DIAGNOSIS:
A-B. BRAIN, RIGHT SIDE LESION, STEREOTACTIC BIOPSY:
GLIOBLASTOMA, WHO GRADE 4.
NEGATIVE FOR IDH1 R132H IMMUNOHISTOCHEMISTRY.
NEGATIVE FOR H3 K27M IMMUNOHISTOCHEMISTRY.
PENDING NGS TESTING.
SEE SYNOPTIC REPORT AND COMMENT.


SYNOPTIC REPORT:
Report Name: CNS - Histological Assessment
Status: Submitted Checklist Inst: 1 Last Updated By: HILARY HIGHFIELD
MD, 10/20/2021 15:16:32
Part(s) Involved:
A: RIGHT SIDE LESION

Synoptic Report:
Clinical
Neuroimaging Findings: MRI: large 4.6 x 4.2 cm lesion centered in the
posterior limb of the right internal capsule likely involving the right thalamus
and posterior right basal ganglia.
Specimen
Procedure: Stereotactic biopsy
Specimen Size, Gross Description: 1.8 Centimeters (cm)
Tumor
Tumor Site: Brain
Tumor Laterality: Right
Histologic Type: Glioblastoma, IDH-wildtype
Histologic Grade: WHO Grade 4
Special Studies
Biomarker Studies: Pending
Comments
NGS pending
Best Blocks for Future Studies: B1, B2

CAP eCC February 2020 Annual Release




PATHOLOGIST COMMENT:
This hypercellular infiltrative astrocytic neoplasm contains areas of necrosis
and microvascular proliferation. The tumor cells have small hyperchromatic
nuclei and a small to moderate amount of eosinophilic cytoplasm. Mitotic
activity is readily identified.

Immunohistochemistry is performed on block B1 to characterize the lesion
including H3 K27M (sendout to Mayo Clinic, Rochester) GFAP, OLIG2, IDH1 R132H,
ATRX, p53, and Ki-67. The tumor cells are immunoreactive for GFAP and OLIG2.
P53 labels rare tumor cell nuclei. The tumor cells are negative for IDH1 R132H
immunohistochemistry, and ATRX expression is retained. The Ki-67 proliferation
index is elevated, estimated as labeling approximately 50% of tumor cell nuclei.
H3 K27M immunohistochemistry, performed at the Mayo Clinic, Rochester, is
negative.

Caris NGS testing is ordered on block B2 per the request of Dr. Sinicrope.
Unstained slides from block B1 are requested for use as research tissue in a
potential clinical trial enrollment. The case is discussed with Dr. Sinicrope by
Dr. Highfield on 10/20/2021 at 3:00 PM.


**Electronically Signed Out on 10/20/2021 **

HILARY HIGHFIELD MD
dmj/10/15/2021

Interpretation performed at:
B - Norton Brownsboro Hospital
4960 Norton Healthcare Blvd
Louisville, KY 40241
INTRAOPERATIVE CONSULTATION:
FROZEN SECTION AND TOUCH PREP DIAGNOSIS:
A. RIGHT SIDE LESION: HIGH-GRADE GLIOMA.
/ Called to Dr. Yao on 10/14/2021 at 1409 by Dr. Hilary Highfield.

HILARY HIGHFIELD MD

CLINICAL HISTORY:
CLINICAL HISTORY AND SPECIAL REQUESTS BRAIN TUMOR

SPECIMEN SOURCE:
A: RIGHT SIDE LESION
B: RIGHT SIDE LESION

GROSS DESCRIPTION:
A. Received in formalin designated "right side lesion" are multiple red-tan
core fragments measuring 1.0 x 0.8 x up to 0.2 cm in aggregate. Two touch preps
are prepared and two fragments are submitted on a single block for frozen
section. Following frozen section, the specimens are submitted in cassette A1.
All remaining tissue is submitted in cassette A2.

B. Received in formalin on multiple rectangular fragments of white Telfa are
multiple cylindrical fragments of pink-tan to red soft tissue consistent with
needle core biopsy specimens. The specimens measure 1.8 x 0.5 x up to 0.3 cm in
aggregate. The specimens are entirely submitted in cassettes B1 and B2.



dd1/10/14/2021
Tabitha Jordan
MICROSCOPIC DESCRIPTION:
Microscopic examination performed.


All controls react appropriately.

DISCLAIMER: "These results are not, in and of themselves, diagnostic, but should
be interpreted in the context of the clinical findings and the histopathologic
diagnosis." This test was developed and its performance characteristics
determined by CPA Lab. It has 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. This test is used for clinical purposes. It should not be
regarded as investigational or for research. This laboratory is certified under
the Clinical Laboratory Improvement Amendments of 1988 ("CLIA") as qualified to
perform high-complexity clinical testing."



Emma H. Coronel, M.D. - Medical Director

Ordered by Tom L. Yao, MD

Collected on 10/14/2021 1:58 PM (Pathology)

Resulted on 10/20/2021 3:24 PM

Result Status: Final result