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Things may not always be as they appear

I've always considered the t(11;14) translocation as the defining marker for Mantle Cell Lymphoma (MCL). If that translocation presents itself, there is a very high probability you have MCL, but the more I read, the less I am convinced of that argument being so set in stone.

Why can't my diagnosis of atypical MCL just as easily be an atypical variant of Splenic Marginal Zone Lyphoma (SMZL)? Sure, I have the t(11;14) translocation, but when all the other factors are considered, I believe I'm a more likely fit for atypical SMZL.

From Lymphomation.org
Splenic Marginal Zone Lymphoma is an indolent (slow growing) b-cell lymphoma. It typically presents with an enlarged spleen (splenomegaly). "Splenic lymphomas present with a massive splenomegaly (enlarged spleen) sometimes with mesenteric lymph nodes or hepatic involvement, but without peripheral lymph nodes; bone marrow and blood are often involved."

With the exception of mesenteric lymph nodes, and hepatic involvement (both of which only occur sometimes), and excluding evidence of the t(11;14) translocation, I fit that description perfectly.

Not that any of this will change how I approach my lymphoma, nor will it influence my treatment decisions. It is interesting none the less, and what I consider a teachable moment.

There are few no absolutes in life! Different conclusions can be drawn from the same facts. We see it in politics, I've experienced it all my life working as a metallurgist, and it is certainly true in medicine.

Like metallurgy and politics, medicine is not an exact science, and we must never lose sight of that.

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Comments

Alan said…
There are absolutes. Don't forget death & taxes
11:41 PM
Marc said…
A technicality. Or semantics might be a better term.

Death is inevitable, as are taxes, but are better described as approximations or "givens".

There is no way to determine in advance when someone is going to die, nor exactly how much in taxes you may have to pay. There are too many variables which can effect the final outcomes.
12:10 AM
Alan said…
The "taxes" aspect of that quotation of course is facetious, but while no one can predict when somebody is going to die (except may by execution) it is an absolute that everyone will die. (unless I'm missing something).
12:42 AM
Marc said…
That's why I said it's really semantics.

Absolutes are like the earth is round, the surface is flat, the line is straight, etc. They're not really, but they're close approximations.

Some things are givens, like death or givens in a mathematical equation. They can be changed and altered, so by definition, not absolute.

Just my opinion!
12:53 AM
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