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Chibuzo INC, Healy R, Hatimy U, Tang VC. Hypercalcemia-leukocytosis syndrome from non-schistosomiasis-associated squamous cell carcinoma of the urinary bladder: a case report and review of the literature. J Med Case Rep 2023; 17:133. [PMID: 37041610 PMCID: PMC10091549 DOI: 10.1186/s13256-023-03860-x] [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: 07/24/2022] [Accepted: 02/28/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Non-schistosomiasis-associated squamous cell carcinoma of the urinary bladder is less common in the Western world. Limited information on its possible paraneoplastic syndromes exists. Leukocytosis tends to commonly be regarded by clinicians as an indication of sepsis, rather than a feature of paraneoplasia, potential surrogate marker for recurrence, and prognostic marker. Accompanying hypercalcemia may be missed entirely. CASE PRESENTATION A 66-year-old Caucasian man presented with visible painless hematuria and symptomatic hypercalcemia. Investigations revealed a squamous cell carcinoma of the urinary bladder with marked leukocytosis. Hypercalcemia and leukocytosis resolved following radical cystectomy, recurred with nodal recurrence and regressed with radiotherapeutic control. Subsequently, serum leukocyte and calcium assays were included in his follow-up protocol. His survival was 20 months by the time of the report. CONCLUSION This report highlights hypercalcemia-leukocytosis syndrome as a paraneoplastic manifestation of non-schistosomiasis-associated squamous cell carcinoma to reemphasize the need for clinicians to assay for calcium in the presence of leukocytosis in such patients. Prompt identification and control of the paraneoplastic derangements, with treatment of the cancer recurrence it may connote, is advocated to provide a chance for better long-term outcomes in these patients.
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Affiliation(s)
- Ijeoma N C Chibuzo
- Department of Urology, Stepping Hill Hospital, Poplar Grove, Stockport, SK27JE, UK.
| | - Rion Healy
- Department of Urology, Stepping Hill Hospital, Poplar Grove, Stockport, SK27JE, UK
| | - Umi Hatimy
- Department of Pathology, Stepping Hill Hospital, Poplar Grove, Stockport, SK2 7JE, UK
| | - Vincent C Tang
- Department of Urology, Stepping Hill Hospital, Poplar Grove, Stockport, SK27JE, UK
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He K, Liu X, Hoffman RD, Shi RZ, Lv GY, Gao JL. G-CSF/GM-CSF-induced hematopoietic dysregulation in the progression of solid tumors. FEBS Open Bio 2022; 12:1268-1285. [PMID: 35612789 PMCID: PMC9249339 DOI: 10.1002/2211-5463.13445] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022] Open
Abstract
There are two types of abnormal hematopoiesis in solid tumor occurrence and treatment: pathological hematopoiesis, and myelosuppression induced by radiotherapy and chemotherapy. In this review, we primarily focus on the abnormal pathological hematopoietic differentiation in cancer induced by tumor-released granulocyte colony stimulating factor (G-CSF) and granulocyte-macrophage colony stimulating factor (GM-CSF). As key factors in hematopoietic development, G-CSF/GM-CSF are well-known facilitators of myelopoiesis and mobilization of hematopoietic stem cells (HSCs). In addition, these two cytokines can also promote or inhibit tumors, dependent on tumor type. In multiple cancer types, hematopoiesis is greatly enhanced and abnormal lineage differentiation is induced by these two cytokines. Here, dysregulated hematopoiesis induced by G-CSF/GM-CSF in solid tumors and its mechanism are summarized, and the prognostic value of G-CSF/GM-CSF-associated dysregulated hematopoiesis for tumor metastasis is also briefly highlighted.
