[Taco Cat]

Bone lesion on arm: how likely is it to be malignant?

by Taco Cat on Mon May 14, 2018 11:22 pm

Hi everyone,

I just had the skeletal survey done and it has a concerning result. It detected a lesion in my right arm. See below from the report:

"There is a small well-defined ovoid lesion in the right radial shaft, which is nonspecific. No other focal bone lesions. Low bone mineral density. No fracture."

I am under good care and see the hematologist on Thursday, but I've read enough to know we can't yet tell if this thing is malignant or not and that more testing is required to determine that. So, it'll be at least a week at this point before I know the answer. Man, you gotta love this myeloma waiting game!

So, although I know no one can really answer the burning question of malignancy, what I wanted to pitch to the group is just how realistic is it to hope that the lesion turns out benign and that there only turns out to be one of them? Can anyone give me some hope because right now it's pretty dark.

My lab numbers are off and the IFE has come back lambda specific positive several times. The bone marrow biopsy showed 5% clonal plasma cells. The significant blood markers are:

IgA: 735 mg/dL
IgG: 1540 mg/dL
IgM: 102 mg/dL
M-Spike: none detected

sFLC:
Lambda FLC: 24.4 mg/dL
Kappa: 2.54 mg/dL
Kappa/Lambda Ratio: 0.1 (way too low I know)

Nothing else is out of range.

Age: 43 and otherwise healthy

I guess the other question is, if this lesion is not malignant, then what is driving my lambda light chain numbers so high? Is the 5% bone marrow plasma enough to cause the lambda light chains to be so high? Or, is something else lurking yet to be discovered?

Thanks in advance to everyone.

[Foundry738]

Re: Bone lesion on arm: how likely is it to be malignant?

by Foundry738 on Wed May 16, 2018 10:24 pm

Hello Taco Cat,

Regarding the scan, you didn't say if it was just a CT scan, or if it include a PET scan, which is often added when multiple myeloma is suspected. PET will show if the lesion is active because some lesions are not and may not be myeloma-related.

In any event, I believe it is the marrow cells that drive the blood numbers. Hope your doctor can clear this up for you on Thursday.

Best regards,

[Taco Cat]

Re: Bone lesion on arm: how likely is it to be malignant?

by Taco Cat on Thu May 17, 2018 5:19 pm

Thanks for the reply. It was the skeletal survey that picked up the bone lesion, and I think that's just x-ray.

I met with the doctor today and he ordered the PET scan but doesn't think it will show anything. He's just being cautious. That makes me feel a LOT better, but I won't be out of the woods until that comes back negative.

He thinks that my high IgA numbers and excess light chains are due to a chronic allergic response. So, the light chain numbers aren't troubling in this context. Specifically, there is no M-spike detected and with IgA numbers that high, the M-spike shouldn't be able to hide. Therefore, he thinks it is mostly polyclonal IgA activity driving the high light chains.

Nonetheless, it is confirmed that I have IgA lambda MGUS. I have a new "friend for life"!