Chen Y M, Whang-Peng J, Liu J M, Chao Y, Lai C R, Wang S Y, Perng R P
Cancer Clinical Research Center, Institute of Biomedical Sciences, Academia Sinica, Taipei.
Jpn J Clin Oncol. 1995 Aug;25(4):168-72.
We report a male patient with metastatic high-grade mucoepidermoid carcinoma and associated leukemoid reaction. The patient was transferred to our hospital due to persistent spiking fever, marked granulocytosis, and suspected liver abscess. After thorough bacteriological studies, including cultures of blood and material aspirated from the "liver abscess", no evidence of infection was documented. The patient suffered from persistent spiking fever for more than 4 weeks in spite of empirical antibiotic treatment, and repeated aspiration of the presupposed liver abscess. He underwent exploratory laparotomy for intended surgical evacuation of the liver abscess and bacteriological diagnosis. The operative findings were compatible with metastatic carcinoma with multiple liver and retroperitoneal lymph node involvement and tumor necrosis. The pathology report indicated high-grade mucoepidermoid carcinoma. Immunohistochemistry showed positive staining for interleukin-1 alpha (IL-1 alpha) and IL-6. Elevation of cytokine levels in the necrotic tumor fluid, including IL-1 alpha, IL-6, granulocyte-macrophage colony-stimulating factor and granulocyte colony-stimulating factor was confirmed by ELISA test. This case shows that multiple cytokine production from a metastatic tumor and its central necrotic area in the liver can produce a febrile leukemoid reaction mimicking a pyogenic liver abscess.
我们报告了一名患有转移性高级别黏液表皮样癌及相关类白血病反应的男性患者。该患者因持续高热、明显的粒细胞增多症以及疑似肝脓肿而被转诊至我院。经过全面的细菌学检查，包括血液培养和从“肝脓肿”抽取的物质培养，未发现感染证据。尽管进行了经验性抗生素治疗以及反复抽吸假定的肝脓肿，患者仍持续高热超过4周。他接受了剖腹探查术，旨在通过手术引流肝脓肿并进行细菌学诊断。手术结果显示为转移性癌，伴有多处肝脏和腹膜后淋巴结受累以及肿瘤坏死。病理报告显示为高级别黏液表皮样癌。免疫组化显示白细胞介素-1α（IL-1α）和IL-6呈阳性染色。通过酶联免疫吸附测定（ELISA）试验证实，坏死肿瘤液中的细胞因子水平升高，包括IL-1α、IL-6、粒细胞-巨噬细胞集落刺激因子和粒细胞集落刺激因子。该病例表明，肝脏转移性肿瘤及其中心坏死区域产生的多种细胞因子可引发类似化脓性肝脓肿的发热性类白血病反应。
