Production of granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor by carcinomas in a dog and a cat with paraneoplastic leukocytosis

Probable paraneoplastic leukocytosis in a dog with a gastrointestinal stromal tumor

A 9-year-old female spayed Boston Terrier presented for diagnostic investigation of lethargy, poor appetite, weight loss, and a marked leukocytosis. Significant muscle wasting and a palpable abdominal mass were present on physical examination. Abdominal imaging revealed the mass to be of small intestinal origin; consequently, an intestinal resection and anastomosis were performed without complication. The histopathologic diagnosis was a gastrointestinal stromal tumor, verified by immunohistochemical positivity to CD117 (KIT). Two weeks after discharge, the leukocytosis had resolved. Though the exact molecular mediator of the severe leukocytosis was undetermined, resolution following tumor removal suggests a paraneoplastic cause. To the authors' knowledge, this is the first reported case of probable paraneoplastic leukocytosis secondary to a gastrointestinal stromal tumor in the dog. Gastrointestinal tract imaging should be performed when this uncommon hematologic abnormality is present.

Klinisch-pathologische Befunde, postoperative Überlebenszeiten und prognostische Faktoren bei Hunden mit primären Lungenkarzinomen

Einleitung Primäre Karzinome der Lunge (PLK) beim Hund sind selten, ihre Behandlung erfolgt chirurgisch. Ziel dieser Studie war die Untersuchung klinisch-pathologischer Befunde, postoperativer medianer Überlebenszeiten (mÜZ) und prognostischer Faktoren.

Material und Methoden Retrospektive Auswertung von 61 Hunden mit 62 PLK, die zwischen 2007 und 2017 chirurgisch behandelt wurden. Die statistische Auswertung erfolgte mittels Kaplan-Meier und Logrank Methoden.

Ergebnisse Von 62 PLKs lagen 35 (56 %) peripher im Lungenlappen, 21 (34 %) hilusnah und 6 (10 %) betrafen den gesamten Lungenlappen. In 49 Fällen lagen differenzierte Adenokarzinome vor; niedrig differenzierte bzw. anaplastische Karzinome (n = 10) und Plattenepithelkarzinome (n = 2) waren deutlich seltener. Eine Prädisposition für bestimmte Lungenlappen war nicht nachzuweisen. Dreizehn (21 %) Patienten zeigten keine und 10 (16 %) nur unspezifische, nicht auf den Respirationstrakt hinweisende Symptome. Insgesamt zeigten 48 (79 %) Hunde klinische Symptome wie Husten, Dyspnoe, Lethargie, Gewichtsverlust, Leistungsschwäche, Erbrechen und/oder Fieber. Die tracheobronchialen Lymphknoten (TBLN) waren in 9 von 51 untersuchten Fällen histologisch positiv für Metastasierung (N1) und negativ (N0) in 42 Fällen (nicht untersucht n = 10). Daten zum Langzeitverlauf waren für 50 Patienten verfügbar. Prognostisch relevante Variablen waren Lymphknotenmetastasierung in die TBLN (mÜZ: N1 41 Tage, N0 570 Tage; p < 0,01), Lungenmetastasen (mÜZ: M1 125 Tage, M0 630 Tage; p < 0,01), histologischer Subtyp (mÜZ: differenzierte Karzinome 620 Tage; andere Karzinome 135 Tage; p < 0,01), Tumordurchmesser größer als 3 cm (mÜZ < 3 cm 1155 Tage, ≥ 3 cm 330 Tage; p = 0,02) und Tumorlokalisation (mÜZ: hilusnah 330 Tage, peripher 650 Tage; p = 0,04).

Schlussfolgerung Beim PLK sind TBLN Status, Organmetastasen, Tumorlokalisation, histologischer Subtyp und Tumorgröße prognostisch relevante Kriterien. Hunde ohne prognostisch negative Faktoren können lange Überlebenszeiten aufweisen. In mehr als einem Drittel der Fälle bleiben die Tumoren asymptomatisch (21 %) bzw. ohne respirationstraktspezifische (16 %) Symptome.

Etiology and outcome of extreme neutrophilic leukocytosis: A multi-institutional retrospective study of 269 dogs

Background

The magnitude of diagnostic abnormalities can influence the perception of clinical outcome. Extreme neutrophilic leukocytosis (ENL) is an uncommon finding caused by markedly increased granulopoiesis. A lack of recent, large‐scale studies limits our understanding of the importance, causation, and prognosis associated with ENL in dogs.

Hypothesis/Objectives

Describe disease categories (DC) identified in dogs with ENL and identify variables associated with survival. We hypothesized that factors including fever, segmented and band neutrophil counts, and DC would be negatively associated with survival.

