Dr. Sadaf Mustafa
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
About one week ago, I felt a tender lump in the occipital area of my head. It is pea sized and movable. It hurt only when I touch. It has not got any worse. In fact, it is better and less tender unless I touch it. When I had an appointment with my doctor, I was asked to give a blood sample. I got the reports back and everything was normal except the CBC. The polymorphs were 82.4 (normal range is 36 to 78) and the lymphocytes were 9.7 (normal range is 12 to 48). WBC 9.21, HCT 12.3 and HGB 36.8. I do not have any fever, night sweats, weight loss, chills or fatigue. I work out every day. I am a 50 year old mother of four teenagers. Also, I work part time. I do not have any significant medical or surgical history. My last two CBCs were normal. As I was having perimenopausal irregular bleedings, my OB drew blood. Before two years, I had similar results (high polymorphs and low lymphocytes). When it was repeated after three months, they were normal. My scalp is a bit on and off itchy, but there is no rash or open areas. I am just concerned about the blood tests along with the occipital lump.
Hello,
Welcome to icliniq.com. The lump in your occipital region may be a small lipoma, but it would be best to have it examined by your doctor for a proper evaluation. As for the abnormalities on your blood work, it would be helpful if you could provide the absolute numbers rather than percentages. The percentage values can sometimes be falsely elevated when the total leukocyte count is within the normal range. In cases of lymphoma or leukemia, we typically see extremely high numbers that do not normalize periodically. By obtaining the absolute numbers, I would be able to better understand the situation and provide you with more accurate insights.
Patient's Query
Thank you doctor,
I am not sure what you mean by the absolute numbers. I am attaching the actual results. Thank you so much for your concern and the speed of getting back to me. Would a lipoma hurt? It is much smaller and less painful today.
Hello,
Welcome back to icliniq.com. Thank you for the kind compliments. I have calculated your absolute lymphocyte count to be 893 cells per microliter using the formula: % count x total WBC / 100. This count falls within the normal range of 800 to 2600 cells per microliter. Therefore, your lymphocyte count appears to be normal. As for your absolute neutrophil count, it is measured as 7.589 x 10^9 cells per liter. The normal range for neutrophils is typically between 1.5 and 7.5 x 10^9 cells per liter. Your count is slightly elevated, which could be due to various factors such as excessive exercise or a mild infection. However, since you have no band cells, it is less likely to be related to an infection. Regarding the lipoma, it is typically a benign growth that rarely causes pain unless it becomes infected or inflamed. If you are comfortable, could you please share a picture of yours for further evaluation?
Patient's Query
Thank you doctor,
Great news about the blood results. I am less concerned now knowing that most are normal. The lump is under the scalp just above the bone of the scalp, pretty much the occipital area. It is very small now and for sure unable to see from a photo. I have a picture of a small area on my scalp from earlier this week and then again from today. The red one was from earlier and the dried looking one was from today.
Hello,
Welcome back to icliniq.com. I really appreciate your kind compliments, and thank you for sharing the pictures (attachment removed to protect patient identity). Based on the images you provided, it appears that the lesion on the scalp could be the cause of the enlarged lymph node. It is promising to see that the lymph node has reduced in size as the scalp lesion has almost completely healed. From the visual assessment, it is evident that it is not a lipoma. Please let me know if there are any other concerns or if you would like further evaluation or guidance.
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Internal Medicine
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