Paraneoplastic leukemoid reaction: Case report and review of the literature

Abukhiran, Ibrahim; Mott, Sarah L.; Bellizzi, Andrew M.; Boukhar, Sarag

doi:10.1016/j.prp.2020.153295

Cited by 10 publications

(13 citation statements)

References 85 publications

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“…Paraneoplastic leukocytosis occurs through production of cytokines such as granulocyte colony-stimulating factor (G-CSF) more commonly, and granulocyte-macrophage colony-stimulating factor, interleukins (ILs) 1α (osteoclast-activating factor), 3, and 6, and tumor necrosis factor (TNF)-α less commonly [ 11 ]. G-CSF, produced by immature or poorly differentiated cells, stimulates bone marrow production of granulocytes [ 11 ]. TNF-α can stimulate IL-6, G-CSF, and Parathyroid hormone-related protein (PTHrP) production [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Leukocytosis is inversely related to survival, with leukemoid reactions (> 40 × 10 9 /L) and hyperleucocytosis (> 100 × 10 9 /L) having worse prognosis. This may be because G-CSF promotes angiogenesis, invasiveness, an immunosuppressive shield around the cancer, and is produced more aggressively by metastatic foci [ 11 ]. Persistent leukocytosis post-therapy implies recurrence, poor survival, or residual tumor [ 6 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Hypercalcemia–leukocytosis syndrome from non-schistosomiasis-associated squamous cell carcinoma of the urinary bladder: a case report and review of the literature

et al. 2023

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Background Non-schistosomiasis-associated squamous cell carcinoma of the urinary bladder is less common in the Western world. Limited information on its possible paraneoplastic syndromes exists. Leukocytosis tends to commonly be regarded by clinicians as an indication of sepsis, rather than a feature of paraneoplasia, potential surrogate marker for recurrence, and prognostic marker. Accompanying hypercalcemia may be missed entirely. Case presentation A 66-year-old Caucasian man presented with visible painless hematuria and symptomatic hypercalcemia. Investigations revealed a squamous cell carcinoma of the urinary bladder with marked leukocytosis. Hypercalcemia and leukocytosis resolved following radical cystectomy, recurred with nodal recurrence and regressed with radiotherapeutic control. Subsequently, serum leukocyte and calcium assays were included in his follow-up protocol. His survival was 20 months by the time of the report. Conclusion This report highlights hypercalcemia–leukocytosis syndrome as a paraneoplastic manifestation of non-schistosomiasis-associated squamous cell carcinoma to reemphasize the need for clinicians to assay for calcium in the presence of leukocytosis in such patients. Prompt identification and control of the paraneoplastic derangements, with treatment of the cancer recurrence it may connote, is advocated to provide a chance for better long-term outcomes in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hypercalcemia–leukocytosis syndrome from non-schistosomiasis-associated squamous cell carcinoma of the urinary bladder: a case report and review of the literature

et al. 2023

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“…Instead, it seems crucial to demonstrate the production of G-CSF and/or IL-6 by these tumors. However, it should be noted that, whereas in some of the above-reported cases the authors use the term PLR for WBC values of approximately 30,000/μL, the definition of PLR as per literature is deemed to be a WBC count of above 40,000/μL [ 32 , 65 ]. Hence, leukocytosis with high NLR alone related to the progression of the neoplastic disease may not be a determining prognostic factor, as we have recently clearly demonstrated in ovarian cancer.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, 76% of patients who had PLR, if associated with G-CSF production, died within 6 months of presentation [ 29 , 65 ]. Hence, the above hypothesis logically explains the aggressive behavior of these tumors and their poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Pathogenic and Prognostic Roles of Paraneoplastic Leukocytosis in Cervical Cancer: Can Genomic-Based Targeted Therapies Have a Role? A Literature Review and an Emblematic Case Report