Animals

Two‐hundred sixty‐nine dogs with ENL (segmented neutrophils ≥50 × 10³ cells/μL) presented to the veterinary teaching hospitals at Auburn University (n = 164), the University of Missouri (n = 81), and Oklahoma State University (n = 24) between January 1, 2009 and December 31, 2019.

Methods

Retrospective study. Demographic data and outcome variables including temperature, CBC findings, DC, duration of hospitalization (DOH) and outcome were acquired from the medical record. Statistical analyses included chi‐squared and Kruskal‐Wallis tests, and Pearson product moment correlations with a P < .05 significance level.

Results

Mortality was 41%. Survival differed with DC (P = .002). Mortality was higher (P < .05) in dogs with neoplasia (56.2%) vs immune‐mediated disease (20.5%) or tissue damage/necrosis (19%). Weight (P = .001, r = −0.14) and total neutrophil count (P = .04, r = −0.02) were weakly negatively associated with survival whereas DOH was weakly positively associated with survival (P = .03, r = 0.14).

Conclusions and Clinical Importance

Mortality in dogs with ENL is high but differed according to DC. Only weak correlations between clinical or clinicopathologic variables and mortality were identified. Extreme neutrophilic leukocytosis should be interpreted in conjunction with the underlying disease process, and not broadly used to predict clinical outcome.

Neutrophilic leucocytosis induced by granulocyte colony-stimulating factor and interleukin-6 in canine primary lung adenocarcinoma

Background

Neutrophilic leucocytosis as a paraneoplastic syndrome may occur in dogs with lymphoma, renal carcinoma, rectal polyps and metastatic fibrosarcoma. However, the information on canine lung adenocarcinoma with neutrophilic leucocytosis is lacking.

Objective

This study aimed to describe the clinical features and cytokine profiles of canine patients with primary lung adenocarcinoma and neutrophilic leucocytosis.

Methods

Two dogs (cases #1 and #2), each with a solitary lung adenocarcinoma, were included. Both cases had leucocytosis and underwent lung lobectomy. The resected tumours were analysed for the expression of granulocyte colony‐stimulating factor (G‐CSF), granulocyte macrophage colony‐stimulating factor (GM‐CSF) and interleukin‐6 (IL6) by quantitative real‐time PCR compared with normal lung tissues.

Results

At the initial examination, neither patient had any clinical signs or fever. White blood cell count (WBC) was 58,300/μl and 32,900/μl in cases #1 and #2, respectively. The gene expression of G‐CSF increased 6.7‐and 19.7‐fold in cases #1 and #2, respectively. The gene expression of IL6 markedly increased (30‐fold) in case #1, whereas it increased slightly (1.9‐fold) in case #2. On the other hand, that of GM‐CSF was slightly changed in both cases. The WBC count postoperatively decreased to within the normal range in both cases. The postoperative survival times were 347 and 118 days in cases #1 and #2, respectively.

Conclusions

This study describes G‐CSF and IL6 producing lung adenocarcinoma associated with neutrophilic leucocytosis in dogs. Canine patients with pulmonary adenocarcinomas that have elevated G‐CSF and IL6 levels may have a guarded prognosis. Further investigations are needed to clarify the prognosis of canine cytokine‐producing lung adenocarcinoma.

Paraneoplastic neutrophilic leukocytosis syndrome in a cat with recurrent mammary carcinoma

Case summary

A spayed 12-year-old female domestic shorthair cat presented with nodular lesions on the ventral-right thoracic wall after complete mastectomy 4 months previously. The prior diagnosis was tubulopapillary mammary carcinoma with axillary lymph node metastasis, and a recurrence was confirmed. A gradual and sequential increase in the total number of leukocytes with severe neutrophilia (95.632/µl) developed over the course of the illness, along with an increase in the size of the recurrent mass. The severe leukocytosis did not show any response to antibiotic therapy, and no evidence of infection was observed. Bone marrow cytology confirmed hypercellularity in the myeloid cell lineage. Based on these findings, paraneoplastic neutrophilic leukocytosis syndrome was suspected. An incisional biopsy of the recurrent mass was consistent with recurrent tubulopapillary mammary carcinoma. Malignant epithelial cells stained positive upon immunohistochemistry for granulocyte–macrophage colony-stimulating factor, cytokeratin and vimentin. After the final diagnosis of paraneoplastic neutrophilic leukocytosis syndrome, the cat was euthanized at the owner’s request.

Relevance and novel information

This is a novel case of paraneoplastic leukocytosis syndrome associated with mammary carcinoma in a cat. Although there are some reports describing paraneoplastic leukocytosis in cats, the relationship between this syndrome and feline mammary tumors has not been described.

