Yarih Garcia-Ortega Dorian, Bryan Hall-Ramírez William, Antonio Ortega Jiménez José, Paulina Melendez-Fernandez Ana, Claudia Caro-Sánchez, Alamilla-García Gabriela, Kuauhyama Luna-Ortiz
Surgical Oncology, Skin, Soft Tissue & Bone Tumors Department, National Cancer Institute, Mexico City, Mexico.
Surgical Oncology Fellow, Surgical Department, National Cancer Institute, Mexico City, Mexico.
Int J Surg Case Rep. 2024 Jul;120:109819. doi: 10.1016/j.ijscr.2024.109819. Epub 2024 May 31.
Paraneoplastic leukemoid reactions (PLRs) in the context of sarcomas represent a unique clinical entity that poses significant diagnostic challenges and adds valuable insights to the surgical literature. Characterized by an abnormal elevation of white blood cell count, these reactions are often associated with aggressive tumor biology and poor prognosis, emphasizing the need for heightened awareness among clinicians.
A 48-year-old male presented with a rapidly growing, ulcerated tumor on his thigh. Lab tests revealed an extreme leukocytosis with a white blood cell count of 92,860/mm3. Imaging and biopsy confirmed a high-grade spindle cell sarcoma.
After excluding other causes of leukocytosis, a PLR secondary to sarcoma was diagnosed. Despite initial antibiotic treatment, leukocytosis persisted, prompting a decision for surgical intervention. The patient underwent successful tumor resection, resulting in a significant decrease in leukocyte count and subsequent stable recovery, supported by adjuvant radiotherapy.
This case underscores the importance of recognizing PLRs in sarcoma patients as they can significantly impact clinical management and prognosis. It highlights the necessity of a multidisciplinary approach for accurate diagnosis and effective treatment. The case contributes to the surgical literature by detailing the diagnostic process and therapeutic interventions in managing such complex presentations, thereby providing key "take-away" lessons on the importance of considering PLRs in the differential diagnosis of leukocytosis in patients with malignancies.
肉瘤背景下的副肿瘤性类白血病反应（PLR）是一种独特的临床实体，带来了重大的诊断挑战，并为外科文献增添了有价值的见解。这些反应以白细胞计数异常升高为特征，通常与侵袭性肿瘤生物学行为和不良预后相关，强调临床医生需要提高认识。
一名48岁男性患者，大腿出现一个迅速生长的溃疡性肿瘤。实验室检查显示白细胞极度增多，白细胞计数为92,860/mm³。影像学检查和活检证实为高级别梭形细胞肉瘤。
排除白细胞增多的其他原因后，诊断为肉瘤继发的PLR。尽管最初进行了抗生素治疗，但白细胞增多持续存在，促使决定进行手术干预。患者成功接受了肿瘤切除，白细胞计数显著下降，随后在辅助放疗的支持下稳定康复。
本病例强调了认识肉瘤患者中PLR的重要性，因为它们会显著影响临床管理和预后。突出了采用多学科方法进行准确诊断和有效治疗的必要性。该病例通过详细描述此类复杂病例的诊断过程和治疗干预，为外科文献做出了贡献，从而提供了关于在恶性肿瘤患者白细胞增多鉴别诊断中考虑PLR重要性的关键“经验教训”。
