Small Cysts and Blood Test Implications in Oncology

Issues related to small cysts and blood tests?

Hello Dr.
Chen,
In the summer of 2018, I noticed a soft lump near my throat and visited an ENT specialist several times.
The doctor diagnosed it as something resembling a large pimple and prescribed antibiotics to see if it would go away.
I later went to a large hospital for an ultrasound, which confirmed that it was very superficial, and eventually, it disappeared on its own.
However, the doctor did note a slightly deeper lesion, but did not recommend any further tests, suggesting that I could return in six months to a year for a follow-up.
The ultrasound report indicated a lesion measuring 1L 0.95 cm and 2L 0.47 cm.

After that, I returned to Japan for my studies and did not come back until August of last year for military service, so I did not have a follow-up appointment.
However, during a health check at a family medicine clinic, my white blood cell count showed Lymphocytes at 54.6 and ALT at 45.
Consequently, I returned for a follow-up on February 14 of this year, mainly due to concerns about my liver function.
The second test showed Lymphocytes at 33.5, which was normal, but Mono was slightly elevated at 13.0.
My white blood cell count had decreased from 4.69 to 3.31.
The doctor mentioned that I might have a mild cold or inflammation, and advised me to return for blood tests before August.
While organizing my drawer, I came across the previous ultrasound images and realized I had not followed up on the cyst issue, even though the doctor had indicated it was likely benign.
I would like to ask you two questions:
First, can a tumor affect white blood cell abnormalities? I completely forgot about this issue when I visited the family medicine clinic, and I currently do not feel any pain or discomfort; in fact, I cannot even feel the lump as it was previously noticeable near the surface.
My weight has not suddenly dropped.

Second, is the size of the lesion considered large? Although the doctor seemed to indicate there was no significant problem at that time, I recently connected my blood test results to this issue and am concerned it might be something serious, even though the doctor two years ago said it did not seem likely.
I had intended to return for a follow-up appointment but got busy and forgot about it.
Now, my family is advising me to wait until the pandemic situation improves before going to a large hospital.

I plan to discuss the blood test results and show the ultrasound images to my family medicine doctor during my next appointment to determine if further ultrasound examination is necessary.
However, I am still a bit worried, so I wanted to seek your opinion as an oncologist.
I apologize for the lengthy description, and thank you for your time!

Ch, 20~29 year old female. Ask Date: 2020/04/07

Dr. Chen Sirong reply Oncology

Ch, 24 years old, female.
First, would a general tumor affect white blood cell abnormalities? A: Not significantly related.
Second, is this size considered large? A: 0.95 cm requires monitoring.
If it increases in size, closer follow-up is necessary.
However, if you do not notice any significant changes, it would be appropriate to wait until after the pandemic to have another ultrasound in 1-2 years.
Thank you for your inquiry.
Taoyuan Hospital, Dr.
Chen Sih-Rong.

Reply Date: 2020/04/07

More Info

Dear Patient,
Thank you for your detailed inquiry regarding your health concerns, particularly about the small cysts and the implications of your blood test results. I understand that navigating these medical issues can be quite stressful, and I appreciate your patience as we delve into your questions.

Understanding Cysts and Their Implications
Firstly, regarding the cysts you mentioned, it is important to note that many cysts, especially those that are superficial and soft to the touch, are often benign. The ultrasound findings you described, with one cyst measuring approximately 0.95 cm and another at 0.47 cm, suggest that these are relatively small. In general, cysts of this size, particularly if they are asymptomatic (not causing pain or discomfort), are often monitored rather than treated immediately.
The fact that your ENT doctor did not recommend further immediate action after the ultrasound is a positive sign, indicating that they likely assessed the cysts as non-threatening. However, it is always prudent to follow up on any findings, especially if there are changes in your health or if you develop new symptoms.

Blood Test Results and Their Connection to Cysts
Now, regarding your blood test results, particularly the lymphocyte count and the elevated monocyte levels, it is essential to understand that various factors can influence these values. Lymphocytes are a type of white blood cell involved in the immune response, and their levels can fluctuate due to infections, stress, or inflammation. An elevated monocyte count can also indicate an ongoing inflammatory process or infection.

To address your first question: Generally, benign cysts do not directly affect white blood cell counts. However, if there were an infection or inflammation associated with the cyst, it could potentially lead to changes in your blood work. Since you mentioned that you had a slight cold or inflammation, this could explain the variations in your lymphocyte and monocyte counts.

Size and Monitoring of Cysts
As for your second question regarding the size of the cysts, while 0.95 cm is not considered large in the context of cysts, the significance of size can vary depending on the type of cyst and its location. In many cases, cysts that are less than 1 cm and asymptomatic are monitored rather than surgically removed. Your plan to discuss these findings with your family medicine doctor during your next visit is a wise approach. They can help determine if further imaging, such as another ultrasound, is necessary based on your current symptoms and health status.

Recommendations Moving Forward
Given your concerns, here are a few recommendations:
1. Follow-Up Appointment: Schedule a follow-up appointment with your family medicine doctor to discuss your previous ultrasound results and blood test findings. Bring the ultrasound images and any notes from your previous visits.

2. Monitor Symptoms: Keep track of any new symptoms, such as pain, changes in weight, or other unusual signs. If you notice anything concerning, do not hesitate to seek medical attention sooner.

3. Stress Management: Since you mentioned experiencing stress, consider incorporating stress management techniques into your routine, such as mindfulness, exercise, or talking to a mental health professional. Stress can impact overall health and may contribute to physical symptoms.

4. Stay Informed: Educate yourself about cysts and their management. Understanding your condition can help alleviate anxiety and empower you to make informed decisions about your health.

In conclusion, while your concerns are valid, the current evidence suggests that the cysts are likely benign, and the variations in your blood tests may be related to transient factors such as infection or inflammation. Regular monitoring and open communication with your healthcare providers will be key in managing your health moving forward.
Wishing you the best in your health journey, and please feel free to reach out with any further questions or concerns.

Best regards.

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