Korean J Gastroenterol.  2015 Aug;66(2):116-121. 10.4166/kjg.2015.66.2.116.

A Case of Leukemoid Reaction in Pancreatic Ductal Adenocarcinoma

• Hong KH
• Lee JK
• Byun SJ
• Jung JW
• Han IW
• Jung JH
• Kim EJ

• KMID: 2373324
• DOI: http://doi.org/10.4166/kjg.2015.66.2.116

Abstract

Leukemoid reaction is defined as leukocytosis exceeding 50,000 cells/mm3. When it occurs in a patient with a malignancy, secondary causes such as infections, drugs, hematologic diseases and hemorrhage need to be ruled out. After excluding such causes, paraneoplastic leukemoid reaction can be considered as a diagnosis of exclusion. Paraneoplastic leukemoid reactions have been described in association with lung, gastrointestinal, genitourinary and head and neck cancers. However, pancreatic cancer with leukemoid reaction has been rarely reported. We diagnosed a case of a 55-year-old Korean woman with extreme leukocytosis associated with advanced pancreatic cancer.

Keyword

Leukemoid reaction; Paraneoplastic syndromes; Pancreatic neoplasms

MeSH Terms

Carcinoma, Pancreatic Ductal/complications/*diagnosis
Female
Humans
Leukocytes/cytology
Leukocytosis/*complications
Magnetic Resonance Imaging
Middle Aged
Pancreatic Neoplasms/complications/*diagnosis
Positron-Emission Tomography
Tomography, X-Ray Computed

Figure

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  Fig. 1. A 5.5 cm-sized lobulating contour mass with inner cystic area in pancreatic tail with renal and splenic involvement was noted in pancreas dynamic MRI (A) and in whole body PET-CT (maximum standardized uptake value=6.0) (B).

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  Fig. 2. Product of distal pancreatectomy, splenectomy, and left nephrectomy. A large irregular solid mass (6.0×4.2×4.0 cm) was found at distal pancreas.

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  Fig. 3. On histologic examination, poorly differentiated adenocarcinoma (A) with signet ring cell feature (H&E, ×100; inset: ×400) and mucinous cystic component (B) was noticed (H&E, ×100; inset: ×400).

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  Fig. 4. Pancreas CT shows multiple hyperechoic lesions with hypoechoic rim (arrows) in both lobes of the liver suggesting multiple metastases to the liver.

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  Fig. 5. Peripheral blood smear reveals marked granulocytosis without bands, myelocytes or metamyelocytes (H&E; A, ×200; B, ×1,000).

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  Fig. 6. Bone marrow examination reveals reactive bone marrow with granulocyte hyperplasia without evidence of neoplastic cell infiltration (Wright & Giemsa stain; A, ×400; B, ×1,000).

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  Fig. 7. Clinical course of leukocyte counts. A, Catheter related infection was suspected; B, bone marrow examination was performed; C, follow up blood culture showed negative finding; D, maximal white blood cells (WBC) count; E, expired.

Reference

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