Paraneoplastic leukocytosis with mature neutrophilia in a cat with pulmonary squamous cell carcinoma

A 13-year old cat had 3-day duration of vomiting, lethargy, and anorexia. A complete blood count revealed a severe neutrophilia (126.9 x 10(3) cells/microl). Thoracic radiographs demonstrated a large solitary lung mass. A bone marrow aspirate documented myeloid hyperplasia. A left intercostal thoracotomy was performed and left cranial and caudal lung lobectomies were performed in order to remove the mass in its entirety. Histological diagnosis was squamous cell carcinoma of the lung. Following surgery, the severe neutrophilia began to decrease. It was in the normal range approximately 6 weeks postoperatively. The presence of a primary lung tumor combined with a mature neutrophilia with resolution following surgical resection suggests a paraneoplastic syndrome.

Cyclooxygenase-2 inhibitor NS-398 suppresses cell growth and constitutive production of granulocyte-colony stimulating factor and granulocyte macrophage-colony stimulating factor in lung cancer cells

We previously established two lung cancer cell lines, OKa-C-1 and MI-4, which constitutively produce abundant granulocyte-colony stimulating factor (G-CSF) and granulocyte macrophage-colony stimulating factor (GM-CSF). Inflammatory cytokines, tumor necrosis factor-alpha (TNF-alpha) and interleukin (IL)-1beta stimulated the expression of G-CSF, GM-CSF, and cyclooxygenase (COX)-2 in the two cell lines. It is known that increased COX-2 activity promotes tumor growth and induces G-CSF and GM-CSF expression in non-malignant cells, and that selective COX-2 inhibitors inhibit the growth of some types of malignant cells. Therefore, we hypothesized that inhibition of COX-2 activity might suppress constitutive production of G-CSF or GM-CSF in addition to reducing the growth of malignant cells. We confirmed that the selective COX-2 inhibitor, NS-398 suppressed the constitutive production of G-CSF and GM-CSF, and the cell growth in both OKa-C-1 and MI-4 cell lines. Prostaglandin E2 (PGE2) reversed the inhibitions of G-CSF and GM-CSF expression, as well as cell growth, by NS-398. This result confirms that the effects of NS-398 are based on the inhibition of COX activity. Some studies have indicated that nuclear factor kappa B (NF-kappaB) or MAPK (mitogen-activated protein kinase) activation is related to upregulation of G-CSF, GM-CSF or COX-2 expression in some types of cells. Therefore, we examined if the actions of NS-398 might be mediated by the MAP kinase pathway or NF-kappaB activity in OKa-C-1 and MI-4 cells. We found that NS-398 inhibits G-CSF and GM-CSF production and cell growth through an extracellular signal-regulated kinase kinase (MEK) signaling pathway in these cell lines. The prognosis of non-small cell lung cancer showing G-CSF gene expression is significantly worse. G-CSF overproduction by tumor cells is observed at an advanced clinical stage. Our findings imply that a COX-2 inhibitor might improve the prognosis of patients with lung cancer through the reduction of G-CSF or GM-CSF.

Diagnosis of chronic myelogenous leukemia in a dog using morphologic, cytochemical, and flow cytometric techniques

Chronic myelogenous leukemia was diagnosed in a 3.5-year-old neutered male Golden Retriever. The diagnosis was based on persistent leukocytosis (>73.0X10(3)/microliter), composed of a proportionate left shift to progranulocytes with no evidence of underlying inflammation, infection, or neoplasia. Marked dysplasia was evident in neutrophils and platelets in peripheral blood. Bone marrow and splenic aspirates were dominated by mature and immature neutrophils with < 2% myeloblasts. Cytochemical and flow cytometric assays confirmed that cells in the peripheral blood and spleen were of committed neutrophil lineage. The dog responded initially to treatment with hydroxyurea, but developed acute undifferentiated leukemia approximately 83 days after initial presentation.

Neutrophilic leucocytosis in a dog with a rectal tumour

A nine-year-old cocker spaniel was presented with a three-year history of intermittent haematochezia and a palpable rectal mass. Routine haematological examination revealed a marked mature neutrophilia (86.04 x 10(9) neutrophils/litre). A friable mass in the middle portion of the rectum was detected on colonoscopy. Histopathological examination of mucosal pinch biopsies collected from the mass confirmed a diagnosis of adenomatous tubulopapillary polyp. Some evidence of malignant transformation was observed. Palliative treatment with piroxicam suppositories at a dose of 1.4 mg/kg administered rectally every third day was instituted. On re-evaluation, 47 days after starting medical therapy, the owner reported a significant reduction in haematochezia and tenesmus; however, frequency of defecation had remained unaltered. Routine haematology revealed a reduction in the mature neutrophil count (33.67 x 10(9) neutrophils/litre). This report describes a case of a rectal tumour associated with a neutrophilic leucocytosis, which responded to palliative therapy with piroxicam suppositories.