Abstract：
BACKGROUND: Neutrophilia is an increase in the number of neutrophils over 7.5×103/µL. An increase in leukocytes over 50×103/µL is called a leukemoid reaction; and when it is associated with a solid tumor, it is considered a paraneoplastic syndrome called paraneoplastic leukemoid reaction (PLR). It is a very rare clinical condition and it is very unusual for it to be associated with carcinosarcoma. We present two cases of a leukemoid reaction observed in the Medical Oncology Department of the University Hospital of Salamanca between May and September 2023. The main objectives of our article are to describe the unusual appearance of paraneoplastic leukocytosis at the diagnosis of carcinosarcoma carcinosarcoma, explain in a detailed way its diagnostic procedure and to show the poor prognosis to which it is associated.
METHODS: In our presentation, we describe two similar cases: first of all, a 60-year-old woman without relevant medical history. She was referred by her primary physician to the Department of Internal Medicine in August 2023 with asthenia, lumbar pain, and weight loss of 12 kg of 3 months of evolution. The physical examination revealed a palpable hypogastric mass. An abdominal, pelvic, and thoracic computed tomography (CT) scan revealed a heterogenous solid mass with necrotic areas originating in the uterus. The anatomopathological diagnosis was carcinosarcoma. The patient showed a progressive worsening in her renal function associated with hyperviscosity secondary to hyperleukocytosis caused by 170×103/µL neutrophils. In the second case we describe the diagnosis of a PLR secondary to a kidney carcinosarcoma. When the patient started chemotherapy, he presented 55.08×103/µL leukocytes, 53.16×103/µL neutrophils. Eight days after receiving chemotherapy, the patient was admitted as an emergency with oligoanuria and decreased consciousness. He presented creatinine 6.25 mg/dL, phosphate 12.4 mg/dL, leukocytes 1.05×103/µL, and neutrophils 0.71×103/µL. The clinical diagnosis was acute exacerbation of multifactorial mixed (renal and prerenal) chronic kidney disease associated with tumor lysis syndrome and grade 3 neutropenia. The patient presented a poor evolution, dying after 2 months.
CONCLUSIONS: PLR is a severe paraneoplastic syndrome associated with different types of solid tumors. Its appearance at the time of diagnosis of a tumor implies a poor vital prognosis.
METHODS: In our presentation, we describe two similar cases: first of all, a 60-year-old woman without relevant medical history. She was referred by her primary physician to the Department of Internal Medicine in August 2023 with asthenia, lumbar pain, and weight loss of 12 kg of 3 months of evolution. The physical examination revealed a palpable hypogastric mass. An abdominal, pelvic, and thoracic computed tomography (CT) scan revealed a heterogenous solid mass with necrotic areas originating in the uterus. The anatomopathological diagnosis was carcinosarcoma. The patient showed a progressive worsening in her renal function associated with hyperviscosity secondary to hyperleukocytosis caused by 170×103/µL neutrophils. In the second case we describe the diagnosis of a PLR secondary to a kidney carcinosarcoma. When the patient started chemotherapy, he presented 55.08×103/µL leukocytes, 53.16×103/µL neutrophils. Eight days after receiving chemotherapy, the patient was admitted as an emergency with oligoanuria and decreased consciousness. He presented creatinine 6.25 mg/dL, phosphate 12.4 mg/dL, leukocytes 1.05×103/µL, and neutrophils 0.71×103/µL. The clinical diagnosis was acute exacerbation of multifactorial mixed (renal and prerenal) chronic kidney disease associated with tumor lysis syndrome and grade 3 neutropenia. The patient presented a poor evolution, dying after 2 months.
CONCLUSIONS: PLR is a severe paraneoplastic syndrome associated with different types of solid tumors. Its appearance at the time of diagnosis of a tumor implies a poor vital prognosis.
摘要：
背景：中性粒细胞增多是中性粒细胞数量增加超过7.5×103/μL。白细胞增加超过50×103/μL称为类白血病反应；当它与实体瘤相关时，它被认为是一种副肿瘤综合征,称为副肿瘤类白血病反应(PLR).这是一种非常罕见的临床疾病，与癌肉瘤有关的情况非常罕见。我们介绍了2023年5月至9月在萨拉曼卡大学医院肿瘤科观察到的两例类白血病反应。我们文章的主要目的是描述在诊断癌肉瘤癌肉瘤时副肿瘤白细胞增多的异常出现，详细解释其诊断程序，并显示与之相关的不良预后。
方法：在我们的演讲中，我们描述了两种类似的情况:首先，一名60岁女性，无相关病史。2023年8月，她的主治医师因虚弱而转诊至内科，腰椎疼痛,和体重减轻12公斤3个月的进化。体格检查发现明显的胃下肿块。一个腹部，骨盆,和胸部计算机断层扫描（CT）扫描显示不均匀的固体肿块，坏死区域起源于子宫。解剖病理学诊断为癌肉瘤。该患者的肾功能进行性恶化，与170×103/μL中性粒细胞引起的高白细胞增多继发的高粘滞相关。在第二种情况下，我们描述了继发于肾癌肉瘤的PLR的诊断。当病人开始化疗时,他呈现55.08×103/μL白细胞，53.16×103/μL中性粒细胞。接受化疗后八天，患者因少尿症和意识下降而入院。他的肌酐为6.25mg/dL，磷酸盐12.4mg/dL，白细胞1.05×103/μL,中性粒细胞0.71×103/μL。临床诊断为与肿瘤溶解综合征和3级中性粒细胞减少相关的多因素混合（肾脏和肾前）慢性肾脏疾病急性加重。病人表现出较差的进化，2个月后死亡。
结论：PLR是一种与不同类型实体瘤相关的严重副肿瘤综合征。它在诊断肿瘤时的出现意味着不良的预后。
方法：在我们的演讲中，我们描述了两种类似的情况:首先，一名60岁女性，无相关病史。2023年8月，她的主治医师因虚弱而转诊至内科，腰椎疼痛,和体重减轻12公斤3个月的进化。体格检查发现明显的胃下肿块。一个腹部，骨盆,和胸部计算机断层扫描（CT）扫描显示不均匀的固体肿块，坏死区域起源于子宫。解剖病理学诊断为癌肉瘤。该患者的肾功能进行性恶化，与170×103/μL中性粒细胞引起的高白细胞增多继发的高粘滞相关。在第二种情况下，我们描述了继发于肾癌肉瘤的PLR的诊断。当病人开始化疗时,他呈现55.08×103/μL白细胞，53.16×103/μL中性粒细胞。接受化疗后八天，患者因少尿症和意识下降而入院。他的肌酐为6.25mg/dL，磷酸盐12.4mg/dL，白细胞1.05×103/μL,中性粒细胞0.71×103/μL。临床诊断为与肿瘤溶解综合征和3级中性粒细胞减少相关的多因素混合（肾脏和肾前）慢性肾脏疾病急性加重。病人表现出较差的进化，2个月后死亡。
结论：PLR是一种与不同类型实体瘤相关的严重副肿瘤综合征。它在诊断肿瘤时的出现意味着不良的预后。
