Bone Marrow Lesion

[Rhythmauthor1]

I was diagnosed with CLL in 2016. Have been on Watch and wait for five years. My WBC is 55.0 and lymphocyte count is 88.0. I recently had an MRI on my shoulder due to about two months of shoulder pain. The MRI among other things showed Low T1 and High T2 signal with a possible bone marrow lesion measuring 7 cm - about 2 inches - my cll MD said this is common and not to worry but my Sports medicine doc said to get a second MRI with contrast which i just did. Waiting for results. Anyone know what a lesion may mean in terms of CLL? My Cll doc said it is often read as a lesion but it is not. Concurrently, I received a blood test showing Igg kappa with a slight restriction which “could be an artifact, specific immune response or monoclonal protein.” Could these be related? What is a monoclonal protein in relation to CLL? Four months ago my igg and iga were normal - 866 and 168 and igm was 25. Any ideas or thoughts on significance or what this all may mean would be appreciated. Robert

[LeoPa]

I have no answers but I noticed that your WBC and LYMABS is probably reversed. Lymphocytes are a subgroup of WBC.

[AussieNeil Administrator in reply to LeoPa]

Robert, I think you meant to write "My WBC is 55.0 and lymphocyte count is 88.0%". Jm954 may be able to answer your question about that reported lesion, but I would expect your CLL doctor would know more about this than your sports medicine doctor.

LeoPa, it's quite common for the white blood cell differential section of a Complete Blood Exam/Count to only include the absolute white blood cell count and just percentages for the different white blood cell types. If so, Robert's lymphocyte count would be 88% of 55.0 or an absolute lymphocyte count of 44.0

Neil

[Rhythmauthor1 in reply to AussieNeil]

Thank you as usual AussieNeal!

[Rhythmauthor1 in reply to AussieNeil]

In a follow up MRI with contrast found no lesion or mass, just red marrow- apparently this is normal!

[Jm954 Administrator]

CLL can be found anywhere in the body but it is relatively unusual to have a lesion such as you describe in a single location. Perhaps because MRIs are not done very often in CLL patients we don't really know the incidence.

The issue of the report of "Igg kappa with a slight restriction" is not uncommon in CLL, many patients have a small amount of monoclonal protein which is what this phrase is describing and is no cause for concern.

I would listen to your CLL doctor and ask him if he thinks it's worth doing a biopsy of the lesion (depends how easily accessible it is and the risk associated with the procedure). If not, and you are feeling well, then perhaps another MRI in 6-12 months to monitor it might be prudent.

Jackie

[Rhythmauthor1 in reply to Jm954]

Thank you Jackie! I appreciate your information.

[Rhythmauthor1 in reply to Jm954]

Hi Jackie, In a follow up MRI with contrast found no lesion or mass, just red marrow- apparently normal!

[Jm954 Administrator in reply to Rhythmauthor1]

Excellent news!

[Rhythmauthor1 in reply to Jm954]

Jackie, I just read the MRI report, it is saying no lesions and no mass (great news), but it says "findings most suspicious for red marrow at the proximal humeral diametaphysis." What does that mean?

[Jm954 Administrator in reply to Rhythmauthor1]

Ok, a bit of background as well as the explanation.

When you are a child almost all your bones contain red bone marrow to produce blood cells. As you age, this reduces until it's mostly your long bones, sternum, hips, spine and ribs. When you have leukaemia your red bone marrow space expands slightly, this is to compensate for the space taken up by the leukaemia cells. This leads to red bone marrow being detected in areas that it's not often seen in adults.

The humeral diametaphysis is the long bone in the arm as this picture shows. You'll need to open and expand the picture to see all of it.

It's nothing to worry about, just shows your body is responding appropriately to the challenge of your leukaemia.

Jackie

humeral diametaphysis

[Rhythmauthor1 in reply to Jm954]

Thank you Jackie!!

[Rhythmauthor1]

Thank you! Thank you! Thank you!