Day +3817: Waiting for a new day…

”To wipe away the Uncertainty
That flows around me
Once again to stay
So many choices but so few answers
My time slips away while thinking too much…”

5/13/2021: I decided to get a spine biopsy instead of waiting for a repeat MRI or CT scan, thinking it would either provide us more immediate peace of mind with a benign result or confirm a malignancy that could be treated sooner rather than later. After a negative Covid test on April 24, I had the procedure under general anesthesia on April 27; confusing results trickled in 7-10 days later. Fortunately, my hematologist is readily available to answer questions via email. His comments are italicized.

Flow Cytometry: Mixed phenotype with no increase in blasts.
The specimen consists of a mixture of cell types. A limited panel is tested. Blasts with low density CD45 and low right angle scatter are not increased (1% of cells) but show partial loss of HLA-DR and CD38 and partial expression of CD56, but are otherwise difficult to distinguish from normal myeloblasts. There is a small population of phenotypically normal B cell precursors. The findings are non-specific. Clinical and morphologic correlation is necessary. “Can’t make much of it. Seems to be some cells that are not quite normal looking.”

Spine, Thoracic, T-9 (Core Needle Biopsy): Fragments of mature lamellar bone with fibrotic marrow containing abundant chronic inflammation. While there is no evidence of malignancy in this core biopsy, given the clinical suspicion and the radiologic findings, this tissue may not be representative. Clinical correlation is needed. “Looks benign but they are saying it may be a false negative. Get follow-up MRI in 2-3 months.”

Spine, Thoracic, T9 (Fine Needle Aspirate):
Fragments of bland spindled cells in a metachromatic (fibromyxoid) matrix in a background of bone marrow elements and blood. “Just benign cells seen in bony structures.”

So, once again we are left with uncertainty. I don’t regret getting the biopsy but wish the results had been less equivocal.

My otolaryngologist had already put orders in the Hopkins system for MRIs of spine and neck/head that I can schedule anytime. I plan on getting them toward the end of June before I see my transplant doc again. Until then, no news is good news.

xoxo,
Karen

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