SURGICAL PATHOLOGY - Final result (08/20/2024 10:31 AM CDT)Specimen (Source)Anatomical Location / LateralityCollection Method / VolumeCollection TimeReceived TimeTissue specimen (specimen) (Miscellaneous)08/20/2024 10:31 AM CDT08/20/2024 10:31 AM CDTNarrativeWASHINGTON UNIVERSITY PATHOLOGY LAB - 08/22/2024 4:28 PM CDTThis result has an attachment that is not available.EPIC results best viewed via link to PDFWashington UniversityPathology Consult Service660 S. Euclid Ave., Box 8024, St. Louis, MO 63110(314) 362-7784Note to Patients: This report may contain a detailed description of human tissue sent by a health care provider to the laboratory for pathologic evaluation. The content of this report is essential for diagnosis and may provide important critical findings.This information may be unfamiliar to patients to review without a medical professional present. It is advised that the patient review this report in the presence of a health care provider who can answer questions and explain the details.SURGICAL PATHOLOGY REPORT* Consult Report *Washington University is providing an additional review of previously collected tissue.FINALPatient Name:  TOWELL, ALEXANDER R.Address:  304 PICKER AVEN,      WOOD RIVER, IL  62095Gender:  MDOB:  8/4/1975 (Age: 49)MRN :  104670153Hospital #:  2244610558Patient Type:  WUIOLocation:  UNKNOWNAccession #:  W24-7828Taken:  8/20/2024Received:  8/20/2024Accessioned:  8/20/2024Reported:  8/22/2024Physician(s): Benjamin Tan, M.D.Anderson HospitalDepartment of Pathology6800 State Route 162Maryville, IL 62062P: 618-391-6765F: 618-288-6541Histology: 618-391-6774

Diagnosis:Consult material received from Anderson Hospital, Maryville, IL (OSC: AS21-7173; 11/22/2021)A. Stomach, biopsy     - Normal oxyntic mucosa     - No H. pylori organisms are identified by H&E examinationB. Small bowel, biopsy     - Normal duodenal mucosaC. Large bowel, descending colon mass, biopsy     - Ulcerated invasive adenocarcinoma     Consult material received from Anderson Hospital, Maryville, IL (OSC: AS21-7988; 12/29/2021)A. Large bowel, sigmoid, left hemicolectomy     - Moderately differentiated colonic adenocarcinoma invading the visceral peritoneum (pT4a)- Tumor arises in the sigmoid colon and measures 6.0 cm in greatest dimension, per report- Surgical margins are negative for tumor- Negative for perineural or lymphovascular invasion     - Metastatic adenocarcinoma in one of twenty-three lymph nodes(1/23; pN1a)Consult material received from Anderson Hospital, Maryville, IL (OSC: AS24-3099; 05/29/2024)A. Small bowel, terminal ileum ulcerated lesion, biopsy     - Invasive adenocarcinoma, moderately-differentiated     - Intact nuclear expression of mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6) by immunostains  Consult material received from Anderson Hospital, Maryville, IL (OSC: AS24-3810; 07/01/2024)A. Large bowel, right colon and ileum, right hemicolectomy     - Moderately differentiated adenocarcinoma involving the perienteric soft tissue, muscularis propria, submucosa, and mucosa (see comment)     - No precursor lesion identified in the ileal mucosa     - Per report, deep/radial margin positive for tumor     - Distal and proximal margins negative for tumor     - Positive for perineural invasion     - Negative for definitive lymphovascular invasion     - Five tumor deposits identified     - Metastatic adenocarcinoma in four of fourteen lymph nodes (4/14)     - Normal appendixkxb/8/22/2024 16:28 By this signature, I attest that the above diagnosis is based upon my personal examination of the slides(and/or other material indicated in the diagnosis). Kathleen Byrnes, MDReport Electronically Reviewed and Signed Out By Kathleen Byrnes, MD 8/22/2024 16:28:26Microscopic Description and

Comment:OSC: AS21-7988Per report the tumor is negative for KRAS, NRAS, and BRAF V600 mutations. Per report, the tumor is microsatellite stable.OSC: AS24-3810There is no precursor lesion or adenoma identified in the background ileum. The bulk of the tumor appears to arise in the perienteric soft tissue. The tumor is morphologically similar to a colorectal primary, including the previous colonic primary (OSCAS21-7988). These findings could represent a new ileal primary. However, there is concern that this could represent a new metastasis or spread from the prior colonic primary, which was previously a pT4a and had penetrated the serosa. Clinical correlationwith imaging, intraoperative, and molecular findings could be helpful in assessing for this possibility.If this represents a new primary, the stage would be pT3N2b.This case was reviewed in consultation with Dr. Sam Ballentine and he concurs with the diagnosis.Larry Ha, M.D.

History:The patient is a 49-year-old man with history of malignant neoplasm of sigmoid colon.Materials Received:Received for review are twelve slides labeled AS21-7173, thirteen slides labeled AS21-7988, six slides labeled AS24-3099, and twenty-one slides labeled AS24-3810, accompanied by a corresponding pathology report. The material originates from AndersonHospital, Maryville, IL.Selected slide(s) may be digitally scanned for our files, and all materials are returned to the referring institution, along with a copy of our final report.Any testing required for diagnostic purposes was performed in the Department of Pathology and Immunology at Washington University Medical School, 660 South Euclid Ave, St. Louis, MO 63110 CLIA # 26D2013203The performance characteristics of the testing cited in this report (if any) were determined by the  Washington University Department of Pathology and Immunology AMP Core Labs, as part of an ongoing quality assurance program and in compliance withfederally mandated regulations drawn from the Clinical Laboratory Improvement Act of 1988 (CLIA ‘88).  Some of these tests rely on the use of “analyte specific reagents” (ASR) and are subject to specific labeling requirements by the US Food and DrugAdministration.  Such diagnostic tests may only be performed in a facility that is certified by the Department of Health and Human Services as a high complexity laboratory under CLIA ‘88.  The FDA has determined that such clearance or approval is notnecessary.  ASRs should not be regarded as investigational or for research.  ASRs were developed and the performance characteristics determined by the AMP Core Labs, Washington University Department of Pathology and Immunology.  It has not been cleared orapproved by the U.S. Food and Drug Administration.  Any test designated as LDT was developed and its performance characteristics determined by AMP Core Labs. It has not been cleared or approved by the FDA. This test is used for clinical purposes andshould not be regarded as investigational or for research.Report images and/or scanned reports, if included, only viewable in PDF version of report.Authorizing ProviderResult TypeResult StatusBenjamin Tan MDLAB PATHOLOGY ORDERABLESFinal ResultPerforming OrganizationAddressCity/State/ZIP CodePhone NumberWASHINGTON UNIVERSITY PATHOLOGY LAB3710 Floor West Building1 Barnes Hospital PlazaSt Louis, MO 63110314-362-5757