[45Zebras]

Lytic lesions on skull x-ray, normal blood / urine tests

by 45Zebras on Tue Jun 21, 2016 12:13 pm

Hi all,

I know you all must hear the same questions from newbies all the time, so thanks in advance for any advice/answers you can give me. I am actually writing about my wife.

Recently, she had a series of skull x-rays for an unrelated issue, and the x-rays clearly showed several round lesions in different areas of her skull. They each seem to be about the size of a pea or pencil eraser. Maybe 6 to 10 in total. Their discovery led to blood and 24-hour urine tests to check for malignancy (multiple myeloma).

We were surprised to find that her blood/urine tests came back all in normal ranges. The doctors are suggesting we just check it again in a few months. We are, of course, happy about the results, but I'm still extremely worried, because those lesions were not there a year or so ago when she had an earlier x-ray.

I don't want to freak her out, because she was upset to the point of throwing up as we waited for her test results, and she is feeling good about the wait-and-see approach her doctors are suggesting. But no matter where I look online, I keep seeing only the connection between those lesions and multiple myeloma, but no other possible causes that fit the lesions + her test results.

Can anyone suggest other causes that I could research? Does this sound like smoldering multiple myeloma?

Thank you all for any help!

[kshornb]

Re: Lytic lesions on skull x-ray, normal blood / urine tests

by kshornb on Tue Jun 21, 2016 12:35 pm

Hi 45Zebras:

I am so sorry to hear that your wife had to go through this. It is very stressful, and I can certainly understand her anxiety. However, you said that her "blood" tests were normal. Did that include a serum free light chain ("Freelite") assay test? She may be what is known as a nonsecretor, like I am (no protein abnormalities), so any myeloma she may have may not show up in a 24-hour urine test or a typical CBC. However, many of us nonsecretors do have bone lesions, I have extensive lesions.

I am in no way trying to diagnose your wife, but if they did not do a light chain assay, you may want to request one - just to be sure.

Best of luck to you both.

KSH

[Multibilly]

Re: Lytic lesions on skull x-ray, normal blood / urine tests

by Multibilly on Tue Jun 21, 2016 5:49 pm

45Zebras,

Sorry to hear that you wife is going through all this.

I second that a serum free light chain assay would be a good idea if she hasn't already had that test performed. But also keep in mind that a serum free light chain assay won't catch non­se­cre­tory multiple myeloma of the non-producer type, where the patient has neither an M-spike nor an abnormal serum free light chain level. With truly non-producing multiple myeloma patients, one must detect and track the disease via a bone marrow biopsy.

I might therefore suggest making an appointment with a multiple myeloma specialist to go over her test results and to have his/her radiologist go over the x-rays for a second opinion. I might also consider getting a PET/CT to see if the lytic lesions are malignant. If you let us know what city you live in, folks on the forum can recommend some myeloma specialists to seek out.

Lastly, note that if your wife has lytic lesions due to myeloma, she would not be considered to be smoldering since smoldering multiple myeloma implies that one has no organ damage such as lytic lesions. She would instead be diagnosed with symptomatic multiple myeloma if her bone marrow biopsy came out positive for multiple myeloma and her lesions were found to be due to multiple myeloma.

[45Zebras]

Re: Lytic lesions on skull x-ray, normal blood / urine tests

by 45Zebras on Tue Jun 21, 2016 9:41 pm

Thank you, kshornb and Multibilly. You've given me some things to look into.

I don't know if a serum free light chain assay was part of her testing. I also had never heard of non­se­cre­tory multiple myeloma. So, I have some reading to do and some things to talk over with her.

I appreciate the information very much, and I wish the best for you and everyone here.

Cheers