for CD2, CD56; and negative for CD3, CD7). Impression: increased number of NK cells in bone marrow. This finding is consistent with lymphoma involvement in bone marrow of this patient with recent diagnosis of nasal NK/T cell lymphoma. Please refer to bone marrow report (HB-9-93) for full details.

CPT 88189

72. BM: B-cell lymphoma, 20% B cells (small lymphocytes)

Immunophenotyping of bone marrow aspirate by flow cytometry shows a T cell population (about 65% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, an abnormal B cell population (about 20% of the cells analyzed) that is positive for CD19, CD20, CD22, surface lambda light chain restriction. These B cells are negative for CD5, CD10, and CD23. These B cells small nuclear size (based on forward-scatter signal). Impression: These results are consistent with monoclonal B-cells. Further lymphoma workup with lymph node biopsy is suggested.

CPT 88189

73. PB: AML-M4, 2 gates

Immunophenotyping of peripheral blood leukocytes by flow cytometry in gate#2 shows a T cell population (about 35% of the cells in gate#2) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 55% of the cells in gate#2) that is negative for CD5, CD10, no surface light-chain restriction. A predominant monocytic population is seen in gate #1(approximately 60% of all the cells analyzed). They are positive for CD4, CD33, CD38, CD56, and HLA-DR. These cells are negative for CD13, CD34, CD41, CD61, CD117, and TdT. Impression: these findings, together with the presence of numerous monoblasts/ promocytes/ and monocytes in the peripheral blood, are consistent with acute myelomonocytic leukemia.

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74. BM: False Negative for Burkitt lymphoma due to suboptimal aspirate

Immunophenotyping of bone marrow lymphocytes (Gate 1) by flow cytometry shows a T cell population (about 72% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 16% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Analysis of the cells in the blast area (Gate 2) shows fewer than 4% blasts (of the bone marrow cells) that are positive for CD13 and CD33. Impression: no abnormal immunophenotypes are found with flow cytometry. However, this result is not diagnostic due to insufficient number of marrow cells in aspirate (hypocellular aspirate with peripheral blood contamination). Please refer to bone marrow report HB-09-108 for final diagnosis of Burkitt lymphoma.

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75. BM: AML-M4, residual leukemia, s/p therapy

Immunophenotyping of bone marrow aspirate by flow cytometry shows an abnormal population in the same position (CD45/SSC scattergram) as the leukemic cells in original bone marrow sample. The leukemic cells are positive forCD13, CD33, CD56, CD38, CD4. They are negative for CD34, CD117. They account for about 20% of the cells analyzed in the sample.

Impression: these findings are consistent with residual leukemia in this patient with prior diagnosis of AML-M4

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76. Immunophenotyping of bone marrow aspirate by flow cytometry in gate#1 shows a T cell population (about 98% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population (about 1% of the cells analyzed). A small number of normal myeloblasts (<1%) is found in gate#2.

Impression: no residual leukemic population is found with flow cytometry.

CPT 88189

77. BM: a small population of atypical B cells with CD10 expression, and lack of surface light chains

Immunophenotyping of bone marrow aspirate by flow cytometry in gate #1 shows a T cell population (about 57% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 32% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. Analysis of cells in gate#2 shows a small atypical B cell population that is positive for CD10, CD19, CD20, CD38, HLA-DR, lack of both surface kappa light chain and lambda light chain. These B cells are CD45-down regulated and negative for CD5. Impression: a small population of atypical B cells in bone marrow with expression of CD10 and lack of surface light chains.

CPT 88189

78. PB: 0.2% myeloblasts

Immunophenotyping of peripheral lymphocytes (Gate 1) by flow cytometry shows a T cell population (about 34% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 53% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Analysis of the cells in the blast area (Gate 2) shows less than 0.2% of the leukocytes in peripheral blood with co-expression of CD34, CD13, CD33, and CD117.

Impression: a small number of myeloblasts is found in peripheral blood (less than 0.2%). Clinical correlation is suggested.

CPT 88189

79. BM: FL / DLBCL

Immunophenotyping of bone marrow aspirate in gates #1 and #2 by flow cytometry shows a predominant B cell population (about 34% of the cells analyzed) that is positive for CD19, CD20, CD22, CD10, and surface lambda light chain restriction. These B cells are negative for CD5, and CD23. These B cells have large nuclear size (based on forward-scatter signal) in gate #2 and small nuclear size in gate #1.

Impression: these results are consistent with a B-cell lymphoma involvement in bone marrow in this patient with follicular lymphoma transformed to diffuse large B-cell lymphoma.

CPT 88189

80. PB: T CELLS WITH LOSS OF CD7

Immunophenotyping of peripheral leukocytes by flow cytometry in gate #2 shows a T cell population (about 20% of all the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, and a small B cell population (less than 1% of the cells analyzed). Analysis of the lymphocytes in gate #1 shows a T cell population (about 30% of the all the cells analyzed) with loss of CD7, and a small B cell population (less than 1% of the cells analyzed). The T cells are mostly CD8-positive and CD4-negative.

Impression: loss of CD7 in T cells may be seen in benign conditions. However, a T-cell lymphoproliferative disorder cannot be ruled out. Review of peripheral blood smear shows presence of atypical lymphocytes. Further workup to rule out a T-cell lymphoproliferative disorder is suggested if clinically indicated.

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81. Axillary mass: PTCL, NOS

Immunophenotyping of axillary mass by flow cytometry shows an abnormal population of lymphocytes with intermediate-large nuclear size (based on forward-scatter signal). These cells show expression of CD2, CD3, CD4, and CD7. They also show aberrant loss of CD5. CD8-positive cells account for less than 3% of the lymphocytes. Impression: these results, together with morphological findings in biopsy, are consistent with a T-cell lymphoma.