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Affiliation(s)
- Kai He
- The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Xi Liu
- School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Robert D Hoffman
- Yo San University of Traditional Chinese Medicine, Los Angeles, CA, 90066, USA
| | - Rong-Zhen Shi
- Tangqi Branch of Traditional Chinese Medicine Hospital of Yuhang District, Hangzhou, Zhejiang, 311106, China
| | - Gui-Yuan Lv
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University Hangzhou, Zhejiang, 310053, China
| | - Jian-Li Gao
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University Hangzhou, Zhejiang, 310053, China
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Pembrolizumab Treatment and Pathologic Therapeutic Evaluation for Granulocyte Colony-stimulating Factor-producing Bladder Cancer: A Case Report and Literature Review. J Immunother 2021; 43:134-138. [PMID: 32080020 DOI: 10.1097/cji.0000000000000311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Granulocyte colony-stimulating factor (G-CSF)-producing bladder cancer is a rare variant subtype of bladder cancer with a poor prognosis. Pembrolizumab has improved overall survival in bladder cancer and is widely used as a standard second-line treatment. However, no reports on G-CSF-producing cancer treated by pembrolizumab are available. We report a case of the pathologically evaluated antitumor effect of pembrolizumab, a programmed death-1 immune checkpoint inhibitor antibody, in G-CSF-producing bladder cancer. A 53-year-old male patient underwent 4 courses chemotherapy with a combination of gemcitabine and carboplatin before a radical cystectomy with ileal neobladder. Four months after the surgery, local recurrence was detected in the pelvis and therefore pembrolizumab was used. One week after its administration, the patient showed increased mucus in his urine. A computed tomography scan and cystoscopy revealed a fistula between the ileum and the neobladder. He subsequently underwent partial ileectomy and repair of the neobladder-ileum fistula. Pathology-diagnosed tumor response to pembrolizumab in the metastatic tumor showed predominant infiltration by lymphocytes, unlike that in the primary bladder cancer. The patient has shown complete response and no recurrence at 1 year after the beginning of treatment, and therapy is still continuing. Although many questions still remain regarding the treatment of G-CSF-producing bladder cancer, pathologic evaluation of the present case suggests that treatment with pembrolizumab may be one option for G-CSF-producing bladder cancer that has failed chemotherapy treatment, similar to non-G-CSF-producing bladder cancer.
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Hoshi S, Numahata K, Morozumi K, Katumata Y, Kuromoto A, Takai Y, Hoshi K, Bilim V, Sasagawa I. Bladder cancer metastasis producing beta-human chorionic gonadotropin, squamous cell carcinoma antigen, granulocyte-colony stimulating factor, and parathyroid hormone-related protein. IJU Case Rep 2018; 2:47-50. [PMID: 32743371 PMCID: PMC7292181 DOI: 10.1002/iju5.12036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/20/2018] [Indexed: 02/02/2023] Open
Abstract
Introduction In urothelial cancer, several paraneoplastic syndromes can be triggered by the aberrant expression of hormones, growth factors or lymphokines by tumor cells. Case presentation A 71‐year‐old female patient underwent radical cystectomy for muscle‐invasive urothelial cancer. Shortly after the operation, the patient presented with a leukemoid reaction and hypercalcemia. Computed tomography scans revealed a rapidly progressing tumor on the left pelvic side, and serum levels of granulocyte‐colony stimulating factor, parathyroid hormone‐related protein, and beta human chorionic gonadotropin were elevated. The patient also tested positive for serum squamous cell carcinoma antigen. Hypercalcemia was successfully treated with denosumab. However, the patient's leukocyte counts steadily increased, her condition deteriorated and she passed away. Conclusion To the best of our knowledge, this is the first report of urothelial cancer that tested positive for four tumor markers. The findings support the idea that poorly differentiated bladder carcinomas can ectopically secrete multiple proteins causing pleiotropic paraneoplastic syndromes.
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Affiliation(s)
- Senji Hoshi
- Department of UrologyYamagata Tokushukai HospitalYamagataJapan
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Kenji Numahata
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Kento Morozumi
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Yuuki Katumata
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Akito Kuromoto
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Yuuki Takai
- Department of UrologyYamagata Prefectural Central HospitalYamagataJapan
| | - Kiyotugu Hoshi
- Department of UrologyYamagata Tokushukai HospitalYamagataJapan
| | - Vladimir Bilim
- Department of UrologyKameda Daiichi HospitalNiigataJapan
| | - Isoji Sasagawa
- Department of UrologyYamagata Tokushukai HospitalYamagataJapan
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Wang D, Zhang H, Yu F, Fang B. Extreme leukocytosis and leukemoid reaction associated with the lung sarcomatoid carcinoma: an unusual case report. Int J Gen Med 2016; 10:7-9. [PMID: 28096688 PMCID: PMC5207432 DOI: 10.2147/ijgm.s102524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a rare case of extreme leukocytosis and leukemoid reaction associated with lung sarcomatoid carcinoma (LSC) and increase people’s awareness of the disease. Patients and methods A 58-year-old male patient was diagnosed with LSC; however, after the end of the second course of chemotherapy, his white blood cells increased gradually without fever or use of medications such as granulocyte colony-stimulating factor and steroids. A bone marrow biopsy then confirmed it to be a leukemoid reaction. Results The patient died of multiple organ failure 2 months after being diagnosed with leukocytosis. Conclusion LSC associated with leukemoid reaction is very rare and the prognosis is poor. When a patient’s white blood cells are extremely elevated, we should think of the possible causes of the tumor itself and identify it with other diseases. However, more data and evidence are still needed to find an effective adjuvant therapy for these patients.
