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PubMed2002

Mesenteric inflammatory pseudotumor: unusual presentation with leukemoid reaction and massive calcified mass.

The authors describe a child with an unusual presentation of mesenteric inflammatory pseudotumor in association with leukemoid reaction. An 11-year-old-boy admitted with short stature was found to have an abdominal mass localized in the right lower quadrant. The leukocyte count was 92,000/mm3 with neutrophilic leukemoid reaction. Abdominal ultrasonography and computed tomography revealed a massive calcified mass in the pelvis. Total resection of the mass was performed and the pathologic diagnosis of inflammatory pseudotumor of the mesentery was made. Leukemoid reaction dramatically resolved within a few days after surgical resection. Physicians should be aware of the association of inflammatory pseudotumor, leukemoid reaction, and massive calcification.

Abdominal Neoplasms↗
PubMed1986

Leukemoid reaction in a patient with bladder and prostatic cancer.

Leukemoid reactions often are seen in patients with underlying malignancies but they have been reported infrequently in patients with urological malignancies. We report reactive leukocytosis and thrombocytosis in a patient with bladder and prostatic carcinoma. Both hematological abnormalities resolved with definitive surgical therapy. We also review other reported cases of leukemoid reactions in patients with urological malignancies.

Adenocarcinoma↗
PubMed1994

Leukemoid reaction: a rare paraneoplastic syndrome associated with advanced bladder carcinoma.

We report a case of leukemoid reaction associated with tumor recurrence and rapid progression in a patient following resection of a high-grade transitional cell carcinoma of the bladder. The clinical, pathologic, and etiologic features of tumor-associated leukemoid reactions are emphasized. In the setting of recurrent carcinoma, a leukemoid reaction suggests highly aggressive or metastatic disease.

Carcinoma, Transitional Cell↗
PubMed1993

Cytokines in inflammatory malignant fibrous histiocytoma presenting with leukemoid reaction.

Inflammatory malignant fibrous histiocytomas (IMFH) are rare tumors and are frequently associated with leukocytosis. In rare cases, leukemoid reactions were attributed to tumor production of unidentified hematopoietic factors. In this study, we used immunohistochemical techniques to show cytokine immunoreactivity in the malignant cells of two cases of IMFH presenting with leukemoid reactions and compared them with two malignant fibrous histocytomas, noninflammatory type. All four tumors stained positively for stem cell factor (SCF), granulocyte colony-stimulating factor (G-CSF), interleukin-2 (IL-2), IL-4, IL-5, interferon-alpha (IFN-alpha), and insulin-like growth factor-I. Other cytokines detected only in the two IMFH included IL-6, IL-7, IL-8, IFN-gamma, and keratinocyte growth factor. Granulocyte-macrophage-CSF, IL-3, and transforming growth factor-beta staining was present in one of the two IMFH tumors and was not present in the noninflammatory tumors. The immunohistochemical staining was localized to the malignant cells, suggesting deregulated cytokine expression consistent with their monocytic/histocytic origin. Expression of certain cytokines in the IMFH may account for the local inflammatory infiltrate, tumor fibrosis, and the aggressive nature of the malignant cells. We also detected elevated serum levels of SCF, G-CSF, IL-6, and tumor necrosis factor in one or both of the IMFH patients. These latter observations may explain the bone marrow hypercellularity and other paraneoplastic symptoms, including fever, malaise, and weight loss, observed in both patients. Different cytokines present in the two IMFH tumors appear to be responsible for the eosinophilic leukemoid reaction observed in one case and for the granulocytic leukemoid reaction observed in the other patient. They may also be responsible for expansion of the tumor-cell population, fibroblast proliferation, and enhanced secretion of extracellular collagen.

Aged↗
PubMed1996

Leukemoid reaction in epidermal squamous cell carcinoma.