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82. BM: RAEB-1

Immunophenotyping of bone marrow aspirate by flow cytometry in gate #2 shows a normal lymphocytic population (B cell and T cells). Analysis of cells in gate#2 (blast area) shows a myeloblast population that is positive for CD34, CD13, CD33, CD117, CD38, and HLA-DR. These blasts are negative for CD14, CD56, CD19, CD10, and TdT. They also aberrantly expressed CD5. The blasts account for about 6% of the bone marrow nucleated cells (in line with manual differential). Impression: bone marrow is hypercellular (90%) with presence of dysplastic normoblasts, granulocytes, and megakaryocytes. Myeloblasts are increased at 6%. The flow cytometry results, together with these morphological findings, are consistent with refractory anemia with excess blasts-type 1 (RAEB-1)

CPT 88189

83. BM: RAEB-2

Immunophenotyping of bone marrow aspirate by flow cytometry shows a myeloblast population that is positive for CD34, CD13, CD33, CD117, CD38, and HLA-DR. These blasts are negative for CD45, CD14, CD56, CD19, CD10, and TdT. They also aberrantly expressed CD5. The blasts account for about 12% of the bone marrow nucleated cells (in line with manual differential). Impression: bone marrow is hypercellular (95%) with presence of dysplastic normoblasts and dysplastic megakaryocytes. Myeloblasts are increased at 12%. The flow cytometry results, together with these morphological findings, are consistent with refractory anemia with excess blasts-type 2 (RAEB-2)

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84. PB: AML-M5a

Immunophenotyping of peripheral leukocytes by flow cytometry shows a predominant blast population that is positive for CD34, CD13, CD33, CD4, CD38, and HLA-DR. These blasts are negative for CD19, CD10, CD117, and TdT. Impression: these findings, together with morphological findings in peripheral blood smear (88% blasts), are most consistent with acute monoblastic leukemia (AML-M5a).

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85. Paraspinal mass: non-diagnostic for plasmacytoma due to sampling

Immunophenotyping of paraspinal mass leukocytes by flow cytometry shows a T cell population (about 81% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (less than 1% of the cells analyzed). Gating of CD38 is negative for plasma cells. Impression: no abnormal immunophenotypes are found with flow cytometry. Note: histology and immunohistochemistry study of the paraspinal mass are consistent with plasmacytoma (see separate report CA-9-1149). The lack of plasma cells in this flow cytometric analysis indicates normal tissue from the paraspinal mass being submitted for flow cytometry.

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86. BM: 1% polyclonal plasma cells

Immunophenotyping of bone marrow aspirate by flow cytometry shows a T cell population (about 79% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population consisting of less than 1% of the cells analyzed. Plasma cells account for about 1% of the cells analyzed and show no evidence of cytoplasmic light chain restriction. Impression: no evidence of monoclonal plasma cells by flow cytometry.

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87. Chest tube fluid: non-diagnostic due to non-viable sample

Immunophenotyping of chest tube fluid by flow cytometry shows 50% of the cells being postive for CD45. However, only 34% of the cells analyzed are viable. The analyzed cells show no expression of T cell markers (CD2, CD3, CD4, CD8, CD5, CD7) or B cell markers (CD19, CD20). Examination of cytospin sample shows non-viable cells and numerous bacteria. Impression: non-diagnostic results due to low viability of the sample.

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88. LN: normal, 2 gates

Immunophenotyping of lymph node lymphocytes in gate #2 (small lymphocytes) by flow cytometry shows a T cell population (about 52% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 33% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Analysis of the cells in the gate #1 (a smaller number of lymphocytes with intermediate size) shows a T cell population (about 56% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 20% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Impression: no abnormal immunophenotypes are found with flow cytometry.

CPT 88189

89. LN: AITCL

Immunophenotyping of lymph node lymphocytes in gate #2 (small lymphocytes) by flow cytometry shows a T cell population (about 52% of the cells analyzed) with aberrant loss of CD7 (a T-cell marker), a B cell population (about 33% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Analysis of the cells in the gate #1(a smaller number of lymphocytes with intermediate size) shows a T cell population (about 56% of the cells analyzed) also with aberrant loss of CD7, a B cell population (about 20% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Impression: The aberrant loss of CD7 in T-cells is supportive of a T cell lymphoma. Please refer to surgical pathology report HS-09-9079 for full details (angioimmunoblastic T cell lymphoma). Dr Mathivanan was notified of the findings on 12/3/09.

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90. Tonsil: T cell lymphoma

Immunophenotyping of tonsil biopsy by flow cytometry in gate #1 shows a T cell population (about 79% of the cells analyzed in gate #1) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 12% of the cells analyzed in gate #1) that is negative for CD5, CD10, no evidence of surface-light chain restriction. Immunophenotyping cells in gate #2 shows a T cell population (about 78% of the cells analyzed in gate #2) with positivity for CD2 and CD4. They are negative for CD3, CD8, CD5, CD7, and CD56. In gate #2, there is also a small B cell population (about 4% of the cells analyzed in gate #2).

Impression: the immunophenotype results are consistent with a T-cell lymphoma.

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91. LN, CORE BX: FL, GR 1/3

Immunophenotyping of retroperitoneal lymph node by flow cytometry shows an abnormal B cell population (about 54% of the lymphocytes analyzed

) that is positive for CD19, CD20, CD22, CD10, and surface lambda light chain restriction. These B cells are negative for CD5, and CD23. These B cells are predominantly small in size (based on forward-scatter signal)

Impression: these results, together with morphological findings in aspirate smear, are consistent with follicular B-cell lymphoma (low grade with predominant centrocytes).

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92. PB: AML-M4, 3 gates

Immunophenotyping of bone marrow leukocytes by flow cytometry in gate#3 shows mixture of normal T cells and B cells. A predominant blast population is seen in gates #1 and gate #2. They are positive for CD13, CD33, CD34, CD117, CD38, CD56, and HLA-DR. They are also partial positive for CD4 and CD14. These cells are negative for CD2, CD3, CD8, CD5, CD7, CD10, CD19, CD20

Impression: these findings, together with the morphological findings in bone marrow aspirate, are consistent with acute myelomonocytic leukemia.

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93. BM: AML-M6, pure erythroid leukemia, 3 gates

Immunophenotyping of bone marrow cells by flow cytometry in gate #1 shows a normal monocytic population with expression of CD13, CD33, CD4, and negative for CD34, CD117. Analysis of cells in gate #2 shows a mixture of normal T lymphocytes and B lymphocytes. Analysis of cells in gate #3 shows a small myeloblast population (less than 3%) with expression of CD13, CD33, CD117, and CD34. Analysis of cells with negative CD45 expression shows a prominent normoblast population with expression of glycophorin A.

Impression: these findings, together with morphological findings in bone marrow, are consistent with acute erythroid leukemia. Please refer to bone marrow report HB-10-26 (issued on 2/5/2010) for full details.

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94. BAL: DESCRIPTIVE REPORT, NO SPECIFIC FINDINGS

Immunophenotyping of the BAL sample by flow cytometry shows a T cell population (about 96% of the cells analyzed) with high CD4/CD8 ratio (3.4), and a small B cell population (about 2% of the cells analyzed). Lymphocytes account for about 20% of the cells in the sample.

