Wu Evan S, Srour Samer A
Department of Internal Medicine, Baylor College of Medicine, Houston, Texas.
Division of Hematology and Oncology, Baylor College of Medicine, Houston, Texas.
J Pancreat Cancer. 2017 Nov 1;3(1):84-86. doi: 10.1089/pancan.2017.0019. eCollection 2017.
Paraneoplastic hyperleukocytosis is a rare phenomenon observed in patients with adenocarcinomas and other malignancies. In this study, we present a case of paraneoplastic hyperleukocytosis in pancreatic adenocarcinoma secondary to excessive secretion of serum granulocyte colony-stimulating factor (G-CSF). We report a 71-year-old Caucasian male who presented to our hospital with hyperleukocytosis in the setting of locally advanced pancreatic adenocarcinoma. The patient was recently diagnosed 4 months before presentation and received abraxane/gemcitabine in addition to palliative radiation therapy for continued gastrointestinal bleeding. During routine laboratory assessment, the patient was found to have a white blood cell (WBC) count of 153 K/UL (75% neutrophils and 14% bands). Bone marrow biopsy and cytology were negative for neoplastic features. Serum G-CSF levels returned markedly elevated, supporting the diagnosis of paraneoplastic hyperleukocytosis. Interestingly, the WBC count decreased significantly following each of two cycles of chemotherapy, further suggesting a paraneoplastic etiology of hyperleukocytosis. The patient did not receive any growth factor support at any point before or during treatment. In conclusion, the presence of hyperleukocytosis in cancer should raise clinical suspicion of a paraneoplastic phenomenon when other possible causes have been excluded. Hyperleukocytosis in this setting may correlate with progression of disease and lessen with treatment.
副肿瘤性白细胞增多症是在腺癌和其他恶性肿瘤患者中观察到的一种罕见现象。在本研究中，我们报告了一例继发于血清粒细胞集落刺激因子（G-CSF）过度分泌的胰腺腺癌伴副肿瘤性白细胞增多症病例。我们报告了一名71岁的白种男性，因局部晚期胰腺腺癌出现白细胞增多症前来我院就诊。该患者在就诊前4个月被确诊，除接受姑息性放射治疗以治疗持续的胃肠道出血外，还接受了白蛋白结合型紫杉醇/吉西他滨治疗。在常规实验室评估中，发现该患者白细胞（WBC）计数为153 K/UL（75%为中性粒细胞，14%为杆状核细胞）。骨髓活检和细胞学检查未发现肿瘤特征。血清G-CSF水平显著升高，支持副肿瘤性白细胞增多症的诊断。有趣的是，在两个化疗周期中的每一个周期后，白细胞计数均显著下降，进一步提示白细胞增多症的副肿瘤病因。该患者在治疗前或治疗期间的任何时候均未接受任何生长因子支持。总之，当排除其他可能原因时，癌症患者出现白细胞增多症应引起对副肿瘤现象的临床怀疑。这种情况下的白细胞增多症可能与疾病进展相关，并随治疗而减轻。
