Saturday, April 2, 2011

Recurrent CLL in the skin versus a bug bite

The second deeper analysis of my skin biopsy was read, some would say, grossly over read, as consistent with recurrence CLL. Seems like the biopsy was filled with dense infiltrates of slight small atypical lymphocytes. Cancerous B cells perhaps? The third step, now pending, is cytogenetics to look for the dreaded clonality of my B lymphocytes.

Sounds grim.

Before measuring myself for a coffin as the prognosis for leukemia cutis can be pretty bleak, I took a step back and had a friend, a very smart dermatopathologist review the report and he thinks is a classic arthropod bite, completely a benign process, and even shows what a good immune system I have in sending all those lymphocytes to the site of the insult. He is pissed off big time at the overreach of the rare and scary CLL skin diagnosis and the unwillingness to consider a far more common and obvious diagnosis, a bug bite.

Even the fear triggering doctors says it likely that the particular cells I recruit to fight off an insult to my skin simply reflect my particular CLL lymphocyte population. That there is no actual malignant tumor, no leukemia of the skin. Ho. Hum.

I don't buy even that. My absolute lymphocyte count is only 0.7, below normal, and I bet most of that is T cells after all the rituximab last year cleaned out my B cells. I bet my cytogenetics in the skin will also show T cells, no B clones.

If you closed your eyes on some of the turns and spins during this roller coaster ride and are now lost, let me summarize.

I believe this whole CLL in the skin thing is an over reaction, because everyone is so scared to miss a cancer on a doctor who already has cancer. You never get sued for over diagnosing. You just worry the patient and run up big bills.

And besides, my boo boo is healing up with bactroban ointment. Almost gone. Hardly cancer like behavior.

Forman isn't worried. I too refuse to worry about this one.

It wouldn't be CLL if there was agreement between any two of my doctors.

Bone marrow report next week. I can hardly wait.

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4 Comments:

Anonymous Anonymous said...

Just remember one thing my friend...you're the one who got it biopsied...imagine if you had just waited to see if it went away.

April 3, 2011 at 2:44 PM  
Anonymous Anonymous said...

If one accepts the notion that the CLL B-cells live longer than normal B-cells, the following plausibility argument can be made.
With a repair signal, all B-cells respond but only normal ones can do anything and then die. They are then replenished with the same population of B-cells (normal+CLL) so over time, the damaged site becomes enriched with CLL B-cells. With sufficient enrichment, the site could be blocked by the CLL B-cells impeding healing. This is thought to have happened in my case of pleural effusions which were not resolved with standard treatment by responded almost instantly to one cycle of Rituxan. You seem to have some evidence of CLL B-cells because of the slightly enlarged nodes so there must be some background population however small. The enrichment process, if true, would explain the observation of CLL cells in the biopsy. Remember that derm biopsies are basically qualitative and not quantitative so they are almost guaranteed to give a false positive suggestion. Regards, TomD

April 4, 2011 at 10:15 AM  
Anonymous Tom B said...

I thought I was going to have a spot of concern biopsied this last week. The Dermatologist insist it is just a mole, or whatever the medical term they used. I had it frozen off. It had started to bleed and feel funny. It is gone now. Now maybe my immune cells can focus on other more important things.

April 4, 2011 at 9:01 PM  
Anonymous Anonymous said...

Recent biopsy of skin lesion is said to be CLL in the skin. And maybe just a (over)reaction to bug bites (some of which resemble spider bites). Taking two bleach baths a week to reduce staph. Getting worn out from so much itching. Eruptions get red, and crusty, then resolve. And new ones show up anywhere about that time. Dee

August 3, 2015 at 5:25 PM  

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