95. BM: Burkitt Lymphoma

Immunophenotyping of bone marrow aspirate by flow cytometry shows an abnormal B cell population (about 50% of the lymphocytes analyzed) that is positive for CD19, CD20, CD22, CD10, and FMC7. The abnormal cells lack both surface kappa and lambda light chains. These B cells are negative for CD5, and CD23. These B cells are predominantly intermediate in size (based on forward-scatter signal)

Impression: these results, together with morphological findings in aspirate smear and biopsy, are consistent with Burkitt lymphoma

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96. LN: Burkitt Lymphoma

Immunophenotyping of lymph node biopsy by flow cytometry shows an abnormal B cell population (about 99% of the lymphocytes gated) that is positive for CD19, CD20, CD22, CD10, FMC7, and surface lambda light chain restriction. These B cells are negative for CD5, and CD23. These B cells are predominantly intermediate in size (based on forward-scatter signal)

Impression: these results, together with morphological findings in lymph node biopsy, are consistent with Burkitt lymphoma

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97. BM: B lymphoblastic leukemia, Minimal Residual Disease

Immunophenotyping of bone marrow leukocytes by flow cytometry in gate #1 shows a mixture of normal T lymphocytes and B lymphocytes. Analysis of cells in gate #2 shows an abnormal B cell population (about 2-3% of all the bone marrow cells analyzed). These B cells have intermediate nuclear size (based on forward-scatter signal) and show expression CD19, CD38, HLA-DR, and TdT. They are partially positive for CD20 and negative for CD10, CD13, CD117, and CD33. These B cells are in the blast area of the scatter-gram and show intermediate (down-regulated) expression for CD45. This marker profile is found to be similar to that of original diagnostic sample (report GF-9-1168, issued 10/21/2009) which in particular, showed lack of CD10 expression. Note that the lack of CD10 expression and the lack of smear-out pattern of markers rule out the presence of hematogones in the bone marrow.

Impression: the immunophenotype results are consistent with minimal residual disease (2-3% of leukemic cells in this patient with B lymphoblastic leukemia, S/P chemotherapy).

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98. BM: Lymphoplasmacytic lymphoma

Immunophenotyping of leukocytes in bone marrow aspirate by flow cytometry shows an abnormal B cell population (about 25% of the cells analyzed) that is positive for CD19, CD20, and surface kappa light chain restriction. These B cells are negative for CD5, and CD10. These B cells are predominantly small in size (based on forward-scatter signal).

Analysis of CD38-positive cells shows a small abnormal plasma cell population. These plasma cells are positive for CD56, with cytoplasmic kappa light-chain restriction. They are negative for CD19.

Impression: these results, together with morphological findings in bone marrow, are consistent with lymphoplasmacytic lymphoma in this patient with a history of macroglobulinemia.

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99. PB: AML-M4

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a normal lymphoctic population in gate #2 (normal T cell and B cells). Analysis of cells in gate #1 shows a predominant blast population that is positive for CD13, CD33, CD4, CD117, HLA-DR, and partial positivity for CD34. These blasts are negative for CD16, CD56, CD19, CD10, and TdT. Impression: these findings, together with morphology in peripheral blood and bone marrow, are most consistent with acute myelomocytic leukemia (AML-M4).

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100. Bone marrow: no residual AML

Immunophenotyping of bone marrow aspirate by flow cytometry in gate #1 shows a T cell population (about 51% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 42% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. Analysis of cells in gate #2 (blast area)shows a small number of normal myeloblasts (<1%).

Impression: no residual leukemic population is found with flow cytometry in this patient with history of AML-M5.

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101. CSF: AML-M5a relapse

Immunophenotyping of leukocytes in CSF by flow cytometry in both gate #1 and gate #2 shows a predominant blast population that is positive for CD34, CD13, CD14, CD38, and CD117. These blasts are negative for CD33, and TdT. The blasts account for more than 80% of cells in the sample. Impression: these findings, together with morphological findings in CSF, are most consistent with relapse of acute monoblastic leukemia (AML-M5a) in this patient with prior diagnosis of AML-M5a.

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102. PB: markedly decreased B cells, presumably due to chemotherapy with Rituximab

Immunophenotyping of peripheral blood lymphocytes by flow cytometry shows a T cell population (about 89% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population (less than 1% of the cells analyzed). Impression: markedly decreased B cells, presumably due to chemotherapy with Rituximab. Clinical correlation is suggested.

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103. BM: no residual lymphoblastic leukemia

Immunophenotyping of bone marrow lymphocytes (Gate #1) by flow cytometry shows a prodominant T cell population (about 89% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population (less than 1% of the cells analyzed). Analysis of the cells in Gate #2 shows normal monocytic cells. All the analyzed cells are negative for TdT.

Impression: no residual lymphoblastic leukemia is found with flow cytometry.

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104. Retroperitoneal mass: MZL

Immunophenotyping of retroperitoneal mass by flow cytometry shows a T cell population (about 57% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, an abnormal B cell population (about 38% of the cells analyzed) that is positive for CD19, CD20, CD22, surface kappa light-chain restriction. These B cells are negative for CD5, CD10, CD11c, CD23. These B cells have small nuclear size (based on forward-scatter signal). Impression: these results, together morphological findings in retroperitoneal mass, are most consistent with marginal-zone lymphoma.

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105. PB: no evidence of leukemia in pediatric blood smear

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a T cell population (about 76% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 24% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. The analyzed cells are negative for CD34, CD13, CD33, CD117, and TdT. Impression: no abnormal immunophenotypes are found with flow cytometry. Especially, no evidence of leukemia is found.

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106. Mediastinal mass: thymocytes (in thymoma or thymic hyperplasia)

Immunophenotyping of mediastinal mass biopsy by flow cytometry shows a predominant T cell population with cells ranging from small nuclear size in gate #2 to intermediate size in gate #1 (based on forward-scatter signal). These T cells show co-expression of CD2, CD3, CD4, CD8, CD5, CD7, and TdT. Smear pattern in scattergrams is observed for CD2, CD3, CD4, and CD8. The B cells only account for only 2% of the cells analyzed. Impression: The results are most compatible with thymocytes (in thymoma or thymic hyperplasia).

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107. Mediastinal mass: no evidence of lymphoblastic lymphoma or thymoma

51 y/o female with large mediastinal mass, suspicious for thymoma. Only 5% lymphocytes found with flow

Immunophenotyping of lymph node biopsy by flow cytometry shows a small population of lymphocytes (only 5% of the cells analyzed). They are mostly T cells (89% positive for CD5) and negative for TdT.

Impression: Flow cytometry shows mostly non-lymphocytic cells. No evidence of lymphoblasts or thymocytes in sample.

