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Nguyen L, Saha A, Kuykendall A, Zhang L. Clinical and Therapeutic Intervention of Hypereosinophilia in the Era of Molecular Diagnosis. Cancers (Basel) 2024; 16:1383. [PMID: 38611061 PMCID: PMC11011008 DOI: 10.3390/cancers16071383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/17/2024] [Accepted: 03/17/2024] [Indexed: 04/14/2024] Open
Abstract
Hypereosinophilia (HE) presents with an elevated peripheral eosinophilic count of >1.5 × 109/L and is composed of a broad spectrum of secondary non-hematologic disorders and a minority of primary hematologic processes with heterogenous clinical presentations, ranging from mild symptoms to potentially lethal outcome secondary to end-organ damage. Following the introduction of advanced molecular diagnostics (genomic studies, RNA sequencing, and targeted gene mutation profile, etc.) in the last 1-2 decades, there have been deep insights into the etiology and molecular mechanisms involved in the development of HE. The classification of HE has been updated and refined following to the discovery of clinically novel markers and targets in the 2022 WHO classification and ICOG-EO 2021 Working Conference on Eosinophil Disorder and Syndromes. However, the diagnosis and management of HE is challenging given its heterogeneity and variable clinical outcome. It is critical to have a diagnostic algorithm for accurate subclassification of HE and hypereosinophilic syndrome (HES) (e.g., reactive, familial, idiopathic, myeloid/lymphoid neoplasm, organ restricted, or with unknown significance) and to follow established treatment guidelines for patients based on its clinical findings and risk stratification.
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Affiliation(s)
- Lynh Nguyen
- Department of Pathology, James A. Haley Veterans’ Hospital, Tampa, FL 33612, USA
| | - Aditi Saha
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA (A.K.)
| | - Andrew Kuykendall
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA (A.K.)
| | - Ling Zhang
- Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
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2
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Zhang W, He M, Wang Q. Cardiac endothelial sarcoma with hypereosinophilia of children: a case report. J Cardiothorac Surg 2023; 18:106. [PMID: 37029383 PMCID: PMC10080960 DOI: 10.1186/s13019-023-02206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 04/02/2023] [Indexed: 04/09/2023] Open
Abstract
Cardiac malignancies in children are extremely rare and they with hypereosinophilia are rather relatively uncommon. The majority of individuals may survive over the long term even with heart tumors provided they don't have any significant symptoms and their hemodynamics are unaffected. But we should nevertheless be aware of them, especially when they are coupled with persistent hypereosinophilia and the development of a hemodynamic anomaly. The case of a malignant heart tumor with hypereosinophilia in a 13-year-old girl is presented in this paper. She exhibited an echocardiographic deficit and a heart murmur. Additionally, it was difficult to treat her hypereosinophilia. Nevertheless, it was resolved the day after the operation. We presume that there is a certain relationship between them. This study gives clinicians a wide range of options for analyzing the connections between malignancy and hypereosinophilia.
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Affiliation(s)
- Wei Zhang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China
| | | | - Qiang Wang
- Department of Cardiac Surgery, Tianjin Chest Hospital, Tianjin, China.
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3
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Ware JM, Folio LR, Pittaluga S, Klion A, Khoury P. Resolution of hypereosinophilic syndrome following resection of a schwannoma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1320-1322. [PMID: 36621605 PMCID: PMC10085834 DOI: 10.1016/j.jaip.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Affiliation(s)
- JeanAnne M Ware
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Les R Folio
- Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, Fla; Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Stephania Pittaluga
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Md
| | - Amy Klion
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Paneez Khoury
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
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Lazzari C, Yacoub MR, Campochiaro C, Bulotta A, Palumbo D, Ogliari FR, Dagna L, Marchesi S, Ponzoni M, Gregorc V. Case report: Successful use of mepolizumab for immune checkpoint inhibitors-induced hypereosinophilic syndrome in two patients with solid malignancies. Front Oncol 2023; 13:1079034. [PMID: 36776300 PMCID: PMC9911301 DOI: 10.3389/fonc.2023.1079034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
Hypereosinophilic syndrome (HES) represents a group of blood disorders characterized by an absolute eosinophil count (AEC) > 1.5 × 103/μl in the peripheral blood, which eventually extravasate and cause organ damage. It can be primary or secondary to infections or tumors. The infiltration of eosinophils in tissue and organs is associated with different disorders and, in some cases, with life-threatening manifestations. Albeit the pathogenesis of HES in patients with solid tumo\rs is not yet clarified; recently, HES has also been described as an immune-related adverse event in patients with solid tumors receiving immune checkpoint inhibitors. Treatment of HES is still debated, especially in patients with concomitant solid tumors, and different drugs including imatinib, hydroxyurea, interferon-ɑ, glucocorticoids, and the monoclonal antibody targeting circulating IL-5 mepolizumab have been proposed according to the underlying cause and the severity of HES. Herein, we describe, for the first time, the successful use of mepolizumab for the treatment of immune checkpoint-induced HES in two patients with metastatic solid tumor.
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Affiliation(s)
- Chiara Lazzari
- Department of Oncology, Candiolo Cancer Institute Fondazione Piemontese per l'Oncologia-Istituto di Ricerca a Carattere Scientifico (FPO-IRCCS) Candiolo, Torino, Italy,*Correspondence: Chiara Lazzari,
| | - Mona Rita Yacoub
- Department of Rheumatology and Clinical Immunology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Corrado Campochiaro
- Department of Rheumatology and Clinical Immunology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Alessandra Bulotta
- Department of Oncology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Diego Palumbo
- Department of Radiology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Francesca Rita Ogliari
- Department of Oncology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Lorenzo Dagna
- Department of Rheumatology and Clinical Immunology, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Hospital, Milano, Italy
| | - Silvia Marchesi
- Department of Oncology, Candiolo Cancer Institute Fondazione Piemontese per l'Oncologia-Istituto di Ricerca a Carattere Scientifico (FPO-IRCCS) Candiolo, Torino, Italy
| | - Maurilio Ponzoni
- Vita-Salute San Raffaele University, Milano, Italy,Pathology Unit, Istituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milano, Italy
| | - Vanesa Gregorc
- Department of Oncology, Candiolo Cancer Institute Fondazione Piemontese per l'Oncologia-Istituto di Ricerca a Carattere Scientifico (FPO-IRCCS) Candiolo, Torino, Italy
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5
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Ream S, Natarajan P, Gupta S, Sotelo-Rafiq E, Schuller D. Paraneoplastic Hypereosinophilia in Poorly Differentiated Adenocarcinoma of the Lung. Cureus 2023; 15:e34386. [PMID: 36874752 PMCID: PMC9976640 DOI: 10.7759/cureus.34386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
It is well-documented that lung and bronchus cancers are the leading cause of cancer death in the United States in both male and female patients, with lung adenocarcinoma accounting for the highest prevalence of lung cancers. Significant eosinophilia in the setting of lung adenocarcinoma has been documented in a few reports, being described as a rare paraneoplastic syndrome. We report on an 81-year-old female with hypereosinophilia-associated lung adenocarcinoma. A chest film showed a right lung mass, which was not apparent on a chest film 1 year prior, in the setting of significant leukocytosis of 27.90 x 103/mm3 with eosinophilia of 6.40 x 103/mm3. A computed tomography (CT) chest, obtained during admission, demonstrated significant right lower lobe mass enlargement since the previous study completed 5 months prior, with new occlusion of bronchi and pulmonary vessels to the region of the mass. Our observations are consistent with prior reports showing that the presence of eosinophilia in lung cancers may indicate rapid disease progression.
