Bone Marrow Biopsy Results – December

Here they are…

Raw, with no commentary from me. Heh.

Pathologist:   ***************, M.D.

CLINICAL DATA:
Clinical History: 29 year old female with history of MGUS
Clinical Diagnosis: MGUS


BONE MARROW ASPIRATE REPORT

RESULT:

Differential count:

Cellularity : OK/Increased. Spicules present
Megakaryocytes : Present
Blasts : 1%
Promyelocytes : –
Myeloid : 62%
Erythroid : 25%
Lymphocytes : 11%
Plasma cells : 1%; rare binucleate forms
Others : -; Touch prep also examined
M:E ratio : 2.4:1

INTERPRETATION:

Maturing trilineage hematopoiesis with 1% plasma cells.
See biopsy, flow cytometry and cytogenetics for definitive evaluation of plasma
cell population.

 Final Diagnosis by  *********** M.D., Electronically signed on Friday
December 14, 2012 at 09:27:17AM







Resident: **************, M.D., Ph.D.
Pathologist:   *************, M.D.

CLINICAL DATA:
Clinical History: 29 year-old woman with history of MGUS
Clinical Diagnosis: None given.


RESULT:

FLOW CYTOMETRY REPORT — MYELOMA PANEL

Gating is by CD38 and CD138 on plasma cells with <1% of the total cells in the
gate.

T cell % Positive B cell % Positive Myeloid/Others % Positive
———————————————————————–
CD3 CD19 1 CD45
CD5 CD38+CD138+ 74 CD34
CD3+CD4+ CD19+CD5+ CD14
CD3+CD8+ CD38+CD56+ HLA-DR
CD3+CD7+ CD138+CD56+ 2 CD33
CD2 CD19+CD11c+ CD13
CD7 CD22 CD11b
CD19+CD38+ CD117
NK cell CD19+Kappa+ TdT
CD16 CD19+Lambda+ CD10
CD56 9 CytoKappa+ 26 CD15
CD57 CytoLambda+ 78 CD64
CD3+94+ CD19+CD52+ Glycophorin
———————————————————————–

INTERPRETATION:
Flow cytometric analysis of this bone marrow aspirate reveals a minute
population of plasma cells that is positive for CD38 and CD138, negative for
CD56, and shows apparent cytoplasmic lambda light chain staining, HIGHLY
SUSPICIOUS FOR INVOLVEMENT BY A PLASMA CELL NEOPLASM. Correlation with
morphologic findings (BS-12-56932) is required for further evaluation.

These tests were developed and their performance characteristics determined by
the Hematology Laboratory, Brigham and Women’s Hospital. 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.


Final Diagnosis by  *************** M.D., Electronically signed on
Wednesday December 12, 2012 at 12:50:01PM









Accession Number:  ********                     Report Status: Final
Type: Surgical Pathology
Specimen Type: Bone marrow biopsy

Procedure Date: 12/10/2012
Ordering Provider:  *************M.D.

CASE:**********
PATIENT: ELIZABETH *********

Resident: **************, M.D., Ph.D.
Pathologist:   **********, M.D., Ph.D.

PATHOLOGIC DIAGNOSIS:

BONE MARROW BIOPSY:

MOST CONSISTENT WITH INVOLVEMENT BY A PLASMA CELL NEOPLASM (see NOTE)

Hemorrhagic moderately hypercellular marrow (20% fat/80% cellular).
Approximately 10% of the cellularity (5% of intertrabecular space) is comprised
of plasma cells that occur singly and in small clusters.
Immunoperoxidase and in-situ hybridization studies performed on paraffin
sections reveal that the CD138-positive plasma cells express excess lambda
light chain over kappa light chains.
Of the remaining cellularity:
Erythroid elements are present in normal proportion and exhibit maturation.
Myeloid elements are present in normal proportion, exhibit maturation and
include increased number of early and eosinophilic forms.
Blasts comprise less than 5% of the marrow cellularity.
Bone trabeculae exhibit focal osteoblastic and focal osteoclastic activity.
Giemsa stains were examined.
The aspirate smear findings are of a cellular, spicular smear showing maturing
trilineage hematopoiesis with mildly increased number of plasma cells.
Blasts are not increased.

Bone Marrow aspirate reading at DFCI (BL**********):

Differential count:
Cellularity : OK/Increased. Spicules present
Megakaryocytes : Present
Blasts : 1%
Promyelocytes : –
Myeloid : 62%
Erythroid : 25%
Lymphocytes : 11%
Plasma cells : 1%; rare binucleate forms
Others : -; Touch prep also examined
M:E ratio : 2.4:1
Maturing trilineage hematopoiesis with 1% plasma cells.

Flow cytometric analysis performed at BWH (*********, 12/10/2012) showed a

minute population of plasma cells that is positive for CD38 and CD138, negative
for CD56, and shows apparent cytoplasmic lambda light chain staining, HIGHLY
SUSPICIOUS FOR INVOLVEMENT BY A PLASMA CELL NEOPLASM.

NOTE:
The overall findings are a moderately hypercellular marrow showing maturing
trilineage hematopoiesis and 10% plasma cells with excess lambda light chain;
focal osteoclastic activity is present. Although definitive light chain
restriction is not observed by in-situ hybridizations studies, in light of IgG
lambda monoclonal gammopathy, the overall findings are MOST CONSISTENT WITH
INVOLVEMENT BY A PLASMA CELL NEOPLASM. Correlation with clinical, laboratory,
cytogenetic, and radiologic findings is recommended for further classification.



(Clinical: 29 year-old female with history of monoclonal gammopathy of
undetermined significance)

CLINICAL DATA:
History: 29 year-old female with history of monoclonal gammopathy of
undetermined significance.
Operation: Bone marrow biopsy.

TISSUE SUBMITTED:
A/1. Bone marrow biopsy.

GROSS DESCRIPTION:
The specimen, labeled with the patient’s name, unit number and “PRI”, consists
of a tan core of tissue, measuring 1.3 cm in length x 0.2 cm in diameter. It
is fixed in Bouin’s solution and briefly decalcified in RapidCal-Immuno for 15
minutes. A Wright-Giemsa stained bone marrow aspirate smear is received.

Micro A1: Bone marrow biopsy, ESS, 1 frag, 1 cass.

CASE NUMBER: 56932.


Dictated by: **********

The immunoperoxidase, immunofluorescence and in-situ hybridization tests
performed at Brigham and Women’s Hospital were developed and their performance
characteristics determined by the Immunohistochemistry Laboratories in the
Department of Pathology at BWH. They have not been cleared or approved by the
U.S. Food and Drug Administration (FDA). The FDA has determined that such
clearance or approval is not necessary.

By his/her signature below, the senior physician certifies that he/she

personally conducted a microscopic examination (“gross only” exam if so stated)

of the described specimen(s) and rendered or confirmed the diagnosis(es)
related thereto.

Final Diagnosis by  ************M.D., Ph.D., Electronically signed on
Friday December 14, 2012 at 02:58:32PM

I will say I am happy to see these numbers are a bit lower than in July.

However, there is some language that is different than my other biopsy results such as rare binucleate forms and focal osteoblastic and focal osteoclastic activity.

I meet with Dr. R this afternoon so we’ll see. :)