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108. AML-M5a: s/p chemo, no residual leukemia, 3 gates

Immunophenotyping of bone marrow aspirate by flow cytometry in gate #1 shows a T cell population (about 81% of the cells gated) with no aberrant loss or aberrant expression of T cell markers, a B cell population (less than 1% of the cells gated ). Analysis of cells in gate #2 shows a small number of normal myeloblasts (<2% of the cells gated). No residual leukemic cells are detected [pretreatment profile on 6/3/2010: CD13(+), CD33(+), CD117(+), CD4(+)]. Analysis of cells in gate #3 shows normal monocytes.

Impression: these results indicate no residual leukemic population with flow cytometry.

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109. PB: APL

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a predominant leukemic cell population in gate #1 that is positive for CD13, CD33, MPO, CD2, and CD117. The CD33 distribution is bright and homogeneous. The CD13 distribution is heterogenous. The leukemic cells show only partial expression for HLA-DR and CD34. They are negative for TdT. These cells have intermediate granularity (based on side-scatter signal). Immunophenotyping of the cells in gate #2 shows a normal lymphocytic population consisting of B cell and T cells with normal marker profile.

Impression: these results, together with morphological findings in peripheral blood, are not diagnostic but they are supportive of acute promyelocytic leukemia. Note that FISH and PCR testing for PML/RARA are pending (see separate reports)

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110. Hematogones: APL, s/p chemo

Immunophenotyping of aspirate by flow cytometry shows a lymphocytic population (Gate #1) with normal immunophenotype. A small population of hematogones is found (Gate #2) which express CD45, CD10, CD19, CD20, and TdT (partial positivity). Scattergrams of these markers show a smear-out pattern indicating a continuum of maturation, consistent with that of hematogones. The hematogones account for approximatedly 5% of the bone marrow cells. Hematogones may be increased in regenerating bone marrow as seen in this patient after chemotherapy. Impression: no evidence of residual leukemia by flow cytometry.

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111. BM: AML, 2 gates, aberrant expression of CD19, TdT

Immunophenotyping of bone marrow aspirate by flow cytometry shows a lymphocytic population (Gate #2) with normal immunophenotype for B cells and T cells. Analysis of cells in Gate #1 shows a predominant myeloblast population that is positive for CD34, CD13, CD33 (partial, and dim signal for CD33), CD117, CD38, and HLA-DR. These blasts are also partially positive for CD19 and TdT (aberrant expression). They are negative for CD14, CD16, CD56, and CD10.

Impression: these findings are consistent with acute myeloid leukemia. Note that the partial positivity for CD19 and TdT is not adequate to support a diagnosis of mixed phenotype acute leukemia.

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112. BM: CMML, 3 gates, no transformation to acute leukemia

Immunophenotyping of bone marrow leukocytes (Gate 3) by flow cytometry shows a small lymphocytic population consisting of normal B lymphocytes and T lymphocytes. Analysis of cells in the monocytic area (Gate 2) shows a mature monocytic population. Analysis of the cells in the blast area (Gate 1) shows fewer than 5% blasts (of the bone marrow cells) that are positive for CD13, CD33, and MPO. TdT is negative for all the cells analyzed.

Impression: these immunophenotype results, together with morphological findings, show no evidence of transformation to acute leukemia.

113. Nasal mass: non-hematopoietic malignancy, CD56-pos (small blue cell tumor)

Immunophenotyping of spinal mass biopsy by flow cytometry shows that most of the cells in the sample are not leukocytes (they are negative for CD45) and they do not express any markers for B cells and T cells in this panel. These cells are positive for CD56 by flow cytometry. These cells have large nuclear size compared to that of small lymphocytes (based on forward-scatter signal). Impression: these results are suggestive of small blue cell tumor (such as neuroblastoma, Ewing sarcoma, premitive neuroectodermal tumor, or rhabdomyosarcoma). Correlation with morphology is suggested.

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114. BM: FL with no definitive kappa/lambda restriction

Immunophenotyping of bone marrow aspirate by flow cytometry in gate 2 shows a normal population of B lymphocytes and T lymphocytes. Analysis of cells in gate 1 shows a small T cell population (about 5% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a prominant B cell population (about 76% of the cells analyzed) that is positive for CD19, CD20, CD22, CD10,and FMC7. These B cells are negative for CD5, CD23, and TdT. These abnormal B cells have small nuclear size (based on forward-scatter signal). Surface and cytoplasmic kappa/lambda do not show a definitive restriction pattern. However, this predominant B cell population with negative TdT is monoclonal mature B cells with this marker profile.

Impression: these immunophenotypic results, together with morphological findings, are consistent with B-cell lymphoma involvement in bone marrow, favoring follicular lymphoma. Note that grading of follicular lymphoma would require examination of primary site of lymphoma (excisional biopsy). Findings were discussed with Dr Gonzales on 9/22/2010.

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115. Biopsy containing carcinoma, no lymphocytes

Flow cytometry analysis shows less than 1% of the cells from the sample expressing leukocytic markers (CD45)

The flow cytometry results are non-diagnostic due to the lack of sufficient lymphocytes from the sample for analysis. This is most likely due to the tissue sample containing very few lymphocytes.

116. SLL: polyclonal with surface K/L and monoclonal with cytoplasmic K/L

Immunophenotyping of the left kidney aspiration by flow cytometry shows an abnormal B cell population (about 91% of the cells analyzed) that is positive for CD5, CD19, CD20, CD22, CD23, and CD38. Surface kappa and lambda do not show light-chain restriction. However, cytoplasmic lambda light-chain shows restriction. These B cells are negative for CD10, and TdT. These B cells have small nuclear size (based on forward-scatter signal). Impression: these results are consistent with small lymphocytic lymphoma (SLL) in the left kidney. Note: previous flow cytometry done on lymph node biopsy (collected on 8/25/10) also showed results diagnostic of SLL

117. PB: chronic lymphoproliferative disorder of NK cells vs. aggressive NK cell leukemia

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a T cell population (about 72% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population (about 1% of the cells gated). Approximately 30% of the lymphocytes express a marker profile consistent with NK cell lineage (positive for CD2, CD56; and negative for CD3, CD7). Review of peripheral blood smear shows presence of many large-granular lymphocytes. Impression: increase in NK cells in peripheral blood. This may be associated with chronic lymphoproliferative disorder of NK cells (an indolent disorder), or aggressive NK cell leukemia. Further workup is suggested. Patient's cardiology team was notified of this finding on 10/15/2010 at 14:00.

