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Medical Forum / Diseases and Disorders / Cancer / June 2004

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What is "lymphoma in bone"?

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Robin - 23 Jun 2004 09:06 GMT
My brother is two years out from stem cell transplant, initial diagnosis
Stage 4, aggressive non-hodgkins lymphoma.  Over the last 3-4 mos., he's
had cat scan, bone marrow biopsy, both of which had clean results,  and
bloodwork once a month (there's been a pattern of high red cell count,
then low).  He's been receiving epogen shots over the last few months
because of frequent colds and flu.  

He also has peripheral neuropathy was increased in duration and severity
and since approx 4 mos ago, its every night, and during day, he calls it
excruciating pain.  Neurontin did not help.  I have purchased him every
gel and cream available, and recently a foot spa and shiatsu massager
which helps somewhat but very temporarily.  He is usually using both
several times a day.

He's also been getting fevers.  His oncologist ordered a Pet scan;
results a higher index is showing which looks "suspicious".  If my
brother had another diagnosis, it might be due to that but since
lymphoma is his only (known) diagnsis, the doctor suspects a recurrence.  
He will be ordering a cat scan and needle biopsy over the next couple of
weeks.

He mentioned something about some indication of a different kind of
lymphoma in the bone.  This is what I'm writing to ask - what is
lymphoma in the bone?  In doing online research, leukemia is often
mentioned.  Is that what lymphoma in the bone is?  I've been doing
searches on symptoms of bone lymphoma but only come up with general
early symtoms of lymphoma.  Search results also include "....if lymphoma
in bone is primary diagnosis, then...".   What would "primary diagnosis"
mean?  That this is first diagnosis of any cancer, or the only one
active?

If any of you had/have bone lymphoma, did you have symptoms of burning
in bottoms of feet (ball of foot)?  Deep ache in lower legs?  leg
cramps? Jaw and/or hand cramps?  And pain in side of torso when turn to
that direction?  These are all the symptoms he's been having lately,
along with fever.  

would appreciate any feedback.

Robin

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J - 23 Jun 2004 11:22 GMT
> <snipped>
>
[quoted text clipped - 15 lines]
>
> <snip>

Hi Robin,

http://www.worldortho.com/database/etext/lymphoma_of_bone.html
Malignant lymphoma of bone is morphologically similar to the lymph node
counterparts ie Non Hodgkins or Hodgkins (rare). When malignant lymphoma is
responsible for a bone lesion it may be -

1. A primary osseous lesion with no distant disease.
2. Multiple skeletal sites but no involvement of any soft tissue.
3. A bone lesion with involvement of other soft tissue sites eg spleen,
liver, lymph nodes.

Primary osseous lymphoma is rare - 3% of bone tumours. In clinical cases of
lymphoma, involvement of the bone is unusual but at autopsy 20% show bone
involvement.

http://www.lymphomainfo.net/nhl/types/bone.html
Primary Lymphoma of Bone
 Lymphomas can arise from most any lymphatic tissue (lymph nodes, spleen,
thymus, mucosa associated lymphoid tissue (MALT)).   It is hard to believe
but the bones are an important part of the lymphatic process: the "B" in
white b-cell is for cell maturation in the bone marrow.
Lymphomas (Nonhodgkin's mostly, rarely Hodgkin's lymphoma) can start in the
bone.  These lymphomas are all quite rare, 3% of bone tumors.  The lymphoma
can be an aggressive one or an indolent form.  These are not to be confused
with lymphomas that have spread to the bone from other areas.

Lymphoma of bone strikes more men than women (4:3 ratio).   They can occur
at all ages but is rare in pediatric (childhood) patients.  20% of cases are
adults in their 60s.

Symptoms
The main symptom is localized pain which has been present for months if not
years.  The area of the primary tumor may be tender or swell.   Fever and
weight loss do not occur."
Robin - 23 Jun 2004 18:34 GMT
> > <snipped>
> >
[quoted text clipped - 41 lines]
> bone.  These lymphomas are all quite rare, 3% of bone tumors.  The lymphoma
> can be an aggressive one or an indolent form.