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Affiliation(s)
- Sarah Ream
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, USA
| | - Piruthiviraj Natarajan
- Department of Internal Medicine, The Hospitals of Providence- Transmountain/Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, USA
| | - Shruti Gupta
- Department of Internal Medicine, The Hospitals of Providence- Transmountain/Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, USA
| | - Elsa Sotelo-Rafiq
- Department of Pathology and Laboratory Medicine, Las Palmas Medical Center, El Paso, USA
| | - Dan Schuller
- Department of Internal Medicine/Pulmonary and Critical Care Medicine, The Hospitals of Providence- Transmountain/Texas Tech University Health Sciences Center El Paso, Paul L. Foster School of Medicine, El Paso, USA
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Wang Z, Chen B, Fu Y, Ou C, Rong Q, Kong X, Xu W, Deng Y, Jiang M, Xie J. Eosinophilia and Lung Cancer: Analysis From Real-World Data and Mendelian Randomization Study. Front Med (Lausanne) 2022; 9:830754. [PMID: 35355607 PMCID: PMC8959488 DOI: 10.3389/fmed.2022.830754] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objective Growing evidence added to the results from observational studies of lung cancer patients exhibiting eosinophilia. However, whether eosinophils contributed to tumor immune surveillance or neoplastic evolution was unknown. This study aimed to analyze the causal association between eosinophilia and lung cancer. Methods The causal effect of eosinophil count on lung cancer from a genome-wide association study (GWAS) was investigated using the two-sample Mendelian randomization (MR) method. Secondary results according to different histological subtypes of lung cancer were also implemented. Meanwhile, we compared the measured levels of blood eosinophil counts among different subtypes of lung cancer from real-world data. Results The median absolute eosinophilic count (unit: 109/L) [median (min, max): Lung adenocarcinoma 0.7 (0.5, 15); Squamous cell lung cancer 0.7 (0.5, 1.3); Small cell lung cancer 0.7 (0.6, 1.3); p = 0.96] and the median eosinophil to leukocyte ratio [median (min, max): Lung adenocarcinoma 8.7% (2.1, 42.2%); Squamous cell lung cancer 9.3% (4.1, 17.7%); Small cell lung cancer 8.9% (5.1, 24.1%); p = 0.91] were similar among different histological subtypes of lung cancer. MR methods indicated that eosinophilia may provide 28% higher risk for squamous cell lung cancer in East Asian [Weighted median method: odds ratio (OR) = 1.28, 95% CI: 1.04–1.57, p = 0.02]. Conclusion Our study suggested that eosinophilia may be a potential causal risk factor in the progression of squamous cell lung cancer in East Asian.
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Affiliation(s)
- Zhufeng Wang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bigui Chen
- Department of Respiratory and Critical Care Medicine, Yangjiang People's Hospital, Yangjiang, China
| | - Yu Fu
- Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Changxing Ou
- Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiuping Rong
- Department of Respiratory and Critical Care Medicine, Yangjiang People's Hospital, Yangjiang, China
| | - Xuetao Kong
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Xu
- The Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Yangqing Deng
- The Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mei Jiang
- National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaxing Xie
- Department of Respiratory and Critical Care Medicine, Yangjiang People's Hospital, Yangjiang, China.,Department of Allergy and Clinical Immunology, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Sloan L, Naik RP, Umrau K, Xian RR, Marrone KA, Voong KR. Case Report: Hematologic Recovery Following Stereotactic Ablative Radiotherapy in a Patient With Early-Stage Non-Small Cell Lung Cancer and Paraneoplastic Myelofibrosis. Front Oncol 2022; 12:842620. [PMID: 35280806 PMCID: PMC8907522 DOI: 10.3389/fonc.2022.842620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Herein, we report the first case presentation of paraneoplastic myelofibrosis associated with cancer. Paraneoplastic syndromes occur in some patients with thoracic malignancies; however, myelofibrosis is not commonly seen in non-small cell lung cancer (NSCLC). We report a case of myelofibrosis in a patient with a new diagnosis of NSCLC that resolved after stereotactic ablative radiotherapy (SABR). In conclusion, NSCLC may evoke unexpected systemic effects that resolve with treatment.
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Affiliation(s)
- Lindsey Sloan
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN, United States.,Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Rakhi P Naik
- Department of Hematology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kavita Umrau
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Rena Ruiyu Xian
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kristen A Marrone
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Khinh Ranh Voong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
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8
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Geng N, Hu W, Ge H, Xie S, Ding C. Tumor-associated eosinophilia in a patient with EGFR-positive, MET-amplified lung adenocarcinoma refractory to targeted therapy: a case report and review of literature. Transl Cancer Res 2022; 10:4988-4996. [PMID: 35116349 PMCID: PMC8798713 DOI: 10.21037/tcr-21-1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
Paraneoplastic eosinophilia is a rare complication observed in 1% solid tumor cases and appears to have tumor type-dependent prognostic impact, in which the increased eosinophil count was generally associated with unfavorable prognosis. In the English literature, more than 20 patients have been reported of eosinophilia associated with primary non-small cell lung cancer (NSCLC) at diagnosis, all of whom underwent either surgery, chemotherapy, or symptomatic therapy. Herein, we describe clinical course a stage IV NSCLC patient with paraneoplastic eosinophilia and leukocytosis and receiving targeted therapy. A 64-year-old male former smoker was diagnosed with lung adenocarcinoma harboring EGFR L858R mutation and MET amplification. Blood eosinophilia was manifested at diagnosis and confirmed to be paraneoplastic by eliminating other potential causes. The disease progressed rapidly within a month on EGFR inhibitor icotinib and then within three months on icotinib plus crizotinib after rapid response within the first month. A multi-target kinase inhibitor anlotinib was added, and the disease progressed one month later despite initial self-reported asymptomatic high-performance status. The patient was lost to subsequent follow-ups. Radiographic evaluation of disease control or progression coincided with respective distinct alleviation or worsening of eosinophilia. Consistent with previous reports of poor clinical outcome associated with blood eosinophilia, our results suggested a negative prognostic impact in EGFR-/MET-altered NSCLC. This case is, to the best of our knowledge, the first to provide evidence for blood eosinophilia paralleling disease progression in an EGFR- and MET-altered lung adenocarcinoma under targeted therapy, which suggested negative prognostic impact of blood eosinophilia in driver-positive NSCLC.
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Affiliation(s)
- Nan Geng
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenxia Hu
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hui Ge
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shaonan Xie
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Cuimin Ding
- Department of Respiratory Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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9
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Muhammad A, Nair HK, Tulpule S, Khan A. Metastatic BRAF V600E-Mutated Adenocarcinoma of the Lung Presenting as Extreme Neutrophilia and Eosinophilia. Cureus 2021; 13:e18930. [PMID: 34812314 PMCID: PMC8604094 DOI: 10.7759/cureus.18930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Hematologic paraneoplastic syndromes with extreme neutrophilia and eosinophilia are very rarely associated with adenocarcinoma of the lung. We describe a case of a 57-year-old female who presented with neutrophil- and eosinophil-predominant hyperleukocytosis and hypoxic respiratory insufficiency. Bone marrow biopsy confirmed metastatic adenocarcinoma, similar to the biopsy-proven adenocarcinoma of the lung. She was administered one dose of cytotoxic chemotherapy with carboplatin and pemetrexed and started on leukoreductive therapy with hydroxyurea. Molecular testing revealed a BRAF V600E mutation and she was started on dabrafenib and trametinib with significant clinical improvement. This is the first reported case of metastatic BRAF V600E mutated non-small cell lung cancer presenting with extreme neutrophilia and eosinophilia treated with a combination BRAF and mitogen-activated extracellular kinase (MEK) inhibitor.
