Esophageal adenocarcinoma with leukemoid reaction: a case report
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(2019) 14:66
CASE REPORT
Open Access
Esophageal adenocarcinoma with leukemoid reaction: a case report Ge Yu, Huaijun Ji* , Chuizheng Meng, Yixuan Huang, Guogang Gao, Chuanping Liu, Shanlei Wang, Lei Zhang and Jin Ju*
Abstract Background: Leukemoid reaction (LR) is defined as a reactive leucocytosis with WBC counts exceeding 50,000/ mm3, and a significant increase in early neutrophil precursors. LR may be a paraneoplastic manifestation of various malignant tumors. Tumor-related LR is a kind of neoplastic syndrome, unrelated to an infection or other diseases. Case presentation: A 74-year-old male visited a local doctor with a 20-day history of progressive dysphagia. The complete blood count revealed leucocytosis. Bone marrow aspirates and a biopsy confirmed LR and excluded chronic myelogenous leukemia. Following radical esophagectomy for an adenocarcinoma the WBC counts successively decreased to 10,450/mm3 and 8670/mm3 within 1 week and 1 month, respectively. Conclusion: We report a rare case of esophageal adenocarcinoma complicated with excessive leucocytosis caused by paraneoplastic LR; we also present a review of literature and an investigation of the clinical features. To our knowledge, this is the first report of LR associated with esophageal adenocarcinoma. Keywords: Leukemoid reaction (LR), Hyperleukocytosis, Esophageal adenocarcinoma, Esophagectomy
Background A leukemoid reaction (LR) is defined as white blood cell (WBC) count exceeding 50,000/mm3, owing to extramedullary causes [1]. LR is most often caused by serious infection [2], but can also be a paraneoplastic manifestation of several cancers, including lung, gastrointestinal, genitourinary, ovarian, and head and neck cancers, and hepatocellular carcinoma [3]. Hughes and Charles first reported a case of LR resulting from a carcinoma of the suprarenal gland in 1952 [4]. Since then, great efforts have been made to elucidate the mechanism of LR. Paraneoplastic syndromes, such as tumour fever and LR, have been described in literature [5, 6]. However, studies on the incidence and course of LR in solid tumours are scarce [7]. One study reported that the occurrence of LR in solid tumours is approximately 1–4% [8]. However, owing to few accounts in medical literature, the causes of this occurrence are not well understood. Here, we report a rare case of esophageal adenocarcinoma complicated with
* Correspondence: [email protected]; [email protected] Department of Thoracic Surgery, Weihai Municipal Hospital, 70 Heping Road, Weihai 264200, Shandong, China
hyperleukocytosis caused by a paraneoplastic leukemoid reaction (PLR).
Case presentation A 74-year-old male visited a local doctor in May 2018 due to a 20-day history of progressive dysphagia. He had no other symptoms suggestive of esophageal cancer. Electronic gastroscopy showed an elevated tumour in the lower segment of his esophagus, which revealed an esophageal adenocarcinoma on biopsy. The complete blood count revealed a total leucocyte count of 24,870/ mm3 and the peripheral blood smear showed differ
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