There have been no previous concrete reports of leukemoid reactions associated with squamous cell carcinoma originating in cutaneous tissue. Here we report a case of epidermal squamous cell carcinoma of the sacral region and an associated leukemoid reaction. The tumor invaded deeply and destroyed both the sacrum and coccyx. The white blood cell count was greater than 20,000/mm3. After resection of the tumor, white blood cells transiently decreased, but did not fall under 10,000/mm3. Post-operative infection by methicillin-resistant Staphylococcus aureus and Bacteroides caccae caused sepsis and further elevation of the leukocytes to greater than 50,000/mm3. The leukemoid reaction in the case appeared to have been caused initially by direct invasion of bone by epidermal squamous cell carcinoma and later by severe infection.

Carcinoma, Squamous Cell↗
PubMed1977

Kinetic studies of a tumor-induced leukemoid reaction in mice.

A transplantable murine breast carcinoma in mice was associated with marked leukemoid reaction. Within 1 week of subcutaneous implantation of tumor the leukocyte count began to increase and reached average levels of 165,000 leukocytes per cubic millimeter within 18 days. This represented an increase in mature neutrophils primarily, although other blood leukocytes were modestly increased as well. The total number of neutrophils per humerus was increased but no increase was detected in the number of myloblasts, promyelocytes, or myelocytes. The tritiated thymidine-labeling index of the latter three cells was not significantly changed during tumor growth. The number of progenitor cells forming granulocytic and mononuclear cells in vitro was decreased in the marrow during tumor growth. Colony-stimulating activity in plasma was slightly increased during the early phase of tumor growth and decreased during later phases. Emergence time of blood neutrophils was normal, as measured by labeling with tritiated thymidine, but decline in labeled cells was abnormally slow in tumor-bearing mice. There was a shift of erythropoiesis to the spleen, but total erythropoiesis appeared to be normal in most mice. Surgical excision of the tumor resulted in prompt reversal of the leukemoid reaction. In the aggregate these results are consistent with a hypothesis that the leukemoid reaction was the result of increased blood transit time of neutrophils primarily, rather than increased neutrophil production.

Animals↗
PubMed1982

Leukemoid reaction induced by different transplantable tumors in three inbred mouse strains.

We have studied the induction of a granulocyte-associated leukocytosis (leukemoid reaction) in C3HA, C57B1/6, and DBA/2 mice by a number of transplantable tumors of different origin. Leukemia L1210, Hepatoma 22, a transplantable mammary carcinoma of spontaneous C3HA origin, and a L929 culture fibroblasts-derived rhabdomyosarcoma, all induced a leukemoid reaction in their specific mouse strain. Melanoma B16 and Lewis lung carcinoma gave no reaction; Adenocarcinoma 755 and Harding-Passey melanoma evoked a leukocytosis but not due to an increase in neutrophils. Some extratumoral factors can influence the hematological response; the intensity of final leukemoid reaction was higher in female mice than in males bearing the same tumor. On the other hand, Ehrlich ascites tumor transplanted in all three inbred mouse strains rendered different levels of leukemoid reaction; response was higher in DBA/2, intermediate in C3HA and lower in C57B1/6.

Animals↗
PubMed2003

Leukemoid reaction response to chemotherapy and radiotherapy in a patient with cervical carcinoma.

A white blood cell count more than 50 x 10(9)/l associated with a cause outside the bone marrow is termed a leukemoid reaction. Although it simulates leukemia, most of its causes are benign. Malignancy as a cause of a leukemoid reaction is still a medical dilemma. It is thought to be attributed to granulocyte colony-stimulating factor (G-CSF) secreted by the tumor cells. To our knowledge this is the first time a leukemoid reaction has been reported in association with cervical cancer. We even managed to monitor the leukemoid reaction response to chemotherapy and radiotherapy.

Aged↗
PubMed1987

[Leukocytosis, the leftward shift of the white blood picture and leukemoid reactions in the internal medicine clinic].