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Affiliation(s)
- Azharuddin Muhammad
- Hematology and Medical Oncology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Hari K Nair
- Hematology and Medical Oncology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Sunil Tulpule
- Hematology and Medical Oncology, Saint Louis University School of Medicine, Saint Louis, USA
| | - Adnan Khan
- Internal Medicine, Saint Louis University School of Medicine, Saint Louis, USA
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Osawa H, Shiozawa T, Okauchi S, Sasatani Y, Ohara G, Sato S, Miyazaki K, Kodama T, Kagohashi K, Satoh H, Hizawa N. Absolute Increase in the Number and Proportion of Peripheral Eosinophils Associated With Immune Checkpoint Inhibitor Treatment in Non-small Cell Lung Cancer Patients. CANCER DIAGNOSIS & PROGNOSIS 2021; 1:485-490. [PMID: 35403161 PMCID: PMC8962858 DOI: 10.21873/cdp.10065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 07/23/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIM To clarify the clinical significance of the absolute increase in the number and proportion of peripheral eosinophils associated with immune checkpoint inhibitor (ICPI) treatment in non-small cell lung cancer (NSCLC) patients. PATIENTS AND METHODS We performed a retrospective study, by reviewing the medical charts of 191 patients who were treated with ICPI monotherapy and 80 patients treated with the combination of ICPI and chemotherapy during the period from February 2016 and April 2021. RESULTS In patients treated with ICPI monotherapy, there was a significant difference in time to treatment failure (TTF) between the two groups divided by eosinophils ≥ or <10%. Similarly, a significant difference was found in TTF between the two groups divided by eosinophils ≥ or <1,500/μl. Factors related to both an increase in the number and percentage of peripheral eosinophils were "immune-related adverse effects (irAE) that did not lead to discontinuation of administration". CONCLUSION Some patients with irAE might have a 'favorable' absolute increase in peripheral eosinophils.
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Affiliation(s)
- Hajime Osawa
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshihiro Shiozawa
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shinichiro Okauchi
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Yuika Sasatani
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Gen Ohara
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Shinya Sato
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Kunihiko Miyazaki
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Takahide Kodama
- Division of Respiratory Medicine, Ryugasaki Saiseikai Hospital, Ryugasaki, Japan
| | - Katsunori Kagohashi
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Hiroaki Satoh
- Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba-Mito Kyodo General Hospital, Mito, Japan
| | - Nobuyuki Hizawa
- Division of Respiratory Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Alves A, Dias M, Campainha S, Barroso A. Peripheral blood eosinophilia may be a prognostic biomarker in non-small cell lung cancer patients treated with immunotherapy. J Thorac Dis 2021; 13:2716-2727. [PMID: 34164164 PMCID: PMC8182546 DOI: 10.21037/jtd-20-3525] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Eosinophils have been traditionally associated with the initiation and propagation of inflammatory responses, particularly in allergic diseases and helminth infections. More recently, an association between eosinophils and cancer has been the focus of several studies, but controversial results have emerged. This study aims to evaluate the prognostic role of peripheral blood eosinophilia in non-small cell lung cancer (NSCLC) patients receiving immunotherapy (IO). We also evaluated the impact of peripheral eosinophilia on the occurrence of immune-related adverse effects (irAEs). Methods Advanced NSCLC patients under IO were included in a retrospective single-center study. Peripheral blood eosinophilia was defined by a count greater than 500/µL. Patients were analyzed for eosinophil counts, overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and disease control rate (DCR). Results A total of 121 NSCLC patients receiving IO were included. Thirty-three (27.3%) patients presented peripheral blood eosinophilia during treatment. Patients with peripheral eosinophilia presented more frequently non-progression as best overall response to IO (83.3% vs. 58.1%, P=0.014), higher median OS (26.6 vs. 9.5 months, P=0.022) and higher median PFS (13.8 vs. 4.6 months, P=0.013). IrAEs were more common in patients with peripheral eosinophilia (66.7% vs. 36.4%, P=0.003). Conclusions This study suggests that peripheral blood eosinophilia may predict better outcomes in NSCLC patients receiving IO, despite being associated with an increased risk of irAEs. According to our findings eosinophils may be involved in immune response against tumor. Routine eosinophils count assessment may be an additional prognostic tool in NSCLC patients receiving IO.
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Affiliation(s)
- Adelaide Alves
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Margarida Dias
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sérgio Campainha
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana Barroso
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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12
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Zalewska E, Obołończyk Ł, Sworczak K. Hypereosinophilia in Solid Tumors-Case Report and Clinical Review. Front Oncol 2021; 11:639395. [PMID: 33842345 PMCID: PMC8024638 DOI: 10.3389/fonc.2021.639395] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/08/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Renal cell cancer may cause various paraneoplastic syndromes; however, paraneoplastic hypereosinophilia occurs exceedingly rare. Thus far, only two cases of clear cell renal cell carcinoma (CCRCC) associated with hypereosinophilia have been reported. In this paper, we present a case of paraneoplastic hypereosinophilia associated with renal cell carcinoma and a review of the reported cases of hypereosinophilia in solid tumors. METHODS The review is based on an electronic literature search performed in the PubMed database in September 2020 with the following key terms: eosinophilia & neoplasm; eosinophilia & cancer; eosinophilia & paraneoplastic syndrome. Papers were included based on screening the titles and/or abstracts. We also included the case of our patient in the analysis. CASE PRESENTATION A 68-year-old Caucasian female patient with recurrent CCRCC was admitted to our Clinic for exacerbating dyspnea and chest and right upper abdominal pain, accompanied by confusion. Preliminary blood tests showed an increased white blood cell count of 40,770/μl, and an increased eosinophil count of 6,530/μl indicating eosinophilia. Several tests were carried out to rule out the noncancer causes of hypereosinophilia. The temporal appearance of eosinophilia and the recurrence of CCRCC without any other apparent potential causes led to the diagnosis of paraneoplastic hypereosinophilia. Despite treating with high doses of corticosteroids, only a transient decrement in eosinophil count was observed along with further deterioration of the patient's condition. The patient succumbed to the disease 6 months following the tumor surgery and 2 months after the diagnosis of hypereosinophilia and tumor recurrence. CONCLUSION Our observations are in agreement with the majority of reports showing that the occurrence of eosinophilia following tumor resection may indicate a poor prognosis, tumor recurrence, and rapid disease progression.
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Affiliation(s)
- Ewa Zalewska
- Department of Endocrinology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Akkad N, Jiang Y, Shin D. Leucocytosis and Stroke in a Lung Cancer Patient. Eur J Case Rep Intern Med 2020; 7:001872. [PMID: 33194867 DOI: 10.12890/2020_001872] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 12/27/2022] Open
Abstract
Significant leucocytosis in the setting of an underlying malignancy may be attributed to several causes and is not uncommon; however, extreme leucocytosis (>50×109 cells/l) and hypereosinophilia is less common and may represent a paraneoplastic syndrome. The underlying mechanism is thought to be bone marrow stimulation by tumour-produced cytokines, most notably interleukin-5 (IL-5) and granulocyte-macrophage colony-stimulating factor (GM-CSF). This paraneoplastic syndrome is likely reflective of extensive disease and dissemination, and options for treatment are limited but include tumour resection, corticosteroids and hydroxyurea. In this report, we discuss an unusual case of known stage III lung adenocarcinoma presenting with an ischaemic stroke and extreme leucocytosis and hypereosinophilia. LEARNING POINTS To illustrate an unusual presentation of progression of non-small-cell lung adenocarcinoma.To highlight the prognostic significance of extreme leucocytosis and hypereosinophilia in patients with an underlying malignancy.
