Monday, November 22, 2010

Update-FOGMACHINES is now AC

Forget all the other letters in the Mnemonic word FOGMACHINES. There are two left according to a new radioiligist describing the Skeletal survey. Bombarded with a hundred zillion x rays of just about every single bone,

There was a different opinion from that of the original reporting radiologist.
This one felt that the Lytic lesion is actually a single solitary expansile lesion. Expansile lesions are not the same animal as the lytic type. The Greek word for Lytic actually means "to separate" or break down, as in destroy.
Expansile has a less scary meaning compared to lytic. Both could be bad, especially in the presence of this much pain...More important, the radiologist describes a lesion which is non agressive in appearance, in other words a well defined sclerotic border, instead of the more scary ill defined squiggly lines of a cancerous bone tumor.

The two letter which are left are

Aneurysmal bone cyst

and

Enchondroma

Where we go from here, nobody knows. The only thing we do know is... OW.
.

Wednesday, November 10, 2010

Let's Get Mnemonic

When you see lytic bone lesion think of FOGMACHINE.

Differential Diagnosis (Mnemonic = FOGMACHINES)
F = Fibrous Dysplasia
O = Osteoblastoma
G = Giant Cell Tumour
M = Metastasis / Myeloma
A = Aneurysmal Bone Cyst
C = Chondroblastoma
H = Hyperparathyroidism(brown tumours)/ Hemangioma
I = Infection
N = Non-ossifying Fibroma
E = Eosinophilic Granuloma / Enchondroma
S = Solitary Bone Cyst

11 choices, spin that wheel, where it stops, you'll still get the bill!

Friday, November 5, 2010

Full x-ray inventory of the skeleton and a rib biopsy

Next up: there will be full x-ray inventory of the skeleton and a rib biopsy.

The plot thickens. There is a suspicious lesion on the liver. There is a suspicious hideous looking lytic lesion on the left anterolateral seventh rib, which feels like a hot nail being driven in to the hilt. This rivals the notorious bone chip in the jaw bone, hunting season 2002, after a deep root cleaning by the worlds most nazi-like dentist ( who shall remain nameless). It is certain that the hygenist broke the rim of the molar and the fragment stayed down in there between the jaw and the gums until it worked it's way out of the bottom of the gumline a month later, after many dreams about being Steve Buscemi in "Fargo"...

"They froozhen shot me!!"
Now the recurring dream is of Wade Gustafson, saying to Carl Showalter "No money, no Jean!"..."No money, no Jean!"...and then he shot Carl Showalter (Steve Bucemi) in the face after Carl shoots him in the left anterolateral seventh rib....

Solitary plasmacytoma

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation.

This tumor has a median patient age of approximately 10 years younger than multiple myeloma.

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

Complete Information on this Tumor

Introduction and Definition:

Solitary plasmacytoma is a large solitary focus of plasma cell proliferation. This tumor is extremely rare and is found in the proximal femur, vertebral bodies, and pelvis in order of descending frequency. Solitary plasmacytoma occurs 70% of the time as an osseous lesion, and the rest of the cases are non-osseous lesions usually found in the upper respiratory tract. Approximately 70% of the patients with solitary plasmacytoma develop multiple myeloma.

Incidence and Demographics:

This tumor has a median patient age of approximately 10 years younger than multiple myeloma, and affects men more than women.

Symptoms and Presentation:

Pain is the most common symptom. However, if the myeloma occurs in the spine, it will usually present with fast developing paraplegia and gibbous deformity due to the vertebral collapse.

X-Ray Appearance and Advanced Imaging Findings:

Radiologically, solitary plasmacytoma appears identical to multiple myeloma.

Differential Diagnosis:

Most authors agree on a strict diagnostic criteria for solitary plasmacytoma. There may be no other radiological identifiable lesions, and bone marrow at another site must have no abnormal plasma cells. There may be no serum abnormalities and no Bence-Jones proteins in the urine. Some authors believe that the diagnosis can only be made if no other lesion is found for a period greater than 1 year.

Preferred Biopsy Technique for this Tumor:

Bone marrow biopsy

Histopathology findings:

Microscopically, solitary plasmacytoma appears as well to poorly differentiated sheets of plasma cells. These cells produce the same osteoclast stimulating factors found in multiple myeloma.

Treatment Options for this Tumor:

Treatment of solitary plasmacytoma includes radiation or en-bloc surgical resection. If abnormal serum or urine findings are present then the patient must be treated as if they have multiple myeloma with chemotherapy and bone marrow transplant 2.

Outcomes of Treatment and Prognosis:

Patients with solitary plasmacytoma have a better prognosis than patients with multiple myeloma, but 70% of solitary plasmacytoma patients develop multiple myeloma, and usually die within 5 years.

Graduation Day

LINAC U

You'd think that 25 radiation treatments wouldn't amount to much of anything. It doesn't sound like a lot.

...25 trips to the hospital. We were wrong. We started the week before Thanksgiving after a month long delay because of a bad bad flu like cold I developed. They wanted a commitment, with as few absences as possible, so we waited. The coughing up blood and fevers subsided, then we started, and got our groove. I say WE because Notbillybob's wife, Sharon drove most days. I was just along for the ride. Well, after 10 treatments, the tiredness set in. Especially for her. Like a new part time job. Notbillybob feeling like a roast ham most days. Kind of like a sun burn inside your guts. He made a big mistake in eating jalapenos one night. Ooh, the burn. So, they asked the doc if the stomach was getting radiation. They said "lets pull up your treatment plan... Yes, see here, inside this red line. The treatment plan showed that it was. The innermost red line is the most radiation, the outer one is the least. The green one is in the middle. A good part of the stomach is even inside the blue line.

The pain was accounted for. They told us that they were also concerned with his platelet count. It was going down again. Down to 37! (Low is 150) It has since stabilized at 40. The thing is that the white cells, red cells, hematocrit are all low. Way low. Bilirubin is elevated. INR is elevated. Not billybob began wearing a mask to treatments. Don't need cooties at a time like this.

Then the really cold weather set in. I know, I know- it doesn't really cause colds and "death of pneumonia" like our moms used to say, but when you have cancer of the immune cells, and then your white cell count goes in the toilet as well...

Notbillybob is going to stay a hermit for the foreseeable future.

But SMILE!

New Years eve was treatment number 25. Graduation day! Graduation from LINAC U!

(LINAC is a Linear Accelerator, an IMRT radiation therapy machine)