The white blood count of 6549 patients with various internal diseases of respiratory, cardiovascular, gastrointestinal, excretory and endocrine systems was studied as well as in neoplasms, collagenosis, etc. with the exception of malignant hemopathies. Leukocytosis was established in 21.8% of them. In almost half of the cases, leukocytosis is low, in 44.6% it ranges from 12-20 X 10(9)/l and in 10.2%--it is high--from 20 to 40 X 10(9)/l. Immature cells in the peripheral blood were established corresponding to stab neutrophils over 0.06-0.10, metamyelocytes, myelocytes reaching myeloblasts in the cases with leukemoid reactions. The leukemoid reactions have, with no exceptions, been of myeloid type and developed in various diseases.

Adolescent↗
PubMed2001

Disseminated hepatosplenic mycobacterial infection masking myeloproliferative diseases as leukemoid reaction: a diagnostic pitfall.

The distinction of myeloproliferative disease (MPD) from leukemoid reactions due to reactive causes can be difficult. In the presence of simultaneous occurrence of MPD and an established infection, only the demonstration of a clonal marker or prolonged observation can substantiate the diagnosis. We present three cases of MPD presenting as leukemoid reaction due to disseminated hepatosplenic mycobacterial sepsis. There appeared to be an association between MPD and reduced resistance to mycobacterial infection. Clinicians and hematologist should be aware of such a predisposition and possible dual pathology for proper diagnosis, therapy and monitoring of both the infection and the myeloproliferation.

Adult↗
PubMed1988

Leukemoid reaction in erythema nodosum leprosum in a leprosy patient.

A case of lepromatous leprosy with erythema nodosum leprosum (ENL) presenting as a myeloid leukemoid reaction is reported. Very high leucocyte count with immaturity of the cells in myeloid series was present in peripheral blood. High leucocyte alkaline phosphatase score, absence of hepatosplenomegaly and transient nature of leukemoid reaction differentiated it from chronic myeloid leukemia and acute myeloblastic leukemia. The possible mechanisms of leukemoid reaction in ENL are discussed.

Adult↗
PubMed2006

An update on the etiology and diagnostic evaluation of a leukemoid reaction.

Persistent neutrophilic leukocytosis above 50,000 cells/muL when the cause is other than leukemia defines a leukemoid reaction. The diagnostic work-up consists of the exclusion of chronic myelogenous leukemia (CML) and chronic neutrophilic leukemia (CNL) and the detection of an underlying cause. The major causes of leukemoid reactions are severe infections, intoxications, malignancies, severe hemorrhage, or acute hemolysis. The present article points out the difficulties in the differential diagnosis of a leukemoid reaction and suggests an algorithm for a rational clinical and laboratory evaluation of this problematic entity.

Journal Article↗
PubMed1983

Comparison of circulating colony-forming cells in chronic granulocytic leukemia and leukemoid reaction.

In vitro culture studies of peripheral blood leukocytes using semi-solid media from 8 patients with chronic granulocytic leukemia (CGL) and 5 patients with granulocytic leukemoid reaction were performed. A markedly increased number of circulating colony-forming units were present in patients with CGL (mean 343 +/- 47) as opposed to those having granulocytic leukemoid reaction (mean 7.0 +/- 4). The colony size was larger in CGL than in granulocytic leukemoid reaction or in normal peripheral blood.

Cells, Cultured↗
PubMed1983

[Neonatal leukemoid reaction caused by prenatal corticoid administration?].

A leukemoid reaction in the neonatal phase of a preterm infant is described. After a maximum of 112,000/microliter at the forth day leukocyte concentration normalized during the end of the second week of life. Intensive investigations could reveal none of the known causes of leukocytosis. The connection with maternal corticoid administration to prevent respiratory distress syndrome is discussed.

Adult↗
PubMed1994

[Immunophenotyping of early-phase chronic myeloid leukemia and leukemoid reaction].

