Hi wondering if someone could give me some info. Here is my background
Plasmacytoma approx 4.8cm x 2.8cmx2.3cm in S1. Confirmed by both biopsy and mri.
Had 20 50gray radiation treatments (on whole sacrum) 5 additional "boost" (focusing on tumour area only). Ended Aut 23/12 I also have a manll persistent IgG 4g/L
Pain in back and leg has become worse after treatment. It's been 2 months since treatment ended.
A bone marrow aspiration/biopsy sample was taken Oct 10/12.
Material Recieved Bone Marrow: left iliac crest: LT ILLIAC CREST BX
Bone Marrow
Aspiration Speciment: could not be obtained
Touch Preparation: Normal appearing granulopoiesis and erythropoiesis. Occasional plasma cells are seen.
BIOPSY: The speciment is 1.5 cm in length. Cellularity is significantly reduced being only about 10% with a few areas of 20%. Magakaryocytes are present although reduced. Clusters of granulocytic cells and isolated erythroblastic islands are present. There is no increase of lymphocyes or plasma cells and no focal aggregations are apparent. There is no increase of fibrous tissue.
DIAGNOSIS:
Hypoplastic marrow with no increase of plasma cells
COMMENT: Hypoplasia is likely secondary to radiation therapy. A CD138 stain to exclude any small aggreagation of plasma cell will be reported as an addendum.
My question is the fact that the sample is apparently affected (Hypoplastic) by the radiation possibly tainting the plasma cell count?
The Oncologist now tells me I don't have Myeloma, is this correct?
Please help, I want to be relieved but something won't allow me!
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Ger - Name: Ger
- Who do you know with myeloma?: Myself Multiple myeloma
- When were you/they diagnosed?: July 16, 2012
- Age at diagnosis: 43
Re: Bone Marrow Biopsy Confusion
Dear Ger,
It sounds like you have been treated as if this was a solitary plasmacytoma. In order to make this diagnosis, and exclude myeloma. there should only be 1 plasmacytoma in the body with no other bony lesions seen; no increase in plasma cells in the bone marrow; and no other end organ damage attributable to myeloma (eg kidney failure, anemia, high calcium). Many patients continue to have a measurable M-protein after completing radiation -- this is due to the long half-life of immunoglobulins and often goes away after several months. Your bone marrow biopsy is unfortunately difficult to interpret because it was done after the radiation, so you are correct that the plasma cell count in this area may not be truly representative of the rest of the body.
One test that might help is a PET/CT scan. If this is negative for any other bone lesions, then it provides reassurance that there isn't active disease at this time, and that you can just be followed expectantly, even if the bone marrow biopsy isn't completely conclusive.
This is something you could discuss with your oncologist.
Hope this helps.
Best regards,
Adam Cohen
It sounds like you have been treated as if this was a solitary plasmacytoma. In order to make this diagnosis, and exclude myeloma. there should only be 1 plasmacytoma in the body with no other bony lesions seen; no increase in plasma cells in the bone marrow; and no other end organ damage attributable to myeloma (eg kidney failure, anemia, high calcium). Many patients continue to have a measurable M-protein after completing radiation -- this is due to the long half-life of immunoglobulins and often goes away after several months. Your bone marrow biopsy is unfortunately difficult to interpret because it was done after the radiation, so you are correct that the plasma cell count in this area may not be truly representative of the rest of the body.
One test that might help is a PET/CT scan. If this is negative for any other bone lesions, then it provides reassurance that there isn't active disease at this time, and that you can just be followed expectantly, even if the bone marrow biopsy isn't completely conclusive.
This is something you could discuss with your oncologist.
Hope this helps.
Best regards,
Adam Cohen
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Dr. Adam Cohen - Name: Adam D. Cohen, M.D.
Beacon Medical Advisor
Re: Bone Marrow Biopsy Confusion
My hematologist assures me that if there had been a high count of plasma cells in the bone marrow prior to the radiation that this would still show even though the area has clearly been affected by the radiation. ie the low 10%-20% cellualarity.
A recent MRI showed what had appeared to the radiologist an increase in size of the lesion in S1 by approx 2 cm as well as a small 4mm lesion in S3 that was not there previous. He had thought the disease had progressed.
My radiation oncologist believes the 2 cm difference could be the visual difference that radiation causes. As for the 4mm due to the fact the whole sacrum had been "hammered" with radiation, he does not feel it would be a new one, but perhaps a small one that had not been visual to them on the previous MRI however is now visible due to the effects radiation had on it.
Does this make sense? And if there is a small second one, does this become a case of multiple myeloma (2 lesions) or because it was also in the sacrum (1 at S1 and 1 at S3) is this still considered a solitary plasmacytoma? My blood work is still only a small M protien of 4g/l and other wise normal except for some slightly low white counts.
A recent MRI showed what had appeared to the radiologist an increase in size of the lesion in S1 by approx 2 cm as well as a small 4mm lesion in S3 that was not there previous. He had thought the disease had progressed.
My radiation oncologist believes the 2 cm difference could be the visual difference that radiation causes. As for the 4mm due to the fact the whole sacrum had been "hammered" with radiation, he does not feel it would be a new one, but perhaps a small one that had not been visual to them on the previous MRI however is now visible due to the effects radiation had on it.
Does this make sense? And if there is a small second one, does this become a case of multiple myeloma (2 lesions) or because it was also in the sacrum (1 at S1 and 1 at S3) is this still considered a solitary plasmacytoma? My blood work is still only a small M protien of 4g/l and other wise normal except for some slightly low white counts.
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Ger - Name: Ger
- Who do you know with myeloma?: Myself Multiple myeloma
- When were you/they diagnosed?: July 16, 2012
- Age at diagnosis: 43
3 posts
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