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Affiliation(s)
- Danyang Wang
- Department of Hematopathy, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Haiyan Zhang
- Department of Hematopathy, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Fengkuan Yu
- Department of Hematopathy, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Baijun Fang
- Department of Hematopathy, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
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Kumar AKL, Satyan MT, Holzbeierlein J, Mirza M, Van Veldhuizen P. Leukemoid reaction and autocrine growth of bladder cancer induced by paraneoplastic production of granulocyte colony-stimulating factor--a potential neoplastic marker: a case report and review of the literature. J Med Case Rep 2014; 8:147. [PMID: 24885603 PMCID: PMC4055228 DOI: 10.1186/1752-1947-8-147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 03/03/2014] [Indexed: 12/25/2022] Open
Abstract
Introduction Granulocyte colony-stimulating factor produced by nonhematopoietic malignant cells is able to induce a leukemoid reaction by excessive stimulation of leukocyte production. Expression of granulocyte colony-stimulating factor and its functional receptors have been confirmed in bladder cancer cells. In vitro studies have demonstrated that granulocyte colony-stimulating factor/receptor exhibits a high affinity binding and this biological axis increases proliferation of the carcinoma. Urothelial carcinoma of the bladder is rarely associated with a leukemoid reaction and autocrine growth induced by paraneoplastic production of granulocyte colony-stimulating factor. In the world literature, there have been less than 35 cases reported in the last 35 years. The clinicopathological aspects, biology, prognosis and management of granulocyte colony-stimulating factor-secreting bladder cancers are poorly understood. Case presentation A 39-year-old Caucasian woman with an invasive high-grade urothelial carcinoma presented with hematuria and low-grade fevers. Laboratory tests revealed an elevated white blood cell count and absolute neutrophil count and an elevated 24-hour urine protein. Upon further evaluation she was found to have locally advanced high-grade urothelial carcinoma without nodal or distant metastasis. Her serum granulocyte colony-stimulating factor level was 10 times the normal limit. This led to the diagnosis of a paraneoplastic leukemoid reaction. Her white blood cell count immediately normalized after cystectomy but increased in concordance with recurrence of her disease. Unfortunately, she rapidly progressed and expired within 10 months from the time of first diagnosis. Conclusions This is one of the few cases reported that illustrates the existence of a distinct and highly aggressive subtype of bladder cancer which secretes granulocyte colony-stimulating factor. Patients presenting with a leukemoid reaction should be tested for granulocyte colony-stimulating factor/receptor biological axis. Moreover, granulocyte colony-stimulating factor could be a potential neoplastic marker as it can follow the clinical course of the underlying tumor and thus be useful for monitoring its evolution. Neoadjuvant chemotherapy should be considered in these patients due to the aggressive nature of these tumors. With a better understanding of the biology, this autocrine growth signal could be a potential target for therapy in future.
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Affiliation(s)
- Anup Kasi Loknath Kumar
- Division of Hematology and Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA.
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Aliper AM, Frieden-Korovkina VP, Buzdin A, Roumiantsev SA, Zhavoronkov A. A role for G-CSF and GM-CSF in nonmyeloid cancers. Cancer Med 2014; 3:737-46. [PMID: 24692240 PMCID: PMC4303143 DOI: 10.1002/cam4.239] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/08/2014] [Accepted: 03/04/2014] [Indexed: 12/17/2022] Open
Abstract
Granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) modulate progression of certain solid tumors. The G-CSF- or GM-CSF-secreting cancers, albeit not very common are, however, among the most rapidly advancing ones due to a cytokine-mediated immune suppression and angiogenesis. Similarly, de novo angiogenesis and vasculogenesis may complicate adjuvant use of recombinant G-CSF or GM-CSF thus possibly contributing to a cancer relapse. Rapid diagnostic tools to differentiate G-CSF- or GM-CSF-secreting cancers are not well developed therefore hindering efforts to individualize treatments for these patients. Given an increasing utilization of adjuvant G-/GM-CSF in cancer therapy, we aimed to summarize recent studies exploring their roles in pathophysiology of solid tumors and to provide insights into some complexities of their therapeutic applications.