118. PB: CML in accelerated phase, 15% myeloblasts

Immunophenotyping of peripheral blood leukocytes by flow cytometry in gate #2 shows a T cell population with no aberrant loss or aberrant expression of T cell markers, a small B cell population that is negative for CD5, CD10, also no surface light-chain restriction. Analysis of cells in gate #1 (blast area) shows a blast population that is positive for CD13, MPO, and CD33. They are partially positive for CD34, and CD117. They are also negative for CD4. Review of the peripheral blood smear shows marked leukocytosis with left shift including 15% blasts, basophilia and eosinophilia. Impression: the immunophenotyping results by flow cytometry, together with morphological findings, are most consistent with chronic myelogenous leukemia in accelerated phase. Result for bcr-abl mutation is pending.

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119. Cervical LN: MZL

Immunophenotyping of left neck lymph node aspirate by flow cytometry shows a T cell population (about 13% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, an abnormal B cell population (about 86% of the cells analyzed) that is positive for CD19, CD20, CD22, FMC7, surface lambda light-chain restriction. These B cells are negative for CD5, CD10, CD11c, CD16, CD56, CD23, CD34, and CD103. These B cells have small nuclear size (based on forward-scatter signal). Impression: these results, together morphological findings in aspirate, are most consistent with a low-grade (indolent) B cell lymphoma, most likely marginal-zone lymphoma.Excisional biopsy with further marker studies are needed for a definitive diagnosis.

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120. LN: non-diagnostic with DLBCL due to poor viability of lymphoma cells

Immunophenotyping of the left groin lymph node biopsy by flow cytometry shows a T cell population (about 78% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 24% of the cells analyzed) that is negative for CD5, CD10, and no surface light-chain restriction. These lymphocytes have small nuclear size (based on forward-scatter signal).

Impression: no abnormal immunophenotypes are found with flow cytometry. Note: these findings are not diagnostic due to low viability of large B cell lymphoma in the sample. Please refer to surgical pathology report S10-2902 for full details.

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121. LN: small-cell carcinoma, CD56-pos; 3% lymphocytes

Flow cytometry analysis shows less than 3% of the cells from the lymph node sample expressing leukocytic markers (CD45). Analysis of these cells shows a T cell population (about 51% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 41% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. Up to 40% of all the cells in the sample are non-leukocyte cells and are positive for CD56.

Impression: the flow cytometry results show no evidence of lymphoma. Carcinoma (such as small-cell carcinoma) cannot be ruled out with the presence of CD56-positive cells in the non-leukocyte group. Morphological correlation is needed.

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122. PB: Transient Abnormal myelopoiesis in Down syndrome, 20% blasts

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a blast population that is positive for CD41 (90% of the blasts), and CD61 (95% of the blasts). These blasts are partially positive for CD13, CD56, and CD117. They are negative for CD34, CD33, HLA-DR, CD14, CD16, CD19, CD10, CD64, and TdT. Impression: these findings, together with morphological finding of 20% blasts in peripheral blood, are consistent with transient abnormal myelopoiesis in Down syndrome in this patient with trisomy 21. Although this disorder has a high rate of spontaneous remission, non-transient acute myeloid leukemia develops later in 20-30% of these cases within 3 years. Close follow-up is suggested. Findings were notified to nurse practitioner Kitty on 12/29/10

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123. BM: MPN/MDS with 7% blasts

Immunophenotyping of bone marrow aspirate by flow cytometry in blast area shows a

myeloblast population that is positive for CD34, CD13, CD4, CD117, and HLA-DR. These blasts are

negative for CD33, CD56, CD19, CD10, and TdT. The myeloblasts account for 7% of the bone marrow cells.

Impression: these findings are consistent with increase in myeloblasts in bone marrow.

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124. T6 LESION, DLBCL

Immunophenotyping of the T6 lesion biopsy by flow cytometry shows a T cell population (about 5% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a prominant B cell population (about 94% of the cells analyzed) that is positive for CD19, CD20, CD22, CD10, FMC7, surface lambda light chain restriction. These B cells are negative for CD5, and CD23. These B cells have intermediate-large nuclear size (based on forward-scatter signal). Impression: these results are consistent with a B-cell lymphoma. Please refer to surgical pathology report HS-11-167 for full details of final diagnosis.

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125. PB: CML with 3% blasts

Immunophenotyping of peripheral blood leukocytes by flow cytometry in blast area shows a

myeloblast population that is positive for CD13, CD15, and MPO. These blasts are negative for CD33, CD56, CD19, and TdT. The myeloblasts account for less than 10% of the peripheral blood leukocytes.

Impression: these findings are consistent with peripheral blood smear findings of chronic myelogenous leukemia.

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126. PB: 14% NK cells in PB, reactive condition vs. NK cell lymphoproliferative disorder

Immunophenotyping of peripheral blood lymphocytes by flow cytometry shows a T cell population (about 39% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 46% of the cells analyzed) that is negative for CD5, CD10, no evidence of surface-light chain restriction. There is a small NK cell population (about 14% of the lymphocytes) with expression of CD16, CD56, and negativity for CD3. Impression: presence of a subpopulation of NK cells in peripheral blood (about 14% of the lymphocytes). This may represent a reactive condition. However, NK cell lymphoproliferative disorder cannot be ruled out. Furher workup is suggested if clinically indicated.

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127. LN: Squamous Cell Carcinoma, less than 1% lymphocytes

Immunophenotyping of left neck mass sample by flow cytometry shows less than 1% of the lymphocytes expressing either T cell markers or B cell markers. This is due to the presence of mostly non-lymphoid tissue in the lymph node (squamous cell carcinoma, please refer to report CA-11-94 for more details).

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128. Thymus: PMLBCL

Immunophenotyping of thymic biopsy by flow cytometry shows a T cell population (about 64% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 37% of the cells analyzed) that is negative for CD5, CD10, no expression of surface-light chains (neither kappa nor lambda). These B cells have intermediate-large nuclear size (based on forward-scatter signal) and are positive for CD19, CD20, CD22, and FMC7. The analyzed lymphocytes (T and B cells) are negative for TdT. Impression: these results are consistent with a B-cell lymphoma, most likely primary mediastinal (thymic) large B cell lymphoma (a subtype of diffuse large B cell lymphoma). Please refer to surgical pathology report HS-11-1215 for further details.

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129. EPIDURAL MASS: HIGH CD4/CD8

Immunophenotyping of epidural mass biopsy by flow cytometry shows a T cell population (about 68% of the cells analyzed) with high CD4/CD8 ratio (10:1); otherwise no aberrant loss or aberrant expression of other T cell markers, a B cell population (about 35% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. All the lymphocytes have small nuclear size (based on forward-scatter signal). Impression: T cell population with a high CD4/CD8 ratio (10:1)

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130. BM: CML, no evidence of accelerated phase

Immunophenotyping of bone marrow leukocytes by flow cytometry in gate #1 shows a T cell population (about 80% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 14% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Analysis of cells in the blast area (gate #2, not displayed) shows a myeloblast population that is positive for CD13, CD33, CD34, and CD117. The myeloblasts account for less than 3% of the bone marrow cells. Impression: these immunophenotypic findings are supportive of the morphological findings of chronic myelogenous leukemia. No evidence of acccelerated phase is found.

