Epic Patient API MCP Server

SPRINGFIELD CYTOLOGY LABORATORY Fluid Cytology Report Patient: Robert Chen MRN: MRN003 Date of Procedure: November 22, 2024 Date of Report: November 25, 2024 Specimen: Peritoneal fluid (ascites) CLINICAL HISTORY: 56-year-old male with metastatic colorectal cancer on chemotherapy. New-onset ascites identified on recent CT imaging. Diagnostic paracentesis performed. GROSS DESCRIPTION: Received 500 mL of straw-colored, slightly turbid peritoneal fluid in sterile container. Fluid processed for cytological examination and cell block preparation. MICROSCOPIC DESCRIPTION: Cytospin preparations and cell block sections show numerous three-dimensional clusters and sheets of malignant epithelial cells in a background of mesothelial cells, lymphocytes, and macrophages. The malignant cells display: - Enlarged hyperchromatic nuclei with irregular nuclear contours - Prominent nucleoli - Increased nuclear to cytoplasmic ratio - Moderate eosinophilic cytoplasm - Occasional glandular/acinar formation Background shows reactive mesothelial cells with no evidence of atypia. No microorganisms identified on Gram stain. IMMUNOHISTOCHEMISTRY (Cell Block): CK20: Positive (diffuse) CDX2: Positive CK7: Negative Calretinin: Negative in malignant cells (positive in mesothelial cells) CEA: Positive The immunophenotype is consistent with colonic/lower GI tract origin. DIAGNOSIS: PERITONEAL FLUID, PARACENTESIS: - POSITIVE FOR MALIGNANT CELLS - CONSISTENT WITH METASTATIC ADENOCARCINOMA - MORPHOLOGY AND IMMUNOPROFILE COMPATIBLE WITH COLORECTAL PRIMARY COMMENT: The cytologic findings confirm malignant ascites in this patient with known metastatic colorectal carcinoma. The presence of tumor cells in peritoneal fluid indicates peritoneal involvement, though no discrete peritoneal masses were identified on recent CT imaging. This represents disease progression. Clinical correlation is recommended regarding adjustment of systemic therapy. FLUID ANALYSIS (sent to Chemistry): Total Protein: 3.8 g/dL (elevated) LDH: 285 U/L (elevated) Serum-Ascites Albumin Gradient (SAAG): 0.8 g/dL (exudative) Cell Count: 1,850 WBC/μL (elevated) Findings consistent with malignant (exudative) ascites. Cytopathologist: Dr. Elizabeth Morgan, MD Board Certified Anatomic and Clinical Pathology Date Signed: November 25, 2024