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Affiliation(s)
- Neha Akkad
- Department of Internal Medicine, Washington University, St. Louis, MO, USA
| | - Yang Jiang
- Division of Hematology and Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | - Daniel Shin
- Division of Hematology and Oncology, University of California Los Angeles, Los Angeles, CA, USA
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14
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Takeuchi E, Takahashi N, Morizumi S, Tamiya H, Matsuoka H, Kuroda N, Yorita K. Interleukin-5-producing malignant pleural mesothelioma with eosinophilic pleural effusion. Thorac Cancer 2020; 11:3043-3046. [PMID: 32894005 PMCID: PMC7529565 DOI: 10.1111/1759-7714.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 12/02/2022] Open
Abstract
Malignant tumors are often associated with eosinophilic pleural effusion. Here, we encountered a case of interleukin‐5 (IL‐5)‐producing malignant pleural mesothelioma with eosinophilic pleural effusion. The patient was a 50‐year‐old male. He had a history of a cough for several weeks and had visited a local doctor. Left pleural effusion was noted, and the patient was referred to our hospital. He was diagnosed with malignant pleural mesothelioma by pleural biopsy, with eosinophilic pleural effusion. IL‐5 in the pleural effusion increased, and tumor cells were IL‐5‐positive by immunostaining. There have been few reports of IL‐5‐producing tumors, and this is the first report of IL‐5‐producing malignant pleural mesothelioma. Host‐tumor cell interactions cause eosinophilic pleural effusion. In patients with eosinophilic pleural effusion, malignant pleural effusion should be considered. It is necessary to clarify the pathophysiology of malignant tumors and eosinophils.
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Affiliation(s)
- Eiji Takeuchi
- Department of Clinical Investigation, National Hospital Organization Kochi Hospital, Kochi, Japan
| | - Naoki Takahashi
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shun Morizumi
- Department of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Nankoku, Japan
| | - Hiroyuki Tamiya
- Respiratory Medicine of Tokushima Prefectural Miyoshi Hospital, Miyoshi, Japan
| | - Hisashi Matsuoka
- Department of Thoracic Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Naoto Kuroda
- Department of Diagnostic Pathology, Konan Medical Center, Kobe, Japan
| | - Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi, Japan
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15
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Aubert H, Hamidou M, Barbarot S, Piriou N, Lefebvre M, Néel A. [Cutaneous hypereosinophilia… Hypereosinophilic syndromes]. Ann Dermatol Venereol 2020; 147:155-166. [PMID: 31948698 DOI: 10.1016/j.annder.2019.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/30/2019] [Accepted: 11/07/2019] [Indexed: 11/27/2022]
Affiliation(s)
- H Aubert
- Clinique dermatologique, CHU de Nantes, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France; Centre de compétence syndromes hyperéosinophiliques, CHU de Nantes, 44000 Nantes, France.
| | - M Hamidou
- Centre de compétence syndromes hyperéosinophiliques, CHU de Nantes, 44000 Nantes, France; Service de médecine interne, CHU de Nantes, 44000 Nantes, France
| | - S Barbarot
- Clinique dermatologique, CHU de Nantes, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France; Centre de compétence syndromes hyperéosinophiliques, CHU de Nantes, 44000 Nantes, France
| | - N Piriou
- Service de cardiologie, CHU de Nantes, 44000 Nantes, France
| | - M Lefebvre
- Service de maladies infectieuses et tropicales, CHU de Nantes, 44000 Nantes, France
| | - A Néel
- Centre de compétence syndromes hyperéosinophiliques, CHU de Nantes, 44000 Nantes, France; Service de médecine interne, CHU de Nantes, 44000 Nantes, France
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16
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Fernandes GC, Alejandro Pajares W, Amboss N, Salerno TA, Mendoza C. Right atrial myxoma with peripheral eosinophilia: Eosinophilia in cardiac myxoma. J Card Surg 2019; 35:507-510. [DOI: 10.1111/jocs.14405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Natalia Amboss
- Department of MedicineFaculdade de Medicina Souza Marques Rio de Janeiro Brazil
| | - Tomas A. Salerno
- Department of Cardiothoracic SurgeryJackson Memorial Hospital Miami Florida
| | - Cesar Mendoza
- Division of CardiologyJackson Memorial Hospital Miami Florida
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17
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Kroegel C, Foerster M, Quickert S, Slevogt H, Neumann T. [Vasculitides and eosinophilic pulmonary diseases]. Internist (Berl) 2019; 59:898-910. [PMID: 30140942 DOI: 10.1007/s00108-018-0479-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Eosinophilic granulocytes form peripheral effector cells controlled by Th2 lymphocytes, which cause local cell, tissue, and functional disorders of infiltrated organs via the release of cytotoxic basic proteins and oxygen radicals. Diseases associated with eosinophilia include systemic and organ-related forms. The lungs are involved in eosinophilic granulomatosis with polyangiitis (EGPA, formerly known as Churg-Strauss syndrome), acute and chronic eosinophilic pneumonia, as well as in an organ manifestation in hypereosinophilic syndrome and certain parasitic diseases. In particular, the lungs are frequently affected in vasculitis of small vessels, including EGPA, granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA). Among these, EGPA is the most frequent pulmonary eosinophil vasculitis representative. In addition, there are various overlap syndromes in which characteristic features of EGPA can be detected in the context of other anti-neutrophil cytoplasmic antibody (ANCA-)associated vasculitides. Occasionally, non-ANCA-associated pulmonary vasculitides occur with eosinophilia (e.g., Schönlein-Henoch purpura, Kawasaki disease, drug-induced hypersensitivity, and paraneoplastic syndrome). Herein, the pulmonary vasculitides accompanying eosinophilia are presented with respect to both the lung manifestations and pulmonary eosinophilia.
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Affiliation(s)
- C Kroegel
- Abt. Pneumologie & Allergologie/Immunologie, Medizinische Klinik I, Klinikum der Universität Jena, Am Klinikum 1, 07740, Jena, Deutschland.
| | - M Foerster
- Abt. Pneumologie & Allergologie/Immunologie, Medizinische Klinik I, Klinikum der Universität Jena, Am Klinikum 1, 07740, Jena, Deutschland
| | - S Quickert
- Abt. Gastroenterologie, Hepatologie, Infektiologie, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - H Slevogt
- AG Host Septomics, Universitätsklinikum Jena, Jena, Deutschland
| | - T Neumann
- Abt. für Rheumatologie, Immunologie und Rehabilitation, Kantonsspital St. Gallen, St. Gallen, Schweiz
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18
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Kroegel C, Foerster M, Quickert S, Slevogt H, Neumann T. [Vasculitides and eosinophilic pulmonary diseases]. Z Rheumatol 2018; 77:907-922. [PMID: 30367242 DOI: 10.1007/s00393-018-0561-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Eosinophilic granulocytes form peripheral effector cells controlled by Th2 lymphocytes, which cause local cell, tissue, and functional disorders of infiltrated organs via the release of cytotoxic basic proteins and oxygen radicals. Diseases associated with eosinophilia include systemic and organ-related forms. The lungs are involved in eosinophilic granulomatosis with polyangiitis (EGPA, formerly known as Churg-Strauss syndrome), acute and chronic eosinophilic pneumonia, as well as in an organ manifestation in hypereosinophilic syndrome and certain parasitic diseases. In particular, the lungs are frequently affected in vasculitis of small vessels, including EGPA, granulomatosis with polyangiitis (GPA), and microscopic polyangiitis (MPA). Among these, EGPA is the most frequent pulmonary eosinophil vasculitis representative. In addition, there are various overlap syndromes in which characteristic features of EGPA can be detected in the context of other anti-neutrophil cytoplasmic antibody (ANCA-)associated vasculitides. Occasionally, non-ANCA-associated pulmonary vasculitides occur with eosinophilia (e.g., Schönlein-Henoch purpura, Kawasaki disease, drug-induced hypersensitivity, and paraneoplastic syndrome). Herein, the pulmonary vasculitides accompanying eosinophilia are presented with respect to both the lung manifestations and pulmonary eosinophilia.