These are not to be confused
> with lymphomas that have spread to the bone from other areas.

Regarding the sentence above - my brother has been in remission since
stem cell transplant for 2 yrs. If he does have it in the bone now, does
that mean its considered "primary" or that the lymphoma has spread to
the bone from lymph nodes?  BTW, thank you so much for researching this.

(You may have read my other posts about sister-in-law with recent breast
cancer diagnosis, asking if lumpectomy and mastectomy are painful.  This
is my brother's wife).  Both have brain disorders.  I wonder what its
like to live a charmed existence, or perhaps that's just a myth.
Robin

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J - 23 Jun 2004 22:43 GMT
> > http://www.lymphomainfo.net/nhl/types/bone.html
> > Primary Lymphoma of Bone
[quoted text clipped - 13 lines]
> that mean its considered "primary" or that the lymphoma has spread to
> the bone from lymph nodes?  BTW, thank you so much for researching this.

Thanks Robin, As Steph said lymphoma can occur anywhere in the body.
If you read the above (further up), the B-cells are in the bone marrow, bone
marrow is part of the lymph system, so it seems to be true that it spreads through
the lymph system. So I would think since he was declared NED, if he does have it,
it would be considered a recurrence, but I'm not an expert.  And it's very
confusing right now, because part or all of it could be neuropathy but perhaps
something else is going on there.

When I was looking up muscle cramps, one web site mentioned lactic acid. I know
lactic dehydrogenase LDH is involved in lymphoma somehow or one of the tests.
(but I don't know if there's a connection between one and the other).
I was going to suggest one of those sports drinks that resets the electrolytes,
but I think that should be checked with his doctor first.
I sure hope they find a way to help him feel better soon and get some answers for
you all. I'll be thinking of you.

> (You may have read my other posts about sister-in-law with recent breast
> cancer diagnosis, asking if lumpectomy and mastectomy are painful.  This
> is my brother's wife).  Both have brain disorders.  I wonder what its
> like to live a charmed existence, or perhaps that's just a myth.

Well, I think it's a myth, because when we "dig deeper" with people, we find out
that many people have troubles (money, health, kids, jobs etc). However, it's a
shame that so many health troubles are in your family.
They're very fortunate to have you looking out for them and inquiring on
newsgroups about their health issues.
But you take care of you too. ok?
Hugs
J
Robin - 24 Jun 2004 05:24 GMT
> > > http://www.lymphomainfo.net/nhl/types/bone.html
> > > Primary Lymphoma of Bone
[quoted text clipped - 56 lines]
> Hugs
> J

Hi J,
Thank you so much.  It's interesting that you mentioned it could be
neuropathy, because that's what I'm thinking.  He just had a bone marrow
biopsy about 1 month ago, all was ok.  But his neuropathy has gotten
progressively worse.  His oncologist feels 50/50 chance its lymphoma
recurrence.  He also told my brother that, if recurrence, because he's 2
years past stem cell transplant, that he can be treated with medication
and perhaps chemo.  If there had been a recurrence shortly after stem
cell transplant, he wouldn't have been able to receive the treatments he
would if it happens now. Again thanks.  Will keep everyone posted.
Robin

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J - 24 Jun 2004 08:31 GMT
> <snip>
> Hi J,
[quoted text clipped - 3 lines]
> progressively worse.  His oncologist feels 50/50 chance its lymphoma
> recurrence.

Well what's it going to take to know? More tests or time and then more tests?
Somethings got to be done about his neuropathy. Poor guy, he sounds like he's in
quite a bit of discomfort.
Maybe somebody (one of his doctors) has to review his meds and see what they can do
with that.
Or maybe palliative care (hospice) could have a look at his file and his meds and
make some practical suggestions?