et al. 2022

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Tumor-associated leukocytosis has been associated with poor prognosis in cervical cancer. Leukemoid reaction (i.e., white blood cell count > 40,000/μL) is defined paraneoplastic (PLR) when it occurs in the presence of a cytokine-secreting tumor (CST) without neoplastic bone marrow infiltration. Cervical cancers displaying PLR represent a peculiar entity characterized by a rapidly progressive behavior typically associated with chemo-radioresistance. The present paper aims to review the literature about the pathogenetic mechanisms of PLR and its prognostic role in cervical cancer. Moreover, it reports the emblematic case of a patient with an advanced cervical cancer associated with PLR that was chemotherapy resistant. The patient underwent a palliative cytoreductive surgery of high complexity, obtaining a temporary regression of PLR. The tumor sample stained positive for G-CSF and IL-6, thus indicating a CST. Notably, the tumor genomic analysis revealed a PI3CKA mutation. Therefore, at the instrumental evidence of a rapidly progressive disease relapse, which was accompanied by reappearance of PLR, we started a targeted treatment with a selective PIK3 inhibitor alpesilib combined with the JAK1-2 inhibitor ruxolitinib. We achieved a relief of symptoms and leukocytosis; however, severe side effects necessitated the treatment suspension. In conclusion, as therapeutic strategies for cancer with PLR are scarcely reported in literature, our study could contribute to expand our understanding of the topic and provide a basis for further research.

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“…A haemorrhagia miatt végzett sürgős opus másnapjára a leukocytaszám drasztikus, 75%-os csökkenését, 1 nappal később további 50%-os redukció-ját tapasztalták. A paraneoplasiás leukaemoid reakcióval járó daganatok agresszív mivoltát erősíti meg, hogy a beteg 4 hónappal a tumorreszekciót követően elhunyt [9]. Az eset kapcsán szakirodalmi kutatást végeztek a solid tumor asszociálta leukaemoid reakciók 1977 és 2020 közötti előfordulásáról.…”

Section: Esetismertetésunclassified

Malignus solid tumorhoz társuló hypereosinophil szindróma

Lontai

Angyal

Folhoffer

et al. 2022

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A hypereosinophil szindróma tartós eosinophil-túltermeléssel járó, a következményes eosinophilinfiltráció és mediátorfelszabadulás miatt többszervi károsodást okozó kórkép. Etiológia szerint megkülönböztetünk myeloproliferativ eredetű, parazitafertőzéshez, solid tumorhoz és T-sejtes lymphomához társuló, valamint idiopathiás formát. Esetismertetésünkben a 49 éves férfit fogyás, alszári oedema, tachycardia miatt vettük fel osztályunkra. Laborjából jelentősen emelkedett epeúti obstrukciós paraméterek, valamint extrém leukocytosis, eosinophilia volt kiemelhető. Hematológiai malignus betegség erős gyanújával kezdtük vizsgálni. Az elvégzett mellkasi, hasi és kismedencei CT hepatosplenomegaliát, multiplex intrahepaticus laesiókat és egy bizonytalan solitaer cystosus képletet írt le a pancreas farki részében, kóros nyirokcsomókkal és pleuralis folyadékgyülemmel. A leírt CT-kép a klinikum ismeretében elsősorban krónikus myeloid leukaemia manifesztációjának volt megfeleltethető, de a diagnózist a perifériás kenet, az áramlási citometria, a csontvelő-biopszia és a genetikai vizsgálat sem igazolta. Mindezek fényében solid tumorhoz társuló leukaemoid reakció irányába folytattuk a kivizsgálást, a májlaesiók pontos verifikálása érdekében vastagtű-biopszia történt. A szövettani eredmény pancreatobiliaris carcinoma áttétének megfeleltethető, alacsonyan differenciált hámtumor infiltrációját mutatta. A diagnózis felállításának másnapján kezelésünk ellenére a beteg exitált. A gastrointestinalis solid tumorokhoz kapcsolódó hypereosinophil szindróma rendkívül ritka kórkép. Tudomásunk szerint ez a magyar orvosi irodalomban közölt első ilyen eset, mely felhívja a figyelmet a magas fehérvérsejtszám és eosinophilarány differenciáldiagnosztikai kérdéseire, valamint arra, hogy nem korreláló hematológiai leletek esetén nem késlekedhetünk a solid eltérések szövettani mintavételével. Orv Hetil. 2022; 163(44): 1758–1762.

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Paraneoplastic leukemoid reaction: Case report and review of the literature

Cited by 10 publications

References 85 publications

Hypercalcemia–leukocytosis syndrome from non-schistosomiasis-associated squamous cell carcinoma of the urinary bladder: a case report and review of the literature

Hypercalcemia–leukocytosis syndrome from non-schistosomiasis-associated squamous cell carcinoma of the urinary bladder: a case report and review of the literature

Pathogenic and Prognostic Roles of Paraneoplastic Leukocytosis in Cervical Cancer: Can Genomic-Based Targeted Therapies Have a Role? A Literature Review and an Emblematic Case Report

Malignus solid tumorhoz társuló hypereosinophil szindróma

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