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131. Mesenteric LN: PTCL, NOS

Impression: these results, together with morphological findings in biopsy, are consistent with a peripheral T-cell lymphoma.

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132. BAL: B lymphoblastic leukemia

Immunophenotyping of BAL specimen by flow cytometry shows an abnormal B cell population (about 14% of all the cells analyzed). These B cells have small-intermediate nuclear size (based on forward-scatter signal) and show expression of CD10, CD19, and CD34. They are negative for CD20, CD2, CD3, CD4, CD8, CD5, CD7, CD56, and MPO. Measurement of TdT is suboptimal (most likely due to low viability of sample at 55%). Impression: the overall immunophenotype results are most consistent with B lymphoblastic leukemic cells in BAL.

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133. LN: ALCL

Immunophenotyping of mesenteric lymph node biopsy by flow cytometry shows a predominant abnormal population of lymphocytes with intermediate-large nuclear size (based on forward-scatter signal). These cells show expression of CD2, CD3 (cytoplasmic), and CD4. They show partial loss of CD7 and CD3 (surface), also aberrant loss of CD5. They are negative for CD8. Impression: these results, together with morphological findings in biopsy, are consistent with a T-cell lymphoma. Please refer to surgical pathology report HS-11-1839 (anaplastic large cell lymphoma) for full details.

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134. BM: CLL/SLL no surface K/L, cytoplasmic Lambda

Immunophenotyping of bone marrow leukocytes by flow cytometry shows an abnormal B cell population (about 30% of the cells analyzed) that is positive for CD5, CD19, CD20, CD22, CD23, lack of both surface kappa and lambda light-chains. These B cells show cytoplasmic lambda light-chain restriction. They are negative for CD10, FMC7, and CD38. These B cells have small nuclear size (based on forward-scatter signal). Impression: these results, together morphological findings in bone marrow, are consistent with chronic lymphocytic leukemia / small lymphocytic lymphoma.

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135. QNS for lymphocytes benign tissue (or a non-lymphoma tumor)

Flow cytometry analysis shows less than 1% of the cells from the sample expressing leukocytic marker (CD45). Impression: the flow cytometry results are non-diagnostic for ruling out lymphoma due to the lack of sufficient lymphocytes from the sample for analysis. This may be seen in benign tissue or a non-lymphoma tumor. Clinical correlation is suggested.

136. PB: Predominant T cells with no abnl immunophenotypes

Immunophenotyping of peripheral blood lymphocytes by flow cytometry shows a predominant T cell population (about 92% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population (less than 1% of the cells analyzed). The lymphocytes have small nuclear size (based on forward-scatter signal). Impression: a predominant small T cell population with no abnormal immunophenotypes by flow cytometry.

137. BM: normal, 2 gates- APL in remission with 3% hematogones

Immunophenotyping of bone marrow lymphocytes (Gate 1) by flow cytometry shows a T cell population (about 72% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 27% of the cells analyzed) that is negative for CD5, CD10, and no surface light-chain restriction. Analysis of the cells in the blast area (Gate 2) shows less than 1% blasts (of the bone marrow cells) that are positive for CD13 and CD33. A small population of hematogones is also found (Gate #2) which express CD45, CD34, CD10, CD19, CD20, and TdT. Scattergrams of these markers show a smear-out pattern indicating a continuum of maturation, consistent with that of hematogones. The hematogones account for approximately 3% of the bone marrow cells. Impression: no abnormal immunophenotypes are found with flow cytometry, especially no evidence of residual leukemic cells.

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138. RIB LESION: 1% monoclonal plasma cells (numerous plasma cells in H&E)

Immunophenotyping of rib lesion biopsy by flow cytometry shows a T cell population (about 62% of the cells gated), a small B cell population (about 9% of the cells gated), Plasma cells (gated with CD38) account for about 1% of all the cells analyzed and show cytoplasmic lambda light chain restriction. The plasma cells are positive for CD56. They are negative for CD19, and cytoplasmic kappa light chain.

Impression: presence of monoclonal plasma cells (1%) in rib lesion. Examination of rib lesion touch preps and biopsy shows numerous plasma cells. The small number of plasma cells in this flow cytometric analysis (compared to microscopic findings) is most likely due to sampling artifacts.

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139. BM: AML with aberrant expression of CD2, CD7

Immunophenotyping of peripheral leukocytes by flow cytometry shows a predominant myeloblast population that is positive for CD34, CD13, CD38, CD117, and HLA-DR. They show aberrant expression of CD2 and CD7. These blasts are negative for MPO, CD33, CD3, CD4, CD8, CD5, CD14, CD16, CD56, CD19, CD20, CD10, CD64, and TdT. Impression: these findings are consistent with acute myeloid leukemia. The positive results for CD34 and HLA-DR do not support acute promyelocytic leukemia. Negative results for CD14, CD64, and CD4 do not support acute myelomonocytic leukemia.

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140. Soft tissue, mandible: artifactual loss of plasma cells (numerous plasma cells in H&E)

Flow cytometry analysis shows less than 0.5% of the cells from the sample expressing plasmacytic marker (CD38). The flow cytometry results are non-diagnostic due to the lack of sufficient plasma cells from the sample for analysis. Morphological review of biopsy shows many plasma cells in tissue sections. The lack of sufficient plasma cells in this flow cytometry sample is likely due to technical artifacts (such as fragile plasma cells)

141. PB: CLL with pos ZAP70

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows an abnormal B cell population (about 93% of the cells analyzed) that is positive for CD5, CD19, CD20, CD22, CD23, surface kappa light chain restriction (dim signal). These B cells are negative for CD10, FMC7, and CD38. These B cells have small nuclear size (based on forward-scatter signal). Impression: Impression: these results, together morphological findings in peripheral blood, are consistent with chronic lymphocytic leukemia (CLL). Note: ZAP70 was sent to Quest Laboratory. The result (4/19/2011) showed 83% of the B cells with co-expression of ZAP70 and CD19. This positive finding of ZAP70 is associated with immunoglobulin VH unmutate genotype and adverse prognosis in this patient with CLL.