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Affiliation(s)
- Alexander M Aliper
- Federal Clinical Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela 1, Moscow, 117198, Russia
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Shapiro DD, Potretzke A, Downs TM. Leukemoid Reaction: A Rare Paraneoplastic Syndrome in Bladder Cancer Associated With a Grave Prognosis. Urology 2014; 83:274-7. [DOI: 10.1016/j.urology.2013.07.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 07/16/2013] [Accepted: 07/26/2013] [Indexed: 11/28/2022]
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Todenhöfer T, Renninger M, Schwentner C, Stenzl A, Gakis G. A new prognostic model for cancer-specific survival after radical cystectomy including pretreatment thrombocytosis and standard pathological risk factors. BJU Int 2012; 110:E533-40. [PMID: 22578156 DOI: 10.1111/j.1464-410x.2012.11231.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
UNLABELLED Study Type - Prognosis (cohort series) Level of Evidence 2a What's known on the subject? and What does the study add? Preoperative thrombocytosis has been identified as a predictor of poor outcome in various cancer types. However, the prognostic role of platelet count in patients with invasive bladder cancer undergoing radical cystectomy is unknown. The present study demonstrates that preoperative thrombocytosis is an independent risk factor for decreased cancer-specific survival after radical treatment of invasive bladder cancer. We developed a new prognostic scoring model for cancer-specific outcomes after radical cystectomy including platelet count and established pathological risk factors. Consideration of platelet count in the final model increased its predictive accuracy significantly. Thrombocytosis may be a useful parameter to include within established international bladder cancer nomograms. OBJECTIVE • To investigate the oncological significance of preoperative thrombocytosis in patients with invasive bladder cancer undergoing radical cystectomy, as it has been reported as a marker for aggressive tumour biology in a variety of solid tumours. PATIENTS AND METHODS • The series comprised 258 patients undergoing radical cystectomy between 1999 and 2010 in whom different clinical and histopathological parameters were assessed. • Elevated platelet count was defined as >450 × 10(9) /L. • Based on regression estimates of significant parameters in multivariable analysis a new weighted scoring model was developed to predict cancer-specific outcomes. RESULTS • The median follow-up was 30 months (6-116). • Of the 258 patients, 26 (10.1%) had elevated and 232 (89.9%) had normal platelet count. The 3-year cancer-specific survival in patients with normal and elevated platelet count was 61.5% and 32.7%, respectively (P < 0.001). • In multivariable analysis, cancer-specific survival was significantly lower in patients with locally advanced disease (≥pT3a) (relative risk 2.91, 1.54-5.65; P= 0.001), positive soft tissue surgical margins (4.03, 1.99-7.92; P= 0.001) and thrombocytosis (2.68, 1.26-5.14; P= 0.011). • The 3-year cancer-specific survival in patients with a score 0 (low risk), 1-2 (intermediate risk) and 3-5 (high risk) was 81.0%, 54.8% and 8.2%, respectively (P < 0.001). • Consideration of preoperative platelet count in the final model increased its predictive accuracy by 1.8% with a concordance index of 0.745 (P= 0.040). CONCLUSIONS • The presence of thrombocytosis at radical cystectomy portends unfavourable prognosis. • We constructed a simple weighted prognostic model for cancer-specific outcomes after radical cystectomy based on pretreatment platelet count and established pathological risk factors. • These data warrant external validation and may allow for tailored monitoring and selection of appropriate patients for neoadjuvant and adjuvant trials.
