TITLE:
Paraneoplastic Leukemoid Reaction in a Patient with Urothelial Carcinoma: A Case Report
AUTHORS:
Aleksi E. Suo, Tahir Abbas
KEYWORDS:
Urothelial Carcinoma, Paraneoplastic, Leukemoid Reaction
JOURNAL NAME:
Case Reports in Clinical Medicine,
Vol.3 No.5,
May
12,
2014
ABSTRACT:
Introduction: Leukemoid
reactions in cancer are rare and associated with a poor prognosis. The
mechanism driving paraneoplastic leukemoid reactions appears to be
gain-of-function granulocyte-colony stimulating factor (G-CSF) secretion by
tumour cells. Case Presentation: A 57-year-old male smoker presented with a
one-year history of painless frank hematuria and three kilograms weight loss.
Cystoscopy revealed a high-grade urothelial carcinoma with sarcomatoid
differentiation. The patient was treated by radical cystoprostatectomy,
bilateral pelvic lymph node dissection and formation of an ileal conduit. In
the absence of bone marrow infiltrations, recurrence of the urothelial
carcinoma three months later was associated with a paraneoplastic leukemoid reaction with a white blood cell count peaking at 82.62 × 109/l. Unfortunately, his condition continued to
deteriorate and he died shortly thereafter. Conclusion: Monitoring of white
blood cell counts in paraneoplastic leukemoid reactions can be a useful
indicator of response of the malignancy to chemotherapy or radiotherapy and an
indication of relapse after treatment. Paraneoplastic leukemoid reactions are
caused by G-CSF secretion by tumour cells and are associated with a poor
prognosis. Whether G-CSF signaling plays a role in the aggressive nature of
these cancers is currently unknown.