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Eosinophilic and neutrophilic leukemoid reaction in a woman with spindle cell sarcoma: a case report.

Snyder MC, Lauter CB - J Med Case Rep (2010)

Bottom Line: The patient received no further treatment.WBC was 107.8 × 109/L, with eosinophil count of 47.43 × 109/L and neutrophil count of 44.10 × 109/L.Interleukin-5 was normal, and granulocyte-macrophage colony-stimulating factor (GM-CSF) was elevated at 208.8 (normal < 4.8).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, William Beaumont Hospital, 3601 W, 13 Mile Road, Royal Oak, MI 48073, USA. mcsnyder15@yahoo.com.

ABSTRACT

Introduction: We report a case of a patient with marked eosinophilia and neutrophilia as a manifestation of a spindle cell sarcoma.

Case presentation: A 41-year-old African American woman presented with an enlarging, painful mass in her right knee area. Four years previously, she had had a mass similar to this diagnosed as an osteosarcoma, and had undergone a radical resection and hinge-knee replacement. Before the surgery, she was treated with neoadjuvant docetaxel and gemcitabine. A biopsy was taken from the recurrent mass, and histological examination revealed high-grade soft-tissue sarcoma. The patient received no further treatment. Complete blood counts revealed a white blood cell (WBC) count of 13.6 to 17.9 × 109/L, with neutrophils being 8.2 to 10.9 × 109/L and eosinophils 1.8 to 1.9 × 109/L. At readmission six months later, WBC was 126.7 × 109/L, with neutrophils being 57.02 × 109/L and eosinophils 60.82 × 109/L. The eosinophils peaked at 77.79 × 109/L two days later. Evaluations for allergies, infection, and autoimmune mechanisms were negative. Bone marrow revealed increased eosinophils without blasts. After resection, blood counts abruptly decreased to the normal range. Pathology confirmed high-grade spindle cell sarcoma. Approximately one year after resection, the patient was readmitted with metastatic disease to her lungs. During this presentation, her eosinophil and neutrophil count was again increased. WBC was 107.8 × 109/L, with eosinophil count of 47.43 × 109/L and neutrophil count of 44.10 × 109/L. Interleukin-5 was normal, and granulocyte-macrophage colony-stimulating factor (GM-CSF) was elevated at 208.8 (normal < 4.8).

Conclusion: In our case, the patient had eosinophilia and neutrophilia associated with a spindle cell sarcoma, possibly representing a paraneoplastic syndrome secondary to GM-CSF. There were no signs of infectious, allergic, or autoimmune causes for the eosinophilia or neutrophilia. Even though the occurrence of eosinophilia and neutrophilia with malignancy is rare, patients who have either condition without an apparent cause should be checked for malignancy.

No MeSH data available.


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The number of white blood cells (WBC), eosinophils, and neutrophils before and after surgery
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Figure 1: The number of white blood cells (WBC), eosinophils, and neutrophils before and after surgery

Mentions: Our patient returned six months later with increased pain in her right leg, and marked growth of the leg mass. She also reported a decreased range of motion secondary to the right knee mass. On physical examination, we found a large mass in the right knee area approximately 150 × 200 mm in size, which was hard, fixed and tender. Owing to the size, there was markedly decreased range of motion. There was no pedal edema, and peripheral pulses were intact. There was also an enlarged (15 × 20 mm), hard, slightly tender lymph node in the right inguinal area. There was no rash. There was no loss of sensation distal to the mass. Laboratory investigations revealed WBC 126.7 × 109/L, neutrophils 57.02 × 109/L, and eosinophils 60.82 × 109/L. The eosinophil level peaked two days later at 77.79 × 109/L (Table 1, Figure 1).


Eosinophilic and neutrophilic leukemoid reaction in a woman with spindle cell sarcoma: a case report.

Snyder MC, Lauter CB - J Med Case Rep (2010)

The number of white blood cells (WBC), eosinophils, and neutrophils before and after surgery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2984466&req=5

Figure 1: The number of white blood cells (WBC), eosinophils, and neutrophils before and after surgery
Mentions: Our patient returned six months later with increased pain in her right leg, and marked growth of the leg mass. She also reported a decreased range of motion secondary to the right knee mass. On physical examination, we found a large mass in the right knee area approximately 150 × 200 mm in size, which was hard, fixed and tender. Owing to the size, there was markedly decreased range of motion. There was no pedal edema, and peripheral pulses were intact. There was also an enlarged (15 × 20 mm), hard, slightly tender lymph node in the right inguinal area. There was no rash. There was no loss of sensation distal to the mass. Laboratory investigations revealed WBC 126.7 × 109/L, neutrophils 57.02 × 109/L, and eosinophils 60.82 × 109/L. The eosinophil level peaked two days later at 77.79 × 109/L (Table 1, Figure 1).

Bottom Line: The patient received no further treatment.WBC was 107.8 × 109/L, with eosinophil count of 47.43 × 109/L and neutrophil count of 44.10 × 109/L.Interleukin-5 was normal, and granulocyte-macrophage colony-stimulating factor (GM-CSF) was elevated at 208.8 (normal < 4.8).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medicine, William Beaumont Hospital, 3601 W, 13 Mile Road, Royal Oak, MI 48073, USA. mcsnyder15@yahoo.com.

ABSTRACT

Introduction: We report a case of a patient with marked eosinophilia and neutrophilia as a manifestation of a spindle cell sarcoma.

Case presentation: A 41-year-old African American woman presented with an enlarging, painful mass in her right knee area. Four years previously, she had had a mass similar to this diagnosed as an osteosarcoma, and had undergone a radical resection and hinge-knee replacement. Before the surgery, she was treated with neoadjuvant docetaxel and gemcitabine. A biopsy was taken from the recurrent mass, and histological examination revealed high-grade soft-tissue sarcoma. The patient received no further treatment. Complete blood counts revealed a white blood cell (WBC) count of 13.6 to 17.9 × 109/L, with neutrophils being 8.2 to 10.9 × 109/L and eosinophils 1.8 to 1.9 × 109/L. At readmission six months later, WBC was 126.7 × 109/L, with neutrophils being 57.02 × 109/L and eosinophils 60.82 × 109/L. The eosinophils peaked at 77.79 × 109/L two days later. Evaluations for allergies, infection, and autoimmune mechanisms were negative. Bone marrow revealed increased eosinophils without blasts. After resection, blood counts abruptly decreased to the normal range. Pathology confirmed high-grade spindle cell sarcoma. Approximately one year after resection, the patient was readmitted with metastatic disease to her lungs. During this presentation, her eosinophil and neutrophil count was again increased. WBC was 107.8 × 109/L, with eosinophil count of 47.43 × 109/L and neutrophil count of 44.10 × 109/L. Interleukin-5 was normal, and granulocyte-macrophage colony-stimulating factor (GM-CSF) was elevated at 208.8 (normal < 4.8).

Conclusion: In our case, the patient had eosinophilia and neutrophilia associated with a spindle cell sarcoma, possibly representing a paraneoplastic syndrome secondary to GM-CSF. There were no signs of infectious, allergic, or autoimmune causes for the eosinophilia or neutrophilia. Even though the occurrence of eosinophilia and neutrophilia with malignancy is rare, patients who have either condition without an apparent cause should be checked for malignancy.

No MeSH data available.


Related in: MedlinePlus