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Shirakawa H, Kikuchi E, Mikami S, Fukamachi S, Miyazaki Y, Tanaka N, Miyajima A, Oya M. Three cases of granulocyte colony-stimulating factor-producing urinary upper tract carcinomas. ACTA ACUST UNITED AC 2012; 46:136-41. [PMID: 22251056 DOI: 10.3109/00365599.2011.644863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This report presents three cases of urinary upper tract carcinomas producing granulocyte colony-stimulating factor (G-CSF), with high blood leukocyte counts and poor prognoses. Case 1 was a 73-year-old man who underwent nephroureterectomy for left renal pelvic carcinoma. Pathologically, urothelial carcinoma (UC), high-grade, was observed, and immunohistochemical analysis showed positive staining for G-CSF. Progressive disease (PD) was observed despite administration of systemic chemotherapy for disease relapse, and the patient died 4.5 months after the operation. Case 2 was a 74-year-old man who had left renal pelvic carcinoma with para-aortic lymph-node metastases. The serum G-CSF was elevated (169 pg/ml). The patient refused any aggressive treatment, and died 2.3 months after his first visit to the hospital. Case 3 was a 75-year-old woman who had left renal pelvic carcinoma with adrenal metastasis. Biopsy confirmed the diagnosis as UC with squamous differentiation, and the serum G-CSF was elevated (138 pg/ml). Systemic chemotherapy was administered. However, the patient showed PD, and died 6.9 months after her first visit to the hospital. Effective treatment strategies are warranted for carcinomas producing G-CSF. Elucidation of the actions of G-CSF on both the carcinoma cells and the tumor microenvironment may contribute to the development of useful strategies.
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Affiliation(s)
- Hiroshi Shirakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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11
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Chang IW, Chen HK, Ma MC, Huang WT. Anaplastic large cell lymphoma with paraneoplastic leukocytosis: a clinicopathological analysis of five cases. APMIS 2011; 119:794-801. [PMID: 21995633 DOI: 10.1111/j.1600-0463.2011.02811.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Anaplastic large cell lymphoma (ALCL) is a type of T-cell lymphoma with a relatively favorable prognosis. However, a certain group of ALCLs is highly aggressive, featuring paraneoplastic leukocytosis (PL) in clinical presentation. The present study evaluated five cases of ALCL presenting with PL, including four men and one woman, with a median age of 58 years. All cases revealed leukocytosis with a range from 15.3 to 112.9 × 10(3) /μL. Five (100%) and 4 (80%) cases demonstrated immunoreactivity for granulocyte-colony-stimulating factor (G-CSF) and tumor necrosis factor-alpha (TNF-α), respectively. There were significant differences in the expression of G-CSF and TNF-α between ALCL cases with or without PL (p < 0.05 for both). The prognosis of ALCL patients with PL was poor. Four of five patients (80%) died of the disease within a median survival time of 3.5 weeks. The release of G-CSF and TNF-α from lymphoma cells may associate with ALCL presenting with PL, leading to cytokine crisis and even poorer prognosis.
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Affiliation(s)
- I-Wei Chang
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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12
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Fahl KN, Poon SA, Badani KK, Benson MC. Paraneoplastic production of heparin-like anticoagulant in a patient with metastatic transitional cell carcinoma. Can Urol Assoc J 2011; 3:E61-3. [PMID: 19829722 DOI: 10.5489/cuaj.1165] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It has been reported that patients with bladder cancer have widely varying paraneoplastic consequences, including metabolic, dermatologic, myopathic and neurologic disturbances. We report a case of a 52-year-old man with advanced transitional cell carcinoma and liver metastases, who developed a severe coagulopathy following robotic radical cystoprostatectomy due to circulating heparin-like substances prior to onset of liver failure. Heparin-like anticoagulant production is a rare paraneoplastic effect documented in concert with transitional cell carcinoma, breast carcinoma and hematological malignancies.
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Affiliation(s)
- Kelly N Fahl
- Department of Urology, Columbia University College of Physicians & Surgeons, New York, NY
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Davis JL, Ripley RT, Frankel TL, Maric I, Lozier JN, Rosenberg SA. Paraneoplastic granulocytosis in metastatic melanoma. Melanoma Res 2010; 20:326-9. [PMID: 20440226 PMCID: PMC3469252 DOI: 10.1097/cmr.0b013e328339da1e] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Paraneoplastic syndromes are an uncommon, yet well-described, phenomenon in cancer patients. The syndrome of granulocytosis caused by granulocyte colony-stimulating factor (G-CSF) production by tumors is rare and is difficult to diagnose in patients receiving treatment for metastatic disease. From January 2005 to May 2009, 626 patients were evaluated for treatment of metastatic melanoma. At initial evaluation or during the course of treatment, six patients had an elevated white blood cell count and no evidence of infection. All six had significantly elevated serum G-CSF. The level of serum G-CSF was directly correlated with the absolute neutrophil count. In-vitro assay of melanoma tumor from two patients showed elevated G-CSF in cell culture supernatant. The paraneoplastic syndrome of granulocytosis resulting from ectopic G-CSF production in patients with metastatic melanoma is rare. This diagnosis should be considered when common causes of granulocytosis have been ruled out.
