ADDENDUM REPORT

Collected:                 Received:
Responsible Pathologist:

Addendum Diagnosis:

- Estrogen receptor: Positive
- Progesterone receptor: Â Positive

Verified by:
Verify Date:
Performing Location:

Addendum Comment:
ER/PR was performed on block A5
Ancillary studies were performed on this case with appropriate controls showing appropriate reactivity. These tests may not have been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance or approval is not necessary, since such tests were developed and their performance characteristics determined by XX Medical Center Laboratory. This test is used for clinical purposes. It should not be regardedas investigational or for research. XX Medical Center is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) as qualified to perform high complexity clinical laboratory testing.

SURGICAL PATHOLOGY FINAL REPORT

Collected:                 Received:

Responsible Pathologist:

FINAL DIAGNOSIS:

Uterus, cervix and bilateral fallopian tubes, hysterectomy : Epithelioid Leiomyosarcoma clear cell features
Specimen integrity: Opened

Tumor size: 8.1 cm

Histologic type: Leiomyosarcoma, epithelioid type Lymphovascular invasion: Present, multifocal
Surgical resection margins: Negative

SURGICAL PATHOLOGY FINAL REPORT

Collected:                 Received:

Responsible Pathologist:

FINAL DIAGNOSIS:

Other tissue organ involvement: Not identified Regional lymph nodes: None submitted Additional findings:

- Unremarkable cervix, negative for dysplasia.

- Intrauterine device.

- Endometrium with progestin effect, negative for hyperplasia .

- Unremarkable fallopian tubes. Pathologic stage classification: pT1bNX.

Verified by:

Verify Date:

Performing Location: XX Medical Center

When applicable, appropriate positive controls and/or negative controls were used for all stains including immunohistochemical stains, special stains and in situ hybridization and reacted appropriately. These tests may not have been cleared or approved by the U.S. Food and Drug Administration. The FDA has determined that such clearance of approval is not necessary since such tests were developed and their performance characteristics determined by XX Medical Center Laboratory. These tests are used for clinical purposes. They should not be regarded as investigational or for research. XX is certified under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) as qualified to perform high complexity clinical laboratory testing.

COMMENT:

Smooth muscle heavy chain myosin and desmin stains performed on the tumor shows strong expression in the tumor cells confirming a diagnosis of leiomyosarcoma. Pankeratin, calretinin and Melan-A stains are negative. This tumor particularly shows extensive clear cell change within the tumor cells and is best classified as a epithelioid leiomyosarcoma with extensive clear cell change. A message was left for Dr.XX by Dr. XX to discuss these histologic findings.

GROSS DESCRIPTION:
The specimen, labeled and designated "uterus, cervix, bilateral tubes," is received in formalin and consists of a disrupted uterus with attached cervix and bilateral fallopian tubes . The uterus measures 11.8 cm fundus-cervix x 8.7 cm left-right x 5.4 cm anterior-posterior and weighs 401 g. The serosa is tan-pale pink and glistening with a surgical defect measuring up to 9.5 cm in greatest dimensions along the right lateral aspect of the uterus, exposing diffusely disrupted underlying presumed mass. The cervix is tan-pale pink and glistening. It measures 4.6 x 3.5 cm and is remarkable for a slit-like os that measures up to 1.7 cm in greatest dimensions. The uterus is opened to reveal a tan-pale pink, faint herringbone pattern endocervical canal that measures 3.5 cm in length x 1.5 cm in diameter. The endometrial cavity measures 4.3 cm in length x 3.1 cm cornu-cornu. It is lined with a tan-pale pink endometrium with an average thickness of 0.1 cm, admixed with a minimal amount of dark red blood clot. Also present is an intact, T-shaped, white synthetic intrauterine device measuring 3.7 x 3.5 x 0.3 cm. There is an attached gray wire present measuring up to 2.5 cm in greatest length. Discrete serial identification numbers are not identified on the IUD.The specimen is serially sectioned to reveal a tan-pale pink, mildly trabeculated myometrium with a maximum thickness of 4.3 cm. The previously exposed, disrupted mass, located within the right posterior aspect of the uterus, measures up to 8.1 cm in greatest dimensions. The cut surface of the mass is tan-white, firm and mildly scalloped to irregular with surrounding satellite nodules ranging from 0.4-1.1 cm in greatest dimensions. The mass appears to come within 0.5 cm of the closest serosal surface. Other areas of interest are not seen grossly. The left fimbriated fallopian tube measures 8.7 cm in length x 0.5 cm in diameter and the right fimbriated fallopian tube measures 10.2 cm in length x 0.5 cm in diameter. The left is differentially inked blue and both are serially sectioned to reveal a tan-pale pink tubular structure with a pinpoint lumen.

SURGICAL PATHOLOGY FINAL REPORT

Collected:                 Received:
Responsible Pathologist:

GROSS DESCRIPTION:
Representative sections are submitted as follows:
A1: Anterior and posterior cervix
A2: Partial thickness section of anterior endomyometrium including serosa
A3: Partial thickness section of posterior endomyometrium
A4-A5: Random sections of disrupted mass (2 pieces per cassette)
A6-A7: Bilateral fallopian tube fimbriae (entirely) and cross-sections; left inked blue
Note: Additional sections are submitted during second look for Dr. XX on XX date in additional cassettes A8-A14.

MICROSCOPIC DESCRIPTION:
Histologic sections of all submitted blocks are examined by light microscopy. These findings, together with the gross examination, support the pathologic diagnosis. Immunostains are performed on block A4 and show the stromal tumor to be strongly positive for desmin smooth muscle myosin heavy chain, while negative for pancytokeratin, Melan-A and calretinin. No atypia is noted. There is no necrosis or increased mitotic activity. This is consistent with a clear cell variant of an epithelioid leiomyoma.