Blood Res.  2013 Mar;48(1):63-66. 10.5045/br.2013.48.1.63.

Acute pyelonephritis with anaplastic thyroid carcinoma producing granulocyte colony-stimulating factor

• Kang K
• Park JH
• Ryu JY
• Lee SY
• Ko GJ
• Kwon YJ

• KMID: 2270730
• DOI: http://doi.org/10.5045/br.2013.48.1.63

Abstract

Paraneoplastic leukocytosis was defined as elevated white blood cell (WBC) levels caused by cytokines, likely produced by the tumor itself, without evidence of infection or myeloproliferative disease. We report a case of anaplastic thyroid carcinoma with leukocytosis caused by elevated production of granulocyte colony-stimulating factor (G-CSF) by the carcinoma. Initially, acute pyelonephritis (APN) was diagnosed and treatment for APN was ongoing, but the WBC count steadily increased to 68.8x10(9)/L. She was diagnosed with anaplastic thyroid carcinoma on her neck mass, and the serum concentration of G-CSF was found to be markedly increased at 1,010 pg/mL. In spite of supportive care, the patient's condition rapidly deteriorated and the patient died on day 23 of hospital stay. Leukocytosis without definite evidence of infection could be a paraneoplastic manifestation in patients with malignant tumors, and paraneoplastic leukocytosis may be related to poor prognosis.

Keyword

G-CSF; Anaplastic thyroid carcinoma; Paraneoplastic leukocytosis

MeSH Terms

Cytokines
Granulocyte Colony-Stimulating Factor
Granulocytes
Humans
Length of Stay
Leukocytes
Leukocytosis
Neck
Prognosis
Pyelonephritis
Thyroid Gland
Thyroid Neoplasms
Cytokines
Granulocyte Colony-Stimulating Factor
Thyroid Neoplasms

Figure

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  Fig. 1 Computed tomography of the neck showed a large thyroid mass invading adjacent structures (A). Multiple metastatic lesions in both lung parenchyma were also noted (B).

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  Fig. 2 A fine needle aspiration specimen from the neck mass showed scattered and small clusters of pleomorphic cells with enlarged bizarre hyperchromatic nuclei and frequent prominent nucleoli, with variable amounts of cytoplasm (×1,000).

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  Fig. 3 Serial white blood cell (WBC) counts and C-reactive protein (CRP) levels. The WBC count increased to 68.8×109/L by day 21 of hospital stay, although the CRP level did not increase in parallel.

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