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142. Nasal mass; pos CD56, negative for NK/T lymphoma

Immunophenotyping of sinonasal mass biopsy by flow cytometry shows an abnormal population (20% of the cells analyzed) that is positive for CD56 and negative for all B cell markers and T cell markers. They are also negative for CD34. Further analysis shows that these cells are negative for CD2 and cytoplasmic CD3. These cells have large nuclear size (based on forward-scatter signal). Impression: no immunophenotypes of lymphoma is found with flow cytometry, especially no evidence of NK/T cell lymphoma. The abnormal CD56-positive population may represent non-hematopoietic tumors such as neuroblastoma.

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143. Retroperitoneal mass: DLBCL, low cell viability

Immunophenotyping of retroperitoneal mass by flow cytometry shows a small T cell population (about 2% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a predominant B cell population (about 71% of the cells analyzed) that is negative for CD5, CD10, CD23, no expression of surface-light chains (neither kappa nor lambda). These B cells are positive for CD20, and partially positive for CD19. Impression: these results are consistent with a B-cell lymphoma. Even though the results are compromised by low cell viability (20%-80%), the diagnosis of diffuse large B cell lymphoma is also supported by morphology and immunostains (please refer to report CA-8-190 for details).

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144. Pleural fluid: a small number of NK cells

Immunophenotyping of pleural fluid by flow cytometry shows a T cell population (about 63% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population (about 1% of the cells analyzed), also a sub-population of NK cells that are positive for CD56 and CD16 (about 21% of the cells analyzed). Impression: no abnormal immunophenotypes are found with flow cytometry.

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145. Mediastinal mass: thymoma or thymic hyperplasia

Immunophenotyping of mediastinal mass biopsy by flow cytometry in gate #1 shows predominant a T cell population (about 84% of all the cells gated). They show expression of CD2, CD5, CD7, TdT, co-expression of CD4 and CD8. Analysis of cells in gate #2 shows a T cells population (about 98% of all the cells gated) that is positive for CD2, CD5, CD7, CD10, TdT with loss of CD3, CD4 and CD8. All the T cells have small nuclear size (based on forward-scatter signal). Smear pattern in scattergrams is observed for CD3, CD4, CD8, and TdT for cells in both gates. Impression: the results are most compatible with thymocytes (in either thymoma or thymic hyperplasia). They are not supportive of T lymphoblastic lymphoma.

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146. Right thigh mass biopsy: T cell/histiocyte-rich large B cell lymphoma (flow is non-diagnostic)

Immunophenotyping of right thigh mass biopsy by flow cytometry shows a large T cell population (about 95% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population (about 6% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Most lymphocytes have small nuclear size (based on forward-scatter signal). Impression: no abnormal immunophenotypes are found with flow cytometry. Note that these results are not diagnostic for T cell/histiocyte-rich large B cell lymphoma in this patient due to the small number of malignant cells (less than 10% of the cells in the sample). Please refer to surgical pathology report HS-11-4252 for further details.

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147. Right tonsil biopsy: follicular hyperplasia (92% B lymphocytes)

Immunophenotyping of the right tonsil biopsy by flow cytometry in the large cell area (with high forward-scatter signal) shows a small T cell population (about 8% of the cells gated), a prominent B cell population (about 92% of the cells gated) that is positive for CD19, CD20, CD22, CD10, and FMC7. They show no surface light-chain restriction. Analysis of small lymphocytes with low forward-scatter signal (not shown) reveals similar marker profile as that of the large lymphocytes. Impression: these immunophenotypic results are consistent with follicular lymphocytes (centroblasts and centrocytes) in reactive follicles of the tonsil. Please refer to UT Surgical Pathology report S11-1460 for further details).

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148. BM: no evidence of MDS

Immunophenotyping of bone marrow lymphocytes by flow cytometry shows a T cell population (about 77% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers except for a low CD4/CD8 ratio (0.15), most consistent with patient's history of HIV, a B cell population (about 12% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Analysis of the cells in the granulocytic area (not shown) demontrates that very few cells are with low side-scatter signals. Also, the granulocytes have normal signal distribution for CD13, CD33, CD16, and CD11b as seen in scattergrams for CD13/CD33, CD13/CD16 and CD11b/CD16 (no increase in CD13 or CD33 signal and no decrease in CD16 or CD11b signals). These results for granulocytes show no evidence of myelodyplasia. Impression: no abnormal immunophenotypes are found with flow cytometry. Especially, no evidence of myelodysplasia is seen in granulocytes.

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149.BM: suggestive of MDS

Immunophenotyping of bone marrow lymphocytes (Gate 1) by flow cytometry shows a T cell population (about 59% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 30% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Analysis of the cells in the granulocytic area (Gate 2) shows that there is a significant number of cells with low side-scatter signals. Also, the granulocytes show increase in CD13 signal and decrease in CD16 or CD11b signals as seen in scattergrams for CD13/CD16 and CD11b/CD16. These results for granulocytes are suggestive of myelodyplasia.

Impression: abnormal immunophenotypic patterns of granulocytes are found with flow cytometry. These findings are suggestive of myelodysplasia.

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150. Supraclavicular lymph node biopsy: plasmablastic lymphoma

Immunophenotyping of supraclavicular lymph node biopsy by flow cytometry in gate #1 shows a T cell population (about 85% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population (about 9% of the cells analyzed) that is negative for CD5, CD10, and no surface light-chain restriction. Analysis of cells gated for CD38 positivity shows a significant cellular population that is positive for CD56 and negative for CD19. Cytoplasmic light-chain analysis of CD38-positive cells shows kappa light chain restriction. Analysis of cells in gate #2 (cells with large size based on forward-scatter signal) shows an abnormal cellular population that is positive for CD56 and negative for CD45, also negative for all T cell markers and B cell markers.

Impression: these results, together with morphological and immunostain findings in lymph node, are consistent with plasmablastic lymphoma (please refer to UT surgical report S11-xxx for further details).

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151. BM: a subpopulation of cells with low side-scatter signal but no evidence of MDS

Immunophenotyping of bone marrow lymphocytes (Gate 1) by flow cytometry shows a monocytic population population (about 15% of the cells analyzed) with expression of CD4, CD11b, CD13, and CD33. Very few cells are seen in the lymphocytic gate (not shown). Analysis of the cells in the granulocytic area (Gate 2) shows that there is a subpopulation of cells with low side-scatter signals. However, the granulocytes have normal signal distribution for CD13, CD16, and CD11b as seen in scattergrams for CD13/CD16 and CD11b/CD16 (no increase in CD13 signal and no decrease in CD16 or CD11b signals). These results for granulocytes show no evidence of myelodyplasia.