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Affiliation(s)
- C Kroegel
- Abt. Pneumologie & Allergologie/Immunologie, Medizinische Klinik I, Klinikum der Universität Jena, Am Klinikum 1, 07740, Jena, Deutschland.
| | - M Foerster
- Abt. Pneumologie & Allergologie/Immunologie, Medizinische Klinik I, Klinikum der Universität Jena, Am Klinikum 1, 07740, Jena, Deutschland
| | - S Quickert
- Abt. Gastroenterologie, Hepatologie, Infektiologie, Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - H Slevogt
- AG Host Septomics, Universitätsklinikum Jena, Jena, Deutschland
| | - T Neumann
- Abt. für Rheumatologie, Immunologie und Rehabilitation, Kantonsspital St. Gallen, St. Gallen, Schweiz
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19
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Abughanimeh O, Tahboub M, Abu Ghanimeh M. Metastatic Lung Adenocarcinoma Presenting with Hypereosinophilia. Cureus 2018; 10:e2866. [PMID: 30148018 PMCID: PMC6107036 DOI: 10.7759/cureus.2866] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Lung cancer is one of the most common malignancies in both male and female patients. It is classified into small cell lung cancers and non-small cell lung cancers. Lung adenocarcinoma is a subtype of non-small cell lung cancer and accounts for the highest prevalence of lung cancer. Eosinophils are white blood cells (WBCs) that originate from the granulocytic lineage. Hypereosinophilia is a rare condition characterized by an absolute eosinophil count (AEC) of more than 1500 cells/µL. This is different from eosinophilia, which is defined as an absolute eosinophil count of more than 500 cells/µL. Hypereosinophilia is associated with several conditions, including allergic disorders, helminth infections, rheumatologic disorders, and hematologic malignancies. Paraneoplastic eosinophilia is a rare finding in solid malignancies. Herein, we report the case of a 55-year-old male who presented with shortness of breath and chest pain and whose workup showed metastatic lung adenocarcinoma associated with hypereosinophilia in the absence of a primary bone marrow disorder.
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Affiliation(s)
- Omar Abughanimeh
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mohammad Tahboub
- Internal Medicine, University of Missouri at Kansas City, Kansas City, USA
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20
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21
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Varricchi G, Galdiero MR, Loffredo S, Lucarini V, Marone G, Mattei F, Marone G, Schiavoni G. Eosinophils: The unsung heroes in cancer? Oncoimmunology 2017; 7:e1393134. [PMID: 29308325 DOI: 10.1080/2162402x.2017.1393134] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 12/16/2022] Open
Abstract
Prolonged low-grade inflammation or smoldering inflammation is a hallmark of a cancer. Eosinophils are components of the immune microenvironment that modulates tumor initiation and progression. Although canonically associated with a detrimental role in allergic disorders, these cells can induce a protective immune response against helminthes, viral and bacterial pathogens. Eosinophils are a source of anti-tumorigenic (e.g., TNF-α, granzyme, cationic proteins, and IL-18) and protumorigenic molecules (e.g., pro-angiogenic factors) depending on the milieu. In several neoplasias (e.g., melanoma, gastric, colorectal, oral and prostate cancer) eosinophils play an anti-tumorigenic role, in others (e.g., Hodgkin's lymphoma, cervical carcinoma) have been linked to poor prognosis, whereas in yet others they are apparently innocent bystanders. These seemingly conflicting results suggest that the role of eosinophils and their mediators could be cancer-dependent. The microlocalization (e.g., peritumoral vs intratumoral) of eosinophils could be another important aspect in the initiation/progression of solid and hematological tumors. Increasing evidence in experimental models indicates that activation/recruitment of eosinophils could represent a new therapeutic strategy for certain tumors (e.g., melanoma). Many unanswered questions should be addressed before we understand whether eosinophils are an ally, adversary or neutral bystanders in different types of human cancers.
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Affiliation(s)
- Gilda Varricchi
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Maria Rosaria Galdiero
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Stefania Loffredo
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Valeria Lucarini
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Giancarlo Marone
- Department of Public Health, University of Naples Federico II, Naples, Italy.,Monaldi Hospital Pharmacy, Naples, Italy
| | - Fabrizio Mattei
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Gianni Marone
- Department of Translational Medical Sciences (DiSMeT), University of Naples Federico II, Naples, Italy.,Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology "Gaetano Salvatore", National Research Council (CNR), Naples, Italy
| | - Giovanna Schiavoni
- Department of Oncology and Molecular Medicine, Istituto Superiore di Sanità, Rome, Italy
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22
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Nakayasu H, Shirai T, Tanaka Y, Saigusa M. Chronic eosinophilic pneumonia after radiation therapy for squamous cell lung cancer. Respir Med Case Rep 2017; 22:147-149. [PMID: 28831373 PMCID: PMC5552058 DOI: 10.1016/j.rmcr.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/02/2017] [Accepted: 08/02/2017] [Indexed: 11/28/2022] Open
Abstract
Reports of chronic eosinophilic pneumonia (CEP) after radiation therapy are limited to breast cancer. We herein describe a case of CEP after radiation therapy for lung cancer. The patient was a 65-year-old man who had asymptomatic peripheral blood eosinophilia but no history of asthma or allergy. One month after completion of radiation therapy, chest CT scan revealed infiltrates inside the irradiated area, leading to the diagnosis of radiation pneumonitis. His condition improved after receiving corticosteroids. However, one months after withdrawal of corticosteroids, he noticed cough and shortness of breath with patchy ground glass opacity in the contralateral lung. The WBC count was 9900/μl with 17% eosinophils and bronchoalveolar lavage showed eosinophils of 14%, leading to the diagnosis of CEP. His condition improved after receiving corticosteroids and subsequent tapering without recurrence. Asymptomatic peripheral blood eosinophilia at the initial diagnosis of lung cancer might be a trigger for developing CEP.
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Affiliation(s)
- Hiromasa Nakayasu
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Toshihiro Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Yuko Tanaka
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Mika Saigusa
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
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23
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Enoki E, Kimura M, Yaguchi T. Squamous cell carcinoma of the lung associated with non-invasive aspergillosis and localised and peripheral blood eosinophilia. Cytopathology 2017; 28:347-348. [PMID: 28217878 DOI: 10.1111/cyt.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- E Enoki
- Clinical Research Center, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan.,Department of Pathology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - M Kimura
- Department of Pathology, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - T Yaguchi
- Medical Mycology Research Center, Chiba University, Chiba, Japan
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24
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Eng SS, DeFelice ML. The Role and Immunobiology of Eosinophils in the Respiratory System: a Comprehensive Review. Clin Rev Allergy Immunol 2016; 50:140-58. [PMID: 26797962 DOI: 10.1007/s12016-015-8526-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The eosinophil is a fully delineated granulocyte that disseminates throughout the bloodstream to end-organs after complete maturation in the bone marrow. While the presence of eosinophils is not uncommon even in healthy individuals, these granulocytes play a central role in inflammation and allergic processes. Normally appearing in smaller numbers, higher levels of eosinophils in the peripheral blood or certain tissues typically signal a pathologic process. Eosinophils confer a beneficial effect on the host by enhancing immunity against molds and viruses. However, tissue-specific elevation of eosinophils, particularly in the respiratory system, can cause a variety of short-term symptoms and may lead to long-term sequelae. Eosinophils often play a role in more commonly encountered disease processes, such as asthma and allergic responses in the upper respiratory tract. They are also integral in the pathology of less common diseases including eosinophilic pneumonia, allergic bronchopulmonary aspergillosis, hypersensitivity pneumonitis, and drug reaction with eosinophilia and systemic symptoms. They can be seen in neoplastic disorders or occupational exposures as well. The involvement of eosinophils in pulmonary disease processes can affect the method of diagnosis and the selection of treatment modalities. By analyzing the complex interaction between the eosinophil and its environment, which includes signaling molecules and tissues, different therapies have been discovered and created in order to target disease processes at a cellular level. Innovative treatments such as mepolizumab and benralizumab will be discussed. The purpose of this article is to further explore the topic of eosinophilic presence, activity, and pathology in the respiratory tract, as well as discuss current and future treatment options through a detailed literature review.
