1Section of Benign Hematology, The University of Texas M.D. Anderson Cancer Center, Houston, USA.
2Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, USA.
A 58-year-old man was diagnosed with essential thrombocythemia in 2010 and was managed with hydroxyurea and aspirin. In October 2014, he presented with right pleural effusion. Work-up revealed renal cell carcinoma metastasizing to the right pleura and lung parenchyma. Complete blood count (CBC) revealed white blood cells (WBC) 8.6×109/L, hemoglobin 11.4 g/dL and platelets 294×103/µL. He underwent pleural decortication and right middle lobectomy, followed by left radical nephrectomy. In January 2015, sunitinib was started (after discontinuing hydroxyurea) resulting in initial tumor response. In May 2015, the cancer progressed and experimental trial was considered. At that point, CBC showed hemoglobin 9.6 g/dL, WBC 7.9×109/L, platelets 446×103/µL. Bone marrow aspirate shows clusters of malignant cells (