> He also told my brother that, if recurrence, because he's 2
> years past stem cell transplant, that he can be treated with medication
> and perhaps chemo.

Well, that's good news to hear Robin.

> If there had been a recurrence shortly after stem
> cell transplant, he wouldn't have been able to receive the treatments he
> would if it happens now. Again thanks.  Will keep everyone posted.

Okay, thanks, will watch for your update,
J
Robin - 24 Jun 2004 18:27 GMT
> > <snip>
> > Hi J,
[quoted text clipped - 5 lines]
>
> Well what's it going to take to know?

Cat scan and Biopsy scheduled over the next two weeks.

> Somethings got to be done about his neuropathy.

Yes.  That's why his oncologist ordered the Pet scan, at least that's
what he told my brother to not alarm him (he has a brain disorder and
scares easily).  His oncologist told me a couple of months ago that
something's "fishy", meaning monthly blood test results, my brother's
various symptoms of frequent colds/flu/fever.  That's why he had bone
marrow biopsy a month ago, came out clean.  Could that biopsy have
missed something that is now showing up in Pet scan? His doctor said
that because my brother was tolerating the biopsy well, he got in there
real good to get a good sample.   That's why I'm thinking (and hoping,
of course) that this is neuropathy, or some other condition yet
undiagnosed rather than recurrence.

Poor guy, he sounds like he's
> in
> quite a bit of discomfort.
> Maybe somebody (one of his doctors) has to review his meds and see what they
> can do
> with that.

He's not on any meds related to cancer/red or white cells.  Most are
related to brain disorder and anxiety, blood pressure and cholesterol.  
The only new med and/or change took place 4-5 mos ago switching from
Lexapro (antidepressent/anxiety) to Effexor.

> Or maybe palliative care (hospice) could have a look at his file and his meds
> and
> make some practical suggestions?

That's an idea.

Robin

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Steph - 24 Jun 2004 02:21 GMT
> > > <snipped>
> > >
[quoted text clipped - 49 lines]
> that mean its considered "primary" or that the lymphoma has spread to
> the bone from lymph nodes?  BTW, thank you so much for researching this.

Almost certainly this is recurrent, rather than new.

> (You may have read my other posts about sister-in-law with recent breast
> cancer diagnosis, asking if lumpectomy and mastectomy are painful.  This
> is my brother's wife).  Both have brain disorders.  I wonder what its
> like to live a charmed existence, or perhaps that's just a myth.
> Robin
J - 24 Jun 2004 08:08 GMT
> "Robin" <robinxjoy@yahoo.com> wrote in message
> > <snip>
[quoted text clipped - 10 lines]
>
> Almost certainly this is recurrent, rather than new.

Thanks Steph,
I can see your message. Not sure if Robin can or not.
J
Robin - 24 Jun 2004 18:27 GMT
> > "Robin" <robinxjoy@yahoo.com> wrote in message
> > > <snip>
[quoted text clipped - 14 lines]
> I can see your message. Not sure if Robin can or not.
> J

I saw it.
Robin

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J - 23 Jun 2004 11:41 GMT
> My brother is two years out from stem cell transplant, initial diagnosis
> Stage 4, aggressive non-hodgkins lymphoma.  Over the last 3-4 mos., he's
[quoted text clipped - 32 lines]
> that direction?  These are all the symptoms he's been having lately,
> along with fever.

It's hard to know what is going on there, Robin.
We'll watch for your updates and hope it isn't a recurrence.
Hugs
J
Steph - 23 Jun 2004 16:22 GMT
> My brother is two years out from stem cell transplant, initial diagnosis
> Stage 4, aggressive non-hodgkins lymphoma.  Over the last 3-4 mos., he's
[quoted text clipped - 36 lines]
>
> Robin

Lymphoma can set up shop anywhere. Lymphoma in bones is not uncommon in
aggressive NHL. It isn't leukaemia.
 
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