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Affiliation(s)
- Stephanie S Eng
- Thomas Jefferson University, Philadelphia, PA, USA
- Division of Allergy and Immunology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA
| | - Magee L DeFelice
- Thomas Jefferson University, Philadelphia, PA, USA.
- Division of Allergy and Immunology, Nemours/AI duPont Hospital for Children, Wilmington, DE, USA.
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25
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Ibrahim U, Asti D, Saqib A, Mudduluru BM, Ayaz S, Odaimi M. Eosinophilia as the presenting sign in pancreatic cancer: an extremely rare occurrence. Postgrad Med 2016; 129:399-401. [PMID: 27718779 DOI: 10.1080/00325481.2017.1246345] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A case of pancreatic adenocarcinoma diagnosed following work up for eosinophilia is reported. A 68-year-old female was referred to our Hematology clinic for an absolute eosinophil count of 1869 per microliter. No allergic signs or symptoms were reported. Laboratory studies for parasitic infestations autoimmune disease and collagen vascular disease were negative. Computed tomography of the abdomen revealed a mass in the neck of the pancreas with fine needle aspiration biopsy consistent with adenocarcinoma. The patient received one cycle of modified FOLFIRINOX with complete resolution of the eosinophilia. There are rare case reports of tumor-associated blood eosinophilia in solid malignancies. The finding may be indicative of rapid disease progression and poor prognosis. Our case is the third in published English literature with eosinophilia being the initial finding in pancreatic cancer.
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Affiliation(s)
- Uroosa Ibrahim
- a Department of Hematology/Oncology , Staten Island University Hospital , Staten Island , NY , USA
| | - Divya Asti
- b Department of Medicine , Staten Island University Hospital , Staten Island , NY , USA
| | - Amina Saqib
- c Department of Pulmonary/Critical Care Medicine , Staten Island University Hospital , Staten Island , NY , USA
| | | | - Sadaf Ayaz
- b Department of Medicine , Staten Island University Hospital , Staten Island , NY , USA
| | - Marcel Odaimi
- a Department of Hematology/Oncology , Staten Island University Hospital , Staten Island , NY , USA
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26
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Baburao A, Narayanswamy H. Clinico-Pathological Profile and Haematological Abnormalities Associated with Lung Cancer in Bangalore, India. Asian Pac J Cancer Prev 2016; 16:8235-8. [PMID: 26745066 DOI: 10.7314/apjcp.2015.16.18.8235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung cancer is one of the most common types of cancer causing high morbidity and mortality worldwide. An increasing incidence of lung cancer has been observed in India. OBJECTIVES To evaluate the clinic- pathological profile and haematological abnormalities associated with lung cancer in Bangalore, India. MATERIALS AND METHODS This prospective study was carried out over a period of 2 years. A total of 96 newly diagnosed and histopathologically confirmed cases of lung cancer were included in the study. RESULTS Our lung cancer cases had a male to female ratio of 3:1. Distribution of age varied from 40 to 90 years, with a major contribution in the age group between 61 and 80 years (55.2%). Smoking was the commonest risk factor found in 69.7% of patients. The most frequent symptom was cough (86.4%) followed by loss of weight and appetite (65.6%) and dyspnea (64.5%). The most common radiological presentation was a mass lesion (55%). The most common histopathological type was squamous cell carcinoma (47.9%), followed by adenocarcinoma (28.1%) and small cell carcinoma (12.5%). Distant metastasis at presentation was seen in 53.1% patients. Among the haematological abnormalities, anaemia was seen in 61.4% of patients, leucocytosis in 36.4%, thrombocytosis in 14.5% and eosinophilia in 19.7% of patients. Haematological abnormalities were more commonly seen in non small cell lung cancer. CONCLUSIONS Squamous cell carcinoma was found to be the most common histopathological type and smoking still remains the major risk factor for lung cancer. Haematological abnormalities are frequently observed in lung cancer patients, anaemia being the commonest of all.
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Affiliation(s)
- Archana Baburao
- Department of Pulmonary Medicine, Kempegowda Institute of Medical Sciences, Bangalore, India E-mail :
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27
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Abstract
Eosinophilia in the peripheral blood can be the manifestation various medical conditions, including benign or malignant disorders. There are 3 main types of eosinophilia-associated myeloid neoplasms (MN-eos): myeloid and lymphoid neoplasms, chronic eosinophilic leukemia not otherwise specified, and idiopathic hypereosinophilic syndrome (HES). Imatinib mesylate has revolutionized the treatment of molecularly defined MN-eos, and novel agents have been successfully used to treat HES. The discovery of new, recurrent molecular alterations in patients with MN-eos may improve their diagnosis and therapy. This review focuses on the hematologist's approach to a patient with eosinophilia and treatment options for those with eosinophilic myeloid neoplasms.
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Affiliation(s)
- Lorenzo Falchi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Srdan Verstovsek
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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28
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Abstract
The symptomatic hypereosinophilic patient must be approached in a stepwise manner, with thorough assessment to determine whether the hypereosinophilia itself is contributing to damage and disease manifestations (thereby defining a hypereosinophilic syndrome), and to identify an eventual cause of hypereosinophilia, followed by initiation of treatment directed against the underlying condition or deleterious hypereosinophilic state. Situations encountered in the clinic are extremely heterogeneous because of the numerous potential causes of hypereosinophilia and the variable spectrum of eosinophil-mediated organ damage. A practical approach to many of these situations is presented in this review.
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29
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Zhou WW, Guan YY, Liu XM. Paraneoplastic Eosinophilia in Clear Cell Renal Cell Carcinoma. Chin Med J (Engl) 2016; 128:2271-2. [PMID: 26265628 PMCID: PMC4717976 DOI: 10.4103/0366-6999.162501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Xin-Min Liu
- Department of Geriatrics, Peking University First Hospital, Beijing 100034, China
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30
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Hibino M, Ito R, Kondo T. Hypereosinophilic Pulmonary Carcinomatous Lymphangitis Mimicking Acute Eosinophilic Pneumonia. Am J Respir Crit Care Med 2015; 192:761-2. [PMID: 26371814 DOI: 10.1164/rccm.201503-0527im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Makoto Hibino
- 1 Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan; and
| | - Ryoji Ito
- 2 Department of General Medicine, Shonan Kamakura General Hospital, Ofuna, Japan
| | - Tetsuri Kondo
- 1 Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan; and
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31
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Zaynagetdinov R, Sherrill TP, Gleaves LA, McLoed AG, Saxon JA, Habermann AC, Connelly L, Dulek D, Peebles RS, Fingleton B, Yull FE, Stathopoulos GT, Blackwell TS. Interleukin-5 facilitates lung metastasis by modulating the immune microenvironment. Cancer Res 2015; 75:1624-1634. [PMID: 25691457 DOI: 10.1158/0008-5472.can-14-2379] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/30/2015] [Indexed: 01/02/2023]
Abstract
Although the lung is the most common metastatic site for cancer cells, biologic mechanisms regulating lung metastasis are not fully understood. Using heterotopic and intravenous injection models of lung metastasis in mice, we found that IL5, a cytokine involved in allergic and infectious diseases, facilitates metastatic colonization through recruitment of sentinel eosinophils and regulation of other inflammatory/immune cells in the microenvironment of the distal lung. Genetic IL5 deficiency offered marked protection of the lungs from metastasis of different types of tumor cells, including lung cancer, melanoma, and colon cancer. IL5 neutralization protected subjects from metastasis, whereas IL5 reconstitution or adoptive transfer of eosinophils into IL5-deficient mice exerted prometastatic effects. However, IL5 deficiency did not affect the growth of the primary tumor or the size of metastatic lesions. Mechanistic investigations revealed that eosinophils produce CCL22, which recruits regulatory T cells to the lungs. During early stages of metastasis, Treg created a protumorigenic microenvironment, potentially by suppressing IFNγ-producing natural killer cells and M1-polarized macrophages. Together, our results establish a network of allergic inflammatory circuitry that can be co-opted by metastatic cancer cells to facilitate lung colonization, suggesting interventions to target this pathway may offer therapeutic benefits to prevent or treat lung metastasis.