Early chronic myeloid leukemia (CML) and leukemoid reaction (LR) sometimes show similar histological pictures. In order to assess the efficacy of immunohistochemistry in the discrimination of the two forms, twenty bone marrow (BM) trephines of patient with CML and twenty with LR were immunostained and studied. A wide spectrum of antibodies effective on paraffin-embedded tissues (NP 57 anti-neutrophil elastase, Leu M1, MAC 387, KP1, Y2/51, LCA, UCHL1, L26, BerH2 and Glycophorin A) and directed against granulopoietic, erythropoietic, megakaryocytic, monocytic and lymphoid cells was tested by means of the alkaline phosphatase anti-alkaline phosphatase (APAAP) method. Expression of neutrophil elastase in CML and LR showed a different pattern of reactivity in normal and neoplastic granulocytic cells and Y2/51 put in evidence significant discrepancies of megakaryocytes in the two groups. Moreover, a greater number of histiocytic, lymphoid and erythropoietic cells were detected in LR after immunostaining with KP1, LCA, UCHL1, L26 and Glycophorin A. The different immunophenotypical pictures observed, suggest the value of immunohistochemistry as a supplementary diagnostic tool for the differential diagnosis between early CML and LR.

Adult↗
PubMed1990

[Leukemoid reaction caused by hypernephroma primary diagnosed as chronic granulocytic leukemia].

A case of leukemoid reaction associated with renal carcinoma is presented. On account of the high leukocyte count and a palpable abdominal mass in the upper left quadrant, interpreted as an enlarged spleen, the primary tentative diagnosis was chronic granulocytic leukemia. Abdominal ultrasonographic scan revealed an enlarged left kidney and subsequent nephrectomy revealed a large hypernephroma. Leukemoid reactions associated with malignant disease are described in general with emphasis on the differential diagnosis.

Adult↗
PubMedDate not supplied

Cutaneous pustular leukemoid reactions in trisomy 21.

We report two neonates with Down syndrome and postnatal leukemoid reactions who developed acute widespread pustular eruptions. The white blood cell (WBC) counts on the first day of life were markedly elevated, with blasts seen on examination of the peripheral blood smear. The skin eruptions progressed and became pustular. Viral and bacterial cultures were negative. Skin examination revealed pustules on an erythematous base on the cheeks, shoulders, trunk, and proximal extremities. Skin biopsy specimens showed an intraepidermal pustule with an inflammatory infiltrate including neutrophils, eosinophils, and mononuclear cells. The mononuclear cells had atypical, immature-appearing nuclei. In patient 1, these cells were strongly myeloperoxidase positive on immunohistochemistry, indicating myeloid lineage. In patient 2, these cells were CD3-positive T cells. Patient 1 received a 5-day infusion of continuous cytarabine (ara-C) secondary to high WBC counts and symptomatic hyperviscosity. During therapy, the high WBC count and the pustules resolved. The lesions of patient 2 improved with topical mometasone furoate and resolved as her WBC count decreased. Recently, similar cases have been reported. Transient myeloproliferative disorders, or leukemoid reactions, should always be considered when newborns with Down syndrome or trisomy 21 mosaicism develop a pustular eruption.

Biopsy, Needle↗
PubMed1976

An autopsy case of liposarcoma with granulocytic leukemoid reaction.

A 57-year-old female with a large retroperitoneal tumor was atutopsied. She showed through the entire course of illness marked leukocytosis with the appearance of immature marrow cells, and this finding was hematologically interpreted as granulocytic leukemoid reaction. An intermittent pyrexia was also seen without infective etiology. The histologic diagnosis of the tumor was liposarcoma of the pleomorphic type. The tumor showed extensive necrosis, but no metastatic invasion was found. So-called leukemoid reaction appears sometimes together with malignant neoplasms. The majority of these tumors show widespread bone marrow metastases, and without bone marrow invasion they only rarely induce this reaction. Besides it is not common for leukemoid reaction to be evoked by the development of malignant mesenchymal tumors except for malignant lymphomas. The pathophysiologic process of the present of the present case is thought to be a rare occurrence.

Autopsy↗