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Affiliation(s)
- Jeremy L. Davis
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - R. Taylor Ripley
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Timothy L. Frankel
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Irina Maric
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Jay N. Lozier
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven A. Rosenberg
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Kodaira K, Kikuchi E, Kosugi M, Horiguchi Y, Matsumoto K, Kanai K, Suzuki E, Miyajima A, Nakagawa K, Tachibana M, Umezawa K, Oya M. Potent cytotoxic effect of a novel nuclear factor-kappaB inhibitor dehydroxymethylepoxyquinomicin on human bladder cancer cells producing various cytokines. Urology 2010; 75:805-12. [PMID: 20156648 DOI: 10.1016/j.urology.2009.11.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 11/03/2009] [Accepted: 11/23/2009] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To explore the potential therapeutic effects of the nuclear factor-kappaB (NF-kappaB) inhibitor dehydroxymethylepoxyquinomicin (DHMEQ). KU-19-19 cells, originally derived from a patient with invasive bladder cancer who exhibited marked leukocytosis, produce multiple cytokines. This model of clinically advanced bladder cancer, in which NF-kappaB is constitutively activated, was used in this study. METHODS Expression of p65 protein in fractionated KU-19-19 cells was determined by Western blotting analysis. DNA-binding activity of NF-kappaB was detected by electrophoretic mobility shift assay. The cytotoxic effects and induction of apoptosis by DHMEQ were analyzed, and cytokines in the supernatant of KU-19-19 cells cultured with or without DHMEQ were measured by enzyme-linked immunosorbent assay (ELISA). Athymic nude mice bearing KU-19-19 subcutaneous tumors were subjected to intraperitoneal administration of 2 mg/kg/d DHMEQ for 3 weeks. Tumor growth was monitored and microvessel density, vascular endothelial growth factor expression, and the apoptotic index of tumors were evaluated by tissue immunohistochemistry. RESULTS NF-kappaB was constitutively activated in KU-19-19 cells. DHMEQ reversibly inhibited the DNA-binding activity of NF-kappaB by blocking its nuclear translocation. Both cell viability and production of cytokines were significantly and dose-dependently suppressed by DHMEQ, and significant apoptosis was also induced. In in vivo studies, the mean tumor volume in mice treated with DHMEQ was significantly smaller than in controls. Immunohistochemical analysis of tumors revealed marked reduction in microvessel density, vascular endothelial growth factor expression, and induction of apoptosis. CONCLUSIONS Blockade of NF-kappaB function by DHMEQ may be a useful new molecular targeting treatment for highly aggressive bladder cancer.
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Affiliation(s)
- Kiichiro Kodaira
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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15
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Perez FA, Fligner CL, Yu EY. Rapid clinical deterioration and leukemoid reaction after treatment of urothelial carcinoma of the bladder: possible effect of granulocyte colony-stimulating factor. J Clin Oncol 2009; 27:e215-7. [PMID: 19786665 DOI: 10.1200/jco.2009.22.4931] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Francisco A Perez
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
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Eosinophilic colitis in a patient with advanced transitional cell carcinoma of the bladder: a paraneoplastic syndrome? Am J Med Sci 2008; 336:81-3. [PMID: 18626244 DOI: 10.1097/maj.0b013e31815adeda] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eosinophilia associated with tumors is extremely rare. The exact underlying pathogenetic mechanisms are not well understood; limited data have been reported about granulocyte colony-stimulating factor and interleukin-5 in the development of eosinophilia. We report a patient with marked eosinophilia, leukocytosis, and eosinophilic colitis presenting with bloody stool. The subsequent diagnosis was advanced high-grade transitional cell carcinoma of the bladder. Leukocyte count, eosinophil count, and colonoscopic findings returned to normal after surgical removal of the tumor. To our knowledge, eosinophilic colonic infiltration as a manifestation of transitional cell bladder carcinoma has not been previously reported.
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