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Affiliation(s)
- Rinat Zaynagetdinov
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA, 37232
| | - Taylor P Sherrill
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA, 37232
| | - Linda A Gleaves
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA, 37232
| | - Allyson G McLoed
- Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA, 37232
| | - Jamie A Saxon
- Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA, 37232
| | - Arun C Habermann
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA, 37232
| | - Linda Connelly
- Department of Pharmaceutical Sciences, University of Hawaii, Hilo, Hawaii, USA, 96720
| | - Daniel Dulek
- Department of Pediatrics, Vanderbilt University, Nashville, TN, USA, 37232
| | - R Stokes Peebles
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA, 37232.,U.S. Department of Veterans Affairs
| | - Barbara Fingleton
- Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA, 37232
| | - Fiona E Yull
- Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA, 37232.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA, 37232
| | - Georgios T Stathopoulos
- Laboratory for Molecular Respiratory Carcinogenesis, Department of Physiology, University of Patras, 26504 Rio, Greece
| | - Timothy S Blackwell
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA, 37232.,Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA, 37232.,U.S. Department of Veterans Affairs.,Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN, USA, 37232.,Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA, 37232
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32
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Kim SJ, Bista AB, Park KJ, Kang DK, Park JH, Park KJ, Sun JS. Simple pulmonary eosinophilia found on follow-up computed tomography of oncologic patients. Eur J Radiol 2014; 83:1977-82. [PMID: 25082475 DOI: 10.1016/j.ejrad.2014.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Revised: 07/01/2014] [Accepted: 07/04/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the prevalence of simple pulmonary eosinophilia (SPE) and validate CT findings of SPE found on follow-up CT of oncologic patients. METHODS We retrospectively reviewed 6977 cases of oncologic patients who underwent chest CT. A total of 66 individuals who met criteria for having SPE were identified. CT scans were fully re-assessed by consensus of 2 radiologists in terms of characteristics of pulmonary lesions. RESULTS The prevalence of SPE was 0.95%. A total of 193 lesions were identified and most of the lesions showed part-solid pattern (69.9%), round to ovoid contour (46.1%), ill-defined margin (90.2%), or partial halo appearance (74.8%). In addition, almost half of the lesions showed the vascular contact (49%). SPE appeared as either solitary (42.4%) or multiple lesions (57.6%). The majority of lesions were located in the periphery (76.2%), and lower lung zonal (67.4%) predominance was found. CONCLUSIONS The frequency of SPE in oncologic patients with CT findings of GGO, part-solid lesion was high (17.5%). Therefore, when key features of CT findings suggesting SPE (part-solid nodule; ill-defined margin; peripheral distribution; and lower lung zone predominance) are newly discovered on follow-up chest CT in oncologic patients, it would be useful to correlate with blood test and do short-term follow-up in order to avoid unnecessary invasive procedure.
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Affiliation(s)
- Sung Jung Kim
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | | | - Kyung Joo Park
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Doo Kyoung Kang
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Joo Hun Park
- Department of Pulmonology and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kwang Joo Park
- Department of Pulmonology and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Joo Sung Sun
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea.
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Wei YB, Yan B, Yin Z, Yang JR. Chromophobe renal cell carcinoma associated with eosinophilia: A report of three cases. Exp Ther Med 2014; 8:91-94. [PMID: 24944603 PMCID: PMC4061223 DOI: 10.3892/etm.2014.1725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/14/2014] [Indexed: 12/29/2022] Open
Abstract
Eosinophilia is typically associated with allergic reactions, parasitic infestations, certain forms of vasculitis, the use of certain medications and hematologic malignancies. In addition to eosinophilia associated with gastrointestinal tumors, lung cancer and thyroid carcinoma in solid malignancies, there are a limited number of cases describing peripheral hypereosinophilia in urologic tumors. The present study reports three cases of eosinophilia in patients with chromophobe renal cell carcinoma (CRCC) and investigates the association between excessive eosinophilia and the recurrence and prognosis of renal carcinoma. This is the first report of CRCC associated with excessive eosinophilia. Eosinophilia following tumor resectioning may indicate a poor prognosis, tumor recurrence and rapid disease progression.
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Affiliation(s)
- Yong-Bao Wei
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Bin Yan
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Zhuo Yin
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Jin-Rui Yang
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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Montgomery ND, Dunphy CH, Mooberry M, Laramore A, Foster MC, Park SI, Fedoriw YD. Diagnostic Complexities of Eosinophilia. Arch Pathol Lab Med 2013; 137:259-69. [DOI: 10.5858/arpa.2011-0597-ra] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.— The advent of molecular tools capable of subclassifying eosinophilia has changed the diagnostic and clinical approach to what was classically called hypereosinophilic syndrome.Objectives.— To review the etiologies of eosinophilia and to describe the current diagnostic approach to this abnormality.Data Sources.— Literature review.Conclusions.— Eosinophilia is a common, hematologic abnormality with diverse etiologies. The underlying causes can be broadly divided into reactive, clonal, and idiopathic. Classically, many cases of eosinophilia were grouped together into the umbrella category of hypereosinophilic syndrome, a clinical diagnosis of exclusion. In recent years, an improved mechanistic understanding of many eosinophilias has revolutionized the way these disorders are understood, diagnosed, and treated. As a result, specific diagnoses can now be assigned in many cases that were previously defined as hypereosinophilic syndrome. Most notably, chromosomal rearrangements, such as FIP1L1-PDGFRA fusions caused by internal deletions in chromosome 4, are now known to be associated with many chronic eosinophilic leukemias. When present, these specific molecular abnormalities predict response to directed therapies. Although an improved molecular understanding is revolutionizing the treatment of patients with rare causes of eosinophilia, it has also complicated the approach to evaluating and treating eosinophilia. Here, we review causes of eosinophilia and present a framework by which the practicing pathologist may approach this diagnostic dilemma. Finally, we consider recent cases as clinical examples of eosinophilia from a single institution, demonstrating the diversity of etiologies that must be considered.
