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Back Pain. MRI Of Spine Done. Diffuse Marrow Signal Abnormality Found. Chances Of Cancer?
Question:
ADMIT DIAGNOSIS: LOW BACK PN/SACRAL ILLIACMRI SPINE LUMBAR W/O CONTRAST
ORDER REASON: BACK PAIN
URGENT UNEXPECTED FINDING
HISTORY: BACK PAIN
TECHNIQUE: MRI LUMBAR SPINE PROTOCOL WITHOUT I/V CONTRAST
COMPARISON: NONE
FINDINGS:
THERE IS DIFFUSE MARROW SIGNAL ABNORMALITY THROUGHOUT THE LOWER THORACIC AND UPPER LUMBAR SPINE TO THE LEVEL OF L4 WITH LARGELY CELLULAR MARROW AND VERY LITTLE FATTY MARROW WHICH IS ATYPICAL FOR AGE. WITHIN L4 L5 AND SACRUM THERE IS ESSENTIALLY FATTY REPLACEMENT IN A MORE UNIFORM PATTERN WHICH CAN BE SEEN FROM PRIOR RADIATION THERAPY, IN A RADIATION PORT. THERE IS MOTTLED ACTIVITY IN THE LUMBAR AND SACRAL SPINE AT THESE LEVELS. THE FINDINGS ARE CONCERNING FOR A CELLULAR MARROW REPLACEMENT PROCESS WITH BROAD DIFFERENTIAL INCLUDING MYELOMA, LYMPHOMA, LEUKEMIA AND OTHERNEOPLASMS
IN THE LOWER THORACIC LEVEL THERE IS SIMILAR REPLACEMENT PROCESS IN THE T12 RIBS BILATERALLY
THERE IS NORMAL ALIGNMENT
VERTEBRAL BODIES HEIGHT ARE NORMAL
THE INTERVETEBRAL BODIES DISCS ARE NORMAL
CONUS MEDULLARIS AND CAUDA EQUINA ARE NORMAL
THE SPINAL CANAL IS GROSSLY PATENT
L1-L2 NORMAL CANAL AND NEUROFORAMEN
L2-L3: NORMAL CANAL AND NEUROFORAMEN THERE IS MILD EDEMA ON THE ANTERIOR/INFERIOR ASPECT AT THE ENDPLATE WHICH MAY REPRESENT DISCOGENIC DEGENERATIVE CHANGE
L3-L4 : NORMAL CANAL AND NEUROFORAMEN
L4-L5: NORMAL CANAL AND NEUROFORAMEN THERE IS DEGENERATIVE FACET CHANGES BILATERALLY
L5-S1: NORMAL CANAL AND NEUROFORAMEN. DEGENERATIVE FACET CHANGES BILATEALLY WITH A SMALL SYNOVIAL CYST ON THE LEFT POSTERIOR ASPECT OF THE INFERIOR FACET
THE PARASPINAL SOFT TISSUES ARE GROSSLY UNREMARKABLE
IMPRESSION: ABNORMAL MARROW SIGNAL AS DESCRIBED ABOVE
MILD DEGENERATIVE CHANGES IN THE LOWER LUMBAR SPINE
LAST BLOOD WORK WAS
PSA 1.89
VIT. D 17 LOW
WBC 6.2
RBC 5.62.
HEMOGLOBIN 17 HEMATOCRIT 52.2
MCV 92.8 MCH 30.2 MCHC 32.6 RDW 14.5
PLATELET COUNT 0000
GRANULOCYTE 55
ALBUMIN 4.4 GLUCOSE 138
ALK. PHOSPOTASE 87 CREATININE 1.06 BUN 16 BILIBUBIN TOTAL 0.9
CALCIUM 8.8 TOTAL PROTIEN 6.0 AST/SGOT 32 ALT/SGPT 45
ABSOLUTE GRAN, LYMPH, MONO, EOS, AND BASO ALL WELL WITHIN RANGE
SODIUM , POTASSIUM, CHLORIDE AND CO2 ARE ALL NORMAL
NO ABNORMAL EXPOSURE TO RADIATION EXCEPT FOR ROUTINE X RAYS
BONE MARROW BIOPSY OF RIGHT ILLIAC CREST WAS ALL WITHIN NORMAL RANGE
ADMIT DIAGNOSIS: LOW BACK PN/SACRAL ILLIACMRI SPINE LUMBAR W/O CONTRAST
ORDER REASON: BACK PAIN
URGENT UNEXPECTED FINDING
HISTORY: BACK PAIN
TECHNIQUE: MRI LUMBAR SPINE PROTOCOL WITHOUT I/V CONTRAST
COMPARISON: NONE
FINDINGS:
THERE IS DIFFUSE MARROW SIGNAL ABNORMALITY THROUGHOUT THE LOWER THORACIC AND UPPER LUMBAR SPINE TO THE LEVEL OF L4 WITH LARGELY CELLULAR MARROW AND VERY LITTLE FATTY MARROW WHICH IS ATYPICAL FOR AGE. WITHIN L4 L5 AND SACRUM THERE IS ESSENTIALLY FATTY REPLACEMENT IN A MORE UNIFORM PATTERN WHICH CAN BE SEEN FROM PRIOR RADIATION THERAPY, IN A RADIATION PORT. THERE IS MOTTLED ACTIVITY IN THE LUMBAR AND SACRAL SPINE AT THESE LEVELS. THE FINDINGS ARE CONCERNING FOR A CELLULAR MARROW REPLACEMENT PROCESS WITH BROAD DIFFERENTIAL INCLUDING MYELOMA, LYMPHOMA, LEUKEMIA AND OTHERNEOPLASMS
IN THE LOWER THORACIC LEVEL THERE IS SIMILAR REPLACEMENT PROCESS IN THE T12 RIBS BILATERALLY
THERE IS NORMAL ALIGNMENT
VERTEBRAL BODIES HEIGHT ARE NORMAL
THE INTERVETEBRAL BODIES DISCS ARE NORMAL
CONUS MEDULLARIS AND CAUDA EQUINA ARE NORMAL
THE SPINAL CANAL IS GROSSLY PATENT
L1-L2 NORMAL CANAL AND NEUROFORAMEN
