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WBC count went from 12 to 14 to 16. Noticed angiokeratomas on scrotum. Psa 16. Used over the counter hydrocortisone. Suggest?

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Hello, I want to ask about angiokeratomas on my scrotum.

My health is very good overall. I work out, good weight. At my last three physicals (over the last three years), my wbc count went from 12 to 14 to 16. All other blood was normal (other than the white counts within the wbc). I was taking a lot of fish oil 4,000 mg a day (I think 500 is the proper dose). I noticed that the wbc may be a result of some type of virus, or possibly arthritis, so I examined my body and noticed angiokeratomas on my scrotum (not big and perhaps 10 to 15, black), and one on the end of my penis. I have used over the counter hydrocortisone on them, and they seem to respond. I have noticed them for then last few years, about the same length of time as my use of fish oil --- maybe 3 or 4 years.
I had a bought of high around 5 or 6 psa about 10 years ago, but it is now controlled by Avodart and my psa is at 1.6, and my prostate has shrunken. So I'm not sure what all of this means.
Posted Tue, 24 Sep 2013 in Hypertension and Heart Disease
Answered by Dr. Jorge Brenes-Salazar 3 hours later
Brief Answer:
Isolated leukocytosis?

Detailed Answer:
Dear Mr XXXXX,

Thanks for your health concerns. There are many causes of elevated WBC: infections, stress, administration of steroids or other medications, hematologic malignancies, etc, but usually they carry out additional symptoms that may prompt a directed workup... which does not seem to be your case. There is an entity, called, isolated leukocytosis which is a diagnosis of exclusion. Now, another cause of elevated white count could be related to increases in specific white cells, such as eosinophils, as a result of an allergy, asthma, ecczema or a parasitic infection. I would recommend the following:

1) Determine if the differential (groups of WBC) is normal or if there is a predominance of one cell group
2) Obtain a peripheral smear to ensure that the shape or morphology of the WBC's is normal
3) The more we look at the use of pharmacologic fish oil, the less encouraging results for cardiovascular health. Nowadays, I recommend my patients to eat plenty of healthy fish and drop the capsules.

Yours truly,

Dr Brenes-Salazar MD
Mayo Clinic MN
Above answer was peer-reviewed by
Follow-up: WBC count went from 12 to 14 to 16. Noticed angiokeratomas on scrotum. Psa 16. Used over the counter hydrocortisone. Suggest? 52 minutes later
Thanks. I had my blood taken about a month ago. My blood was as follows:
WBC- 16.3
Neutrophyls (abs)-3.1
Immature granulocytes 0
Immature granulocytes (abs) 0

Again, I'm not sure what this means. I feel great (except for getting old). The only other relevant factor I can think of is that about 7 years ago I took a statin that caused a reaction and got off of it. I take niacin (1 mg a day) and take Cholestoff (phytostatin) to keep my cholesterol down. It's 122 bad and 55 good. (Total, I recollect is 199).

Does this give any more clues? Thanks. M
Answered by Dr. Jorge Brenes-Salazar 23 minutes later
Brief Answer:
WBC differential is normal

Detailed Answer:

I have reviewed the results of the WBC differential and it appears normal; usually a remote reaction to a statin would not give you leukocytosis. Your cholesterol numbers are good if you are a non-smoker. I don't think the cutaneous lesions could be related, but... if the use of topical steroids is excessive or prolonged, there can be a small amount of systemic absorption that can elevate WBC levels. For completion, the only other test that I would as your doctor is for a peripheral smear to make sure that all white cells have normal shape.

Yours truly,

Dr Brenes-Salazar MD
Mayo Clinic MN
Above answer was peer-reviewed by
Follow-up: WBC count went from 12 to 14 to 16. Noticed angiokeratomas on scrotum. Psa 16. Used over the counter hydrocortisone. Suggest? 10 minutes later
Dr. Brenes-Salazar --- thanks very much for this. Finally, does it appear, or would you guess at this point, that some sort of cancer is involved? Although my earlier prostate issues were negative after two separate biopsies, and my thyroglossal cyst was negative, I now am trying to relieve both myself and my wife that cancer is remote at this point. Getting old is a journey into hypochondria, I'm afraid. I'll be having another blood test in about a week and I'll ask about the peripheral smear. By the way, I've never been a smoker --- former college athlete and have stayed in shape most of my life. I do notice that I'm sensitive to all drugs --- including NSAIDs, aspirin, and that I tend to feel the effects very quickly.
Answered by Dr. Jorge Brenes-Salazar 1 hour later
Brief Answer:
in the differential but less likely

Detailed Answer:

thanks for the updated information. I agree that getting chronologically enriched generates in some of us a fear of losing control over disease, and I have learned from my eldest happiest patients to live one day at a time, at its fullest. As I mentioned, hematologic malignancies can present will elevated wbc and a paucity of symptoms particularly cll, but it would be lower in my differential in your case; however, that would be the intention of the peripheral smear.

yours truly
Above answer was peer-reviewed by
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