Leukemoid Reaction as a “Tumor Marker” in Breast Cancer
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Neutrophilic leukocytosis above 50 × 109/l exclude leukemia, defines a leukemoid reaction (LR). It is associated with several diseases. Although it simulates leukemia, most of the causes are benign. Tumor-related LR is more common. It is associated with ranulocyte colony-stimulating factor (G-CSF) secreted by the tumor cells. A 38-year-old woman, presented with advanced breast cancer and leukocytosis (79.9 × 103/uL) was found. After completion of MRM, the condition of leukocytosis subsided. Two months later, tumor local relapse was found and white blood cells (WBC) rose again. After completion of wide excision, the condition of leukocytosis subsided again. We think this case was associated with leukemoid reaction.Keywords:
Leukemoid reaction
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Leukocytosis
Acute myeloblastic leukemia
Polycythemia rubra vera
Chronic myelogenous leukemia
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The white blood count of 6549 patients with various internal diseases of respiratory, cardiovascular, gastrointestinal, excretory and endocrine systems was studied as well as in neoplasms, collagenosis, etc. with the exception of malignant hemopathies. Leukocytosis was established in 21.8% of them. In almost half of the cases, leukocytosis is low, in 44.6% it ranges from 12-20 X 10(9)/l and in 10.2%--it is high--from 20 to 40 X 10(9)/l. Immature cells in the peripheral blood were established corresponding to stab neutrophils over 0.06-0.10, metamyelocytes, myelocytes reaching myeloblasts in the cases with leukemoid reactions. The leukemoid reactions have, with no exceptions, been of myeloid type and developed in various diseases.
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1 Department of Internal Medicine University of Missouri, Columbia, MO * 2801 West Broadway, R-2, Columbia, MO 65203 Received March 18, 1998; accepted March 18, 1998.
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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.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.The patient died of multiple organ failure 2 months after being diagnosed with leukocytosis.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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Leukemoid reaction like leukemia indicates noticeable increased count of WBCs (White Blood Cells) but the cause of it is due to severe inflammation or infections in other body regions. In automatic diagnosis in classifying leukemia and leukemoid reactions, ALL IDB2 (Acute Lymphoblastic Leukemia-Image Data Base) dataset has been used which comprises 110 training images of blast cells and healthy cells. This paper aimed at an automatic process to distinguish leukemia and leukemoid reactions from blood smear images using Machine Learning. Initially, automatic detection and counting of WBC is done to identify leukocytosis and then an automatic detection of WBC blasts is performed to support classification of leukemia and leukemoid reactions. Leukocytosis is commonly observed both in leukemia and leukemoid hence physicians may have chance of wrong diagnosis of malignant leukemia for the patients with leukemoid reactions. BCCD (blood cell count detection) Dataset has been used which has 364 blood smear images of which 349 are of single WBC type. The Image segmentation algorithm of Hue Saturation Value color based on watershed has been applied. VGG16 (Visual Geometric Group) CNN (Convolution Neural Network) architecture based deep learning technique is being incorporated for classification and counting WBC type from segmented images. The VGG16 architecture based CNN used for classification and segmented images obtained from first part were tested to identify WBC blasts.
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Neutrophilic leukocytosis above 50 × 109/l exclude leukemia, defines a leukemoid reaction (LR). It is associated with several diseases. Although it simulates leukemia, most of the causes are benign. Tumor-related LR is more common. It is associated with ranulocyte colony-stimulating factor (G-CSF) secreted by the tumor cells. A 38-year-old woman, presented with advanced breast cancer and leukocytosis (79.9 × 103/uL) was found. After completion of MRM, the condition of leukocytosis subsided. Two months later, tumor local relapse was found and white blood cells (WBC) rose again. After completion of wide excision, the condition of leukocytosis subsided again. We think this case was associated with leukemoid reaction.
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In controlled experiments during planned studies of cattle for leukemia, animals that showed leukemoid changes in blood – quantitative redistribution of granulocytes and agranulocytes-were identified. Individual analysis revealed that granulocytosis was detected in animals with inflammatory processes. In addition, the article presents comparative indicators of serum proteins in cows at the hematological stage of the leukemic process, with the manifestation of leukemoid reactions and in clinically healthy cows. Characteristic changes in the synthesis of immunoglobulins in cows with leukemia and leukemoid changes in the morphological composition of blood were established. With successful treatment of inflammatory processes, the hematological status of cows is restored to the initial indicators.
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Renal tubular carcinoma was believed responsible for hematuria and extreme leukocytosis in a dog. Other paraneoplastic syndromes possibly associated with this neoplasm included fever, thoracolumbar hyperesthesia, and anemia attributable to myelophthisis. All clinical and clinicopathologic abnormalities resolved after unilateral nephrectomy. Neutrophil cytochemical stains were used to differentiate leukemoid reaction from myelocytic leukemia as the cause of the leukocytosis. The extreme leukocytosis in this dog may have been leukemoid reaction caused by production of colony-stimulating factor by the renal tubular carcinoma.
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Neutrophilic leukocytosis above 50 × 10 reaction (LR). Although it simulates leukemia, most of the causes are inflammatory and benign. LR has been found to be associated with malignancy which is postulated to be caused by granulocyte colony-stimulating factor (G-CSF) secreted by the tumor cell high grade infiltrating ductal carcinoma of breast and leukocytosis (60 × 10 completion of MRM, the condition of neutrophilic leukocytosis subsided. After three months, total leukocyte count rose and l ocal relapse of tumor was found. Following that wide excision was done, and the condition of leukocytosis subsided again. In this case the leukemoid reaction was a paraneoplastic reaction which can be view as a potential for prognostic marker.
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A 57‐year‐old female with a large retroperitoneal tumor was atutopsied. She showed through the entire course of illness marked leukocytosis with the appearance of immature marrow cells, and this finding was hematologically interpreted as granulocytic leukemoid reaction. An intermittent pyrexia was also seen without infective etiology. The histologic diagnosis of the tumor was liposarcoma of the pleomorphic type. The tumor showed extensive necrosis, but no metastatic invasion was found. So‐called leukemoid reaction appears sometimes together with malignant neoplasms. The majority of these tumors show widespread bone marrow metastases, and without bone marrow invasion they only rarely induce this reaction. Besides it is not common for leukemoid reaction to be evoked by the development of malignant mesenchymal tumors except for malignant lymphomas. The pathophysiologic process of the present case is thought to be a rare occurrence.
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