L2-L3: NORMAL CANAL AND NEUROFORAMEN THERE IS MILD EDEMA ON THE ANTERIOR/INFERIOR ASPECT AT THE ENDPLATE WHICH MAY REPRESENT DISCOGENIC DEGENERATIVE CHANGE
L3-L4 : NORMAL CANAL AND NEUROFORAMEN
L4-L5: NORMAL CANAL AND NEUROFORAMEN THERE IS DEGENERATIVE FACET CHANGES BILATERALLY
L5-S1: NORMAL CANAL AND NEUROFORAMEN. DEGENERATIVE FACET CHANGES BILATEALLY WITH A SMALL SYNOVIAL CYST ON THE LEFT POSTERIOR ASPECT OF THE INFERIOR FACET
THE PARASPINAL SOFT TISSUES ARE GROSSLY UNREMARKABLE
IMPRESSION: ABNORMAL MARROW SIGNAL AS DESCRIBED ABOVE
MILD DEGENERATIVE CHANGES IN THE LOWER LUMBAR SPINE
LAST BLOOD WORK WAS
PSA 1.89
VIT. D 17 LOW
WBC 6.2
RBC 5.62.
HEMOGLOBIN 17 HEMATOCRIT 52.2
MCV 92.8 MCH 30.2 MCHC 32.6 RDW 14.5
PLATELET COUNT 0000
GRANULOCYTE 55
ALBUMIN 4.4 GLUCOSE 138
ALK. PHOSPOTASE 87 CREATININE 1.06 BUN 16 BILIBUBIN TOTAL 0.9
CALCIUM 8.8 TOTAL PROTIEN 6.0 AST/SGOT 32 ALT/SGPT 45
ABSOLUTE GRAN, LYMPH, MONO, EOS, AND BASO ALL WELL WITHIN RANGE
SODIUM , POTASSIUM, CHLORIDE AND CO2 ARE ALL NORMAL
NO ABNORMAL EXPOSURE TO RADIATION EXCEPT FOR ROUTINE X RAYS
BONE MARROW BIOPSY OF RIGHT ILLIAC CREST WAS ALL WITHIN NORMAL RANGE
Hello and thank you for submitting your question.
Your question is a very good one and I will work on providing you with some good information and recommendations regarding what is going on.
From reviewing the imaging finding it appears that there is some abnormality which is noted in the bone marrow. Well this is concerning but it does not necessarily indicate some type of malignancy or leukemia.
There are two concerns at this point.
One concern would be that this represents something that we call multiple myeloma.
The other concern would be that this might represent some type of malignancy which has yet to be diagnosed.
At this point I suggest two things. The first suggestion would be to have one of the rib lesions biopsied. This would provide tissue to the pathologist for analysis. It would also help rule out malignancy.
The next suggestion is to have a plasma cell profile performed. This is a special blood test that evaluates for multiple myeloma.
Right now additional tests need to be done as I have outlined here in order to define the diagnosis.
Thanks again for the query. I hope you found my response to be helpful. If you have any additional concerns I would be happy to address them.
Sincerely,
Dr. Galamaga
Your question is a very good one and I will work on providing you with some good information and recommendations regarding what is going on.
From reviewing the imaging finding it appears that there is some abnormality which is noted in the bone marrow. Well this is concerning but it does not necessarily indicate some type of malignancy or leukemia.
There are two concerns at this point.
One concern would be that this represents something that we call multiple myeloma.
The other concern would be that this might represent some type of malignancy which has yet to be diagnosed.
At this point I suggest two things. The first suggestion would be to have one of the rib lesions biopsied. This would provide tissue to the pathologist for analysis. It would also help rule out malignancy.
The next suggestion is to have a plasma cell profile performed. This is a special blood test that evaluates for multiple myeloma.
Right now additional tests need to be done as I have outlined here in order to define the diagnosis.
Thanks again for the query. I hope you found my response to be helpful. If you have any additional concerns I would be happy to address them.
