A Case of Uterine Cervical Cancer Presenting with Granulocytosis

Abstract

Granulocytosis occurs in 40% of patients with lung and gastrointestinal cancers, 20% of patients with breast cancer, 30% of patients with brain tumor and ovarian cancer and 10% of patients with renal cell carcinoma. Granulocytosis occurs because of production of G-CSF, GM-CSF and IL-6. Uterine cervical carcinoma with granulocytosis as a paraneoplastic syndrome, however, has been rarely reported. We recently witnessed a case of invasive squamous cell carcinoma of the uterine cervix with granulocytosis. Leukocytosis developed up to 69,000/µL, and then normalized after chemo-radiotherapy. There was no evidence of infection, tumor necrosis, glucocorticoid administration, or myeloproliferative disease by examination of a bone marrow aspirate when granulocytosis appeared. This phenomenon was probably associated with the secretion of hematopoietic growth factors such as G-CSF, GM-CSF and IL-6 by the tumor. We suggest that, like some other solid tumors, cervical cancer can present with granulocytosis as a paraneoplastic syndrome.

Pretreatment plasma levels and diagnostic utility of hematopoietic cytokines in cervical cancer or cervical intraepithelial neoplasia patients

“…Comparable levels of these three cytokines (but without statistical significance), were observed in the study of Punnonen et al [23], although a different type of research material was used and the tested group of cervical cancer patients was much smaller (n = 23). Significant data for G-CSF has also been observed in www.fhc.viamedica.pl the studies of other authors who additionally confirmed auto -and/or paracrine growth stimulation of tumor cells by this cytokine in different histological types of cervical cancer: carcinosarcoma [24], small-cell [14] and squamous cell [11][12][13] carcinoma. The tissue expression of high levels of G-CSF by tumor cells or elevated levels of G-CSF in patient serum samples have been found to be associated with an aggressive malignant nature of the tumor and poor patient outcomes [12,14].…”

“…Elevated levels of HGFs have also been demonstrated in the sera of patients with malignancies of the reproductive organ, e.g. increased levels of M-CSF in ovarian [21] or endometrial [22], and G-CSF in cervical [11,13] cancer patients.…”

“…The blockade of M-CSFR resulted in the inhibition of tumor growth and the intensification of the apoptosis processes in cancer cells [9,10]. The production of G-CSF and GM-CSF has been demonstrated in a number of nonhematologic malignancies including tumors of the cervix [11][12][13]. Tissue expression of high levels of G-CSF by tumor cells, or elevated levels of G-CSF in patient serum samples, have been found to be associated with an aggressive malignant nature of the tumor and poor patient outcomes [14].…”

Paraneoplastic Syndromes: An Approach to Diagnosis and Treatment

“…Paraneoplastic granulocytosis is associated with lung cancer (particularly large cell lung cancer), 161 as well as gastrointestinal, brain, breast, renal, and gynecologic cancers. 147 The mechanism is poorly understood. Some solid tumors have been shown to produce substances with colony-stimulating activity.…”

“…[137][138][139][140] The clinical features, associated malignancies, diagnostic studies, and treatment of paraneoplastic hematologic syndromes are listed in Table 4. 137,138,[140][141][142][143][144][145][146][147][148][149][150][151][152][153][154][155][156] eoSInopHIlIa Paraneoplastic eosinophilia represents a subset of secondary eosinophilia that appears due to tumor production of the eosinophil growth factors interleukin (IL)-3, IL-5, and GM-CSF. 137,157 By contrast, primary eosinophilia, a separate diagnosis encountered in hematology-oncology practices, often represents a clonal phenomenon caused directly by a hematologic neoplastic process.…”