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Affiliation(s)
- Nathan D. Montgomery
- From the Departments of Pathology and Laboratory Medicine, Division of Hematopathology (Drs Montgomery, Dunphy, Laramore, and Fedoriw); and Medicine, Division of Hematology and Oncology (Drs Mooberry, Foster, and Park), University of North Carolina School of Medicine, Chapel Hill
| | - Cherie H. Dunphy
- From the Departments of Pathology and Laboratory Medicine, Division of Hematopathology (Drs Montgomery, Dunphy, Laramore, and Fedoriw); and Medicine, Division of Hematology and Oncology (Drs Mooberry, Foster, and Park), University of North Carolina School of Medicine, Chapel Hill
| | - Micah Mooberry
- From the Departments of Pathology and Laboratory Medicine, Division of Hematopathology (Drs Montgomery, Dunphy, Laramore, and Fedoriw); and Medicine, Division of Hematology and Oncology (Drs Mooberry, Foster, and Park), University of North Carolina School of Medicine, Chapel Hill
| | - Andrew Laramore
- From the Departments of Pathology and Laboratory Medicine, Division of Hematopathology (Drs Montgomery, Dunphy, Laramore, and Fedoriw); and Medicine, Division of Hematology and Oncology (Drs Mooberry, Foster, and Park), University of North Carolina School of Medicine, Chapel Hill
| | - Matthew C. Foster
- From the Departments of Pathology and Laboratory Medicine, Division of Hematopathology (Drs Montgomery, Dunphy, Laramore, and Fedoriw); and Medicine, Division of Hematology and Oncology (Drs Mooberry, Foster, and Park), University of North Carolina School of Medicine, Chapel Hill
| | - Steven I. Park
- From the Departments of Pathology and Laboratory Medicine, Division of Hematopathology (Drs Montgomery, Dunphy, Laramore, and Fedoriw); and Medicine, Division of Hematology and Oncology (Drs Mooberry, Foster, and Park), University of North Carolina School of Medicine, Chapel Hill
| | - Yuri D. Fedoriw
- From the Departments of Pathology and Laboratory Medicine, Division of Hematopathology (Drs Montgomery, Dunphy, Laramore, and Fedoriw); and Medicine, Division of Hematology and Oncology (Drs Mooberry, Foster, and Park), University of North Carolina School of Medicine, Chapel Hill
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Rapidly evolving asymptomatic eosinophilia in a patient with lung adenocarcinoma causes cognitive disturbance and respiratory insufficiency: Case report. Oncol Lett 2012; 5:495-498. [PMID: 23420572 PMCID: PMC3573146 DOI: 10.3892/ol.2012.1020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 10/31/2012] [Indexed: 12/28/2022] Open
Abstract
Paraneoplastic eosinophilia is an unusual manifestation that usually remains asymptomatic. In this report, we presented the case of an 82-year-old patient with poorly differentiated lung adenocarcinoma and asymptomatic eosinophilia. The patient’s condition worsened rapidly over a week, with episodes of cognitive disturbance, shortness of breath and acute kidney dysfunction. These symptoms were associated with a 4-fold increase in circulating eosinophil counts. The poor condition hindered further anticancer treatment. Treatment of the eosinophilia with corticosteroids and hydroxyurea significantly reduced circulating eosinophil counts to below the initial levels. Results of this case report suggested that lung cancer patients should be monitored closely for rapidly worsening symptoms of cognitive disturbance and respiratory insufficiency as signs of life-threatening asymptomatic eosinophilia, in order to initiate corticosteroid treatment.
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Roufosse F, Garaud S, de Leval L. Lymphoproliferative disorders associated with hypereosinophilia. Semin Hematol 2012; 49:138-48. [PMID: 22449624 DOI: 10.1053/j.seminhematol.2012.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hypereosinophilia, defined as peripheral blood eosinophil counts > 1,500/μL, may complicate the course of various lymphoproliferative disorders. Among these, Hodgkin lymphoma (HL) and certain peripheral T-cell lymphomas (PTCLs) derived from CD4 cells, including Sezary syndrome (SS), adult T-cell leukemia/lymphoma (ATLL), and angioimmunoblastic T-cell lymphoma (AITL), are most commonly associated with increased reactive eosinophilopoiesis. Rarely, marked hypereosinophilia (HE) may occur in the setting of acute B-cell lymphoblastic leukemia, with a substantial impact on disease course. The mechanisms leading to blood and tissue eosinophilia in the setting of lymphoproliferative disorders, as well as the clinical complications and prognostic implications of hypereosinophilia, are discussed in this review.
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Affiliation(s)
- Florence Roufosse
- Department of Internal Medicine, Hôpital Erasme, Université Libre de Bruxelles, 808 Route de Lennik, B-1070 Brussels, Belgium.
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Abstract
Accurate diagnosis of eosinophilic lung diseases is essential to optimizing patient outcomes, but remains challenging. Signs and symptoms frequently overlap among the disorders, and because these disorders are infrequent, expertise is difficult to acquire. Still, these disorders are not rare, and most clinicians periodically encounter patients with one or more of the eosinophilic lung diseases and need to understand how to recognize, diagnose, and manage these diseases. This review focuses on the clinical features, general diagnostic workup, and management of the eosinophilic lung diseases.
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Affiliation(s)
- Evans R Fernández Pérez
- Interstitial Lung Disease Program, Autoimmune Lung Center, National Jewish Health, Denver, CO 80206, USA.
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Curran CS, Evans MD, Bertics PJ. GM-CSF production by glioblastoma cells has a functional role in eosinophil survival, activation, and growth factor production for enhanced tumor cell proliferation. THE JOURNAL OF IMMUNOLOGY 2011; 187:1254-63. [PMID: 21705618 DOI: 10.4049/jimmunol.1001965] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Medicinal interventions of limited efficacy are currently available for the treatment of glioblastoma multiforme (GBM), the most common and lethal primary brain tumor in adults. The eosinophil is a pivotal immune cell in the pathobiology of atopic disease that is also found to accumulate in certain tumor tissues. Inverse associations between atopy and GBM risk suggest that the eosinophil may play a functional role in certain tumor immune responses. To assess the potential interactions between eosinophils and GBM, we cultured human primary blood eosinophils with two separate human GBM-derived cell lines (A172, U87-MG) or conditioned media generated in the presence or absence of TNF-α. Results demonstrated differential eosinophil adhesion and increased survival in response to coculture with GBM cell lines. Eosinophil responses to GBM cell line-conditioned media included increased survival, activation, CD11b expression, and S100A9 release. Addition of GM-CSF neutralizing Abs to GBM cell cultures or conditioned media reduced eosinophil adhesion, survival, and activation, linking tumor cell-derived GM-CSF to the functions of eosinophils in the tumor microenvironment. Dexamethasone, which has been reported to inhibit eosinophil recruitment and shrink GBM lesions on contrast-enhanced scans, reduced the production of tumor cell-derived GM-CSF. Furthermore, culture of GBM cells in eosinophil-conditioned media increased tumor cell viability, and generation of eosinophil-conditioned media in the presence of GM-CSF enhanced the effect. These data support the idea of a paracrine loop between GM-CSF-producing tumors and eosinophil-derived growth factors in tumor promotion/progression.
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Affiliation(s)
- Colleen S Curran
- Department of Animal Health and Biomedical Sciences, University of Wisconsin, Madison, WI 53706, USA
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Liu SH, Wang J, Cui ZB, Ji JF, Li SY. Rectum tumor with marked blood eosinophilia: a case report. Shijie Huaren Xiaohua Zazhi 2010; 18:1948-1950. [DOI: 10.11569/wcjd.v18.i18.1948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the clinical characteristics of blood eosinophilia associated with rectum tumor.
METHODS: A case of rectum tumor with peripheral blood eosinophilia was analyzed. A literature review was also performed to summarize the clinical characteristics of the disease.
RESULTS: An 82-year-old male patient presented with difficult defecation and purulent bloody stools. The number of eosinophils in the peripheral blood increased (percentage: 55.1%; absolute value: 2.41 × 109/L). Colonoscopy revealed a rectum tumor located 10-13 cm from the anus. The enteric cavity became narrow. As a result, the colonoscope could not pass through the narrow segment. Based on pathological examination, a diagnosis of rectum adenocarcinoma was made.
CONCLUSION: Malignant tumors, such as rectum tumor, can result in an increase in the number of eosinophils.
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41
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Extreme eosinophilia caused by interleukin-5-producing disseminated colon cancer. Int J Hematol 2010; 91:328-30. [DOI: 10.1007/s12185-010-0491-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 12/10/2009] [Accepted: 12/27/2009] [Indexed: 02/07/2023]
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El-Osta H, El-Haddad P, Nabbout N. Lung carcinoma associated with excessive eosinophilia. J Clin Oncol 2008; 26:3456-7. [PMID: 18612162 DOI: 10.1200/jco.2007.15.8899] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Hazem El-Osta
- University of Kansas School of Medicine Wichita, Wichita, Kansas, USA
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