Impression: no abnormal immunophenotypes are found with flow cytometry. Especially, no evidence of myelodysplasia is seen in granulocytes.

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152. BM: lymphoplasmacytic lymphoma

Immunophenotyping of bone marrow aspirate by flow cytometry shows an abnormal B cell population (about 88% of the cells analyzed) that is positive for CD19, CD20, CD22, HLA-DR, FMC7, surface kappa light chain restriction, also cytoplasmic kappa light chain restriction. These B cells are negative for CD5, CD10, CD11c, and CD103. These B cells are predominantly small in size (based on forward-scatter signal). Analysis of CD38-positive cells shows a small abnormal plasma cell population. These plasma cells are partially positive for CD56, with cytoplasmic kappa light-chain restriction. They are negative for CD19. Impression: these flow cytometry results, together with morphological findings in bone marrow (diffuse lymphocytic infiltrates consisting of mature lymphocytes, some with plasmacytoid forms, admixed with plasma cells), are most consistent with lymphoplasmacytic lymphoma.

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153. LN: cHL (flow is not diagnostic)

Immunophenotyping of lymph node core biopsy by flow cytometry shows a T cell population (about 73% of the cells analyzed) with high CD4/CD8 ratio (6:1), otherwise no aberrant loss or aberrant expression of T cell markers, a B cell population (about 24% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Impression: no abnormal immunophenotypes are found with flow cytometry. Note that classical Hodgkin lymphoma cannot be diagnosed with flow cytometry testing. Please refer to cytopathology report (CA-11-xxxx issued on 9/6/2011) for full details.

CPT:88189

154. BM: 20% hematogones in 15 y/o male with neuroblastoma

Immunophenotyping of bone marrow aspirate by flow cytometry shows a lymphocytic population (Gate #1) with normal immunophenotype. A sub-population of hematogones is found (Gates #2 and #3) which express CD45, HLA-DR, CD34 (variable), CD10, CD19, CD20 (variable), and TdT (variable). Scattergrams of these markers show a smear-out pattern indicating a continuum of maturation, consistent with that of hematogones. The hematogones account for approximatedly 20% of the bone marrow cells. Note that hematogones may be increased in bone marrow of very young patients. Impression: presence of a sub-population of hematogenes in bone marrow; no evidence of hematologic malignancy.

CPT:88189

155. BM: AML with only 1% myeloblasts in aspirate due to dilution

Immunophenotyping of bone marrow aspirate (Gate 1) by flow cytometry shows a T cell population (about 89% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population (about 4% of the cells analyzed) that is negative for CD5, CD10, no surface light-chain restriction. Analysis of the cells in the blast area (Gate 2) shows less than 1% of the leukocytes in peripheral blood with co-expression of CD34, CD13, CD33, and CD117.

Impression: a small number of myeloblasts is found bone marrow aspirate with flow cytometry. This is most likely due to suboptimal aspirate (peripheral blood contamination). Bone marrow aspirate smear and biopsy show numerous myeloblasts. Please refer to bone marrow report HB-11-163 for full details.

CPT:88189

156. BM: No residual myeloblasts, CML with accelerated phase, s/p chemo

Immunophenotyping of bone marrow aspirate by flow cytometry in gate #1 shows a T cell population (about 87% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a small B cell population (less than 1% of the cells analyzed). Analysis of cells in gate #2 (blast area) shows a small number of normal myeloblasts (<2%) that are positive for CD13, CD33, and negative for TdT. Impression: no residual myeloblasts are found with flow cytometry in this patient with history of CML in accelrated phase.

CPT:88189

157. BAL: low number of lymphocytes and a high H/S ratio

Immunophenotyping of the BAL sample by flow cytometry shows a T cell population (about 86% of the cells analyzed) with a high CD4/CD8 ratio (5.1), a small B cell population (less than 1% of the cells analyzed). Lymphocytes account for only 10% of the cells in the sample.

Impression: small number of lymphocytes in BAL sample with a predominant CD4-pos cells.

CPT:88187

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158. Very few leukocytes in sample

Flow cytometry analysis of lymph node sample shows less than 1% of the cells from the sample expressing leukocytic marker (CD45). They consist of a T cell population (about 83% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 15% of the cells analyzed) that is negative for CD5, CD10, and no surface light-chain restriction. Impression: A small number of normal lymphocytes are detected with the flow cytometry. The remaining cells (99% of the sample cells) are not leukocytes. This may be seen in benign tissue or a non-lymphoma tumor. Clinical correlation is suggested.

CPT:88189

159. BM: NK/T Lymphoma

160. BM:CMML-accelerated phase

Immunophenotyping of bone marrow leukocytes by flow cytometry gated in blast area shows a blast population that is positive for CD13, MPO, CD33, CD11b, CD4, CD117, and CD15. They are negative for CD34, CD14, CD64, CD56, CD19, CD10, and TdT. The blasts account for about 15% of bone marrow cells. Review of the aspirate smear shows 15% blasts, and 20% monocytes. Impression: the immunophenotyping results by flow cytometry, together with morphological findings, are most consistent with chronic myelomonocytic leukemia in accelerated phase.

CPT:88189

161. Spine lesion: plasma cell malignancy

Immunophenotyping of the spine lesion biopsy by flow cytometry shows a small lymphocytic population (2% of the analyzed cells) with normal marker profile for B cells and T cells. There is a predominant plasma cell population (about 85% of the cells analyzed) that is positive for CD38, cytoplasmic lambda light chain restriction. The plasma cells are negative for CD19, and CD56. Impression: presence of numerous monoclonal plasma cells (85%) in spine lesion. Examination of spine lesion biopsy shows numerous plasma cells. The findings are consistent with a plasma cell malignancy. Please refer to surgical pathology report HS-12-xxxx for full details.

162. PB: aggressive NK cell leukemia vs. chronic NK cell lymphoproliferative disorder

Immunophenotyping of peripheral blood leukocytes by flow cytometry shows a T cell population (about 30% of the cells analyzed) with no aberrant loss or aberrant expression of T cell markers, a B cell population (about 10% of the cells analyzed) that is negative for CD5, CD10, and no surface light-chain restriction. Approximately 60% of the lymphocytes express a marker profile consistent with NK cell lineage (positive for CD2, CD56, CD7; and negative for CD5, CD3, CD4, CD8, CD16, CD19, CD20, and other B cell markers). These NK cells account for about 30% of the peripheral blood leukocytes. Impression: increased number of NK cells in peripheral blood. This may represent aggressive NK cell leukemia or chronic NK cell lymphoproliferative disorder. Clinical correlation is suggested.

CPT 88189