Sincerely,
Dr. Galamaga
Above answer was peer-reviewed by :
Dr. Yogesh D
THEY DID A SERUM PROTIEN ELECTROPHORISIS AND A BONE MARROW BIOPSY DO YOU THINK THIS COULD BE A CANCER THAT HAS SPREAD FROM SOMEWHERE THEY SAID IT SHOWED NO MYELOMA OR LYMPHOMA OR LEUKEMIA AM SUPPOSED TO GET ANOTHER BIOPSY OF THE ACTUAL SACRAL AREA OF THE BONE ITSELF
Hello again,
I really doubt this is myeloma. I am suspicious howeer of the rib findings on the imaging study. I would consider obtaining a tissue biopsy of the suspicious ribs noted on the scan to see if this will lend any further light on things.
In addition a PET scan could be considered which might help the doctors find an area which could be a source of all of this. Assuming the patient is male - has a PSA been requested?
Thanks again for the query and followup. Please let me know if you have any additional concerns or considerations.
Sincerely,
Dr. Galamaga
I really doubt this is myeloma. I am suspicious howeer of the rib findings on the imaging study. I would consider obtaining a tissue biopsy of the suspicious ribs noted on the scan to see if this will lend any further light on things.
In addition a PET scan could be considered which might help the doctors find an area which could be a source of all of this. Assuming the patient is male - has a PSA been requested?
Thanks again for the query and followup. Please let me know if you have any additional concerns or considerations.
Sincerely,
Dr. Galamaga
Above answer was peer-reviewed by :
Dr. Raju A.T
WELL MY PSA ON AUGUST 18TH WAS 1.89 LAST YEAR 1.30 PLEASE TELL WHAT COULD BE THE MAIN CONCERN WITH rIBS THIS HAS BEEN GOING ON FOR A FEW WEEKS NOW ALL MY LABS NORMAL FOR LAST 3 BLOOD TEST AND LAST CHEST XRAY BUT THAT WAS LAST JULY
I AM PRETTY CLOSE TO SUICIDAL MY LIFE HAS FALLEN APART IN 4 WEEKS. cOULD THERE BE A PROSTATE CANCER IN THESE LOW RANGES. THANK YOU DOC I REALLY MEAN THAT LAST QUESTION PROMIISE
I AM PRETTY CLOSE TO SUICIDAL MY LIFE HAS FALLEN APART IN 4 WEEKS. cOULD THERE BE A PROSTATE CANCER IN THESE LOW RANGES. THANK YOU DOC I REALLY MEAN THAT LAST QUESTION PROMIISE
Hello and thank you for the follow question.
I completely understand the frustration and anxiety you have regarding what you're dealing with.
Regarding your PSA it would be very unlikely that you would have some type of prostate cancer with a PSA in the normal range what you have indicated. The reason why I was concerned that the ribs were involved is that some cancers can spread to the ribs. The fact that your PSA is normal. Makes me much more comfortable about the fact that you do not have a prostate cancer.
I am not saying that you certainly have a malignancy at this point but I think all tools need to be used in order to rule that out and try to help the determine why the bone marrow signal appears abnormal. Certain malignancies can spread to the bone and I'm sure your doctors have this in mind in the process of their continued work up. At this time I would suggest a CT scan of the chest, abdomen and Palace in order to evaluate for any abnormalities. If all of this is normal then you may need to sit down with a hematologist to discuss why the signal is abnormal in the MRI.
Again try to maintain some degree of calm at this time. Your doctors are going to work and do their best to try to figure out what is going on and design a treatment plan for you if any treatment is indicated. Again remind yourself that there is no diagnosis of cancer at this time. You are otherwise healthy and need to support your general health with good nutrition and healthy exercise. Medication may also help with some of the anxiety you're having.
I thank you again for submitting your question. I hope you can't buy responses to be helpful. If you have any additional concerns. You're welcome to ask.
Sincerely,
Dr. Robert
I completely understand the frustration and anxiety you have regarding what you're dealing with.
Regarding your PSA it would be very unlikely that you would have some type of prostate cancer with a PSA in the normal range what you have indicated. The reason why I was concerned that the ribs were involved is that some cancers can spread to the ribs. The fact that your PSA is normal. Makes me much more comfortable about the fact that you do not have a prostate cancer.
I am not saying that you certainly have a malignancy at this point but I think all tools need to be used in order to rule that out and try to help the determine why the bone marrow signal appears abnormal. Certain malignancies can spread to the bone and I'm sure your doctors have this in mind in the process of their continued work up. At this time I would suggest a CT scan of the chest, abdomen and Palace in order to evaluate for any abnormalities. If all of this is normal then you may need to sit down with a hematologist to discuss why the signal is abnormal in the MRI.
Again try to maintain some degree of calm at this time. Your doctors are going to work and do their best to try to figure out what is going on and design a treatment plan for you if any treatment is indicated. Again remind yourself that there is no diagnosis of cancer at this time. You are otherwise healthy and need to support your general health with good nutrition and healthy exercise. Medication may also help with some of the anxiety you're having.
I thank you again for submitting your question. I hope you can't buy responses to be helpful. If you have any additional concerns. You're welcome to ask.
Sincerely,
Dr. Robert
Above answer was peer-reviewed by :
Dr. Raju A.T
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