Case Report
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Blood Res 2013; 48(1):
Published online March 31, 2013
https://doi.org/10.5045/br.2013.48.1.63
© The Korean Society of Hematology
Acute pyelonephritis with anaplastic thyroid carcinoma producing granulocyte colony-stimulating factor
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Correspondence to : Correspondence to Young Joo Kwon, M.D., Ph.D. Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul 152-703, Korea. Tel: +82-2-2626-3036, Fax: +82-2-2626-1798, yjkwon@korea.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Paraneoplastic leukocytosis was defined as elevated white blood cell (WBC) levels caused by cytokines, likely produced by the tumor itself, without evidence of infection or myeloproliferative disease. We report a case of anaplastic thyroid carcinoma with leukocytosis caused by elevated production of granulocyte colony-stimulating factor (G-CSF) by the carcinoma. Initially, acute pyelonephritis (APN) was diagnosed and treatment for APN was ongoing, but the WBC count steadily increased to 68.8×109/L. She was diagnosed with anaplastic thyroid carcinoma on her neck mass, and the serum concentration of G-CSF was found to be markedly increased at 1,010 pg/mL. In spite of supportive care, the patient's condition rapidly deteriorated and the patient died on day 23 of hospital stay. Leukocytosis without definite evidence of infection could be a paraneoplastic manifestation in patients with malignant tumors, and paraneoplastic leukocytosis may be related to poor prognosis.
Keywords G-CSF, Anaplastic thyroid carcinoma, Paraneoplastic leukocytosis
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Case Report
Blood Res 2013; 48(1): 63-66
Published online March 31, 2013 https://doi.org/10.5045/br.2013.48.1.63
Copyright © The Korean Society of Hematology.
Acute pyelonephritis with anaplastic thyroid carcinoma producing granulocyte colony-stimulating factor
Keunhee Kang, Joo Hee Park, Ja Young Ryu, Sang Yup Lee, Gang Jee Ko, and Young Joo Kwon*
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Correspondence to: Correspondence to Young Joo Kwon, M.D., Ph.D. Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, 148, Gurodong-ro, Guro-gu, Seoul 152-703, Korea. Tel: +82-2-2626-3036, Fax: +82-2-2626-1798, yjkwon@korea.ac.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Paraneoplastic leukocytosis was defined as elevated white blood cell (WBC) levels caused by cytokines, likely produced by the tumor itself, without evidence of infection or myeloproliferative disease. We report a case of anaplastic thyroid carcinoma with leukocytosis caused by elevated production of granulocyte colony-stimulating factor (G-CSF) by the carcinoma. Initially, acute pyelonephritis (APN) was diagnosed and treatment for APN was ongoing, but the WBC count steadily increased to 68.8×109/L. She was diagnosed with anaplastic thyroid carcinoma on her neck mass, and the serum concentration of G-CSF was found to be markedly increased at 1,010 pg/mL. In spite of supportive care, the patient's condition rapidly deteriorated and the patient died on day 23 of hospital stay. Leukocytosis without definite evidence of infection could be a paraneoplastic manifestation in patients with malignant tumors, and paraneoplastic leukocytosis may be related to poor prognosis.
Keywords: G-CSF, Anaplastic thyroid carcinoma, Paraneoplastic leukocytosis
Fig 1.
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Computed tomography of the neck showed a large thyroid mass invading adjacent structures
Fig 2.
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A fine needle aspiration specimen from the neck mass showed scattered and small clusters of pleomorphic cells with enlarged bizarre hyperchromatic nuclei and frequent prominent nucleoli, with variable amounts of cytoplasm (×1,000).
Fig 3.
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Serial white blood cell (WBC) counts and C-reactive protein (CRP) levels. The WBC count increased to 68.8×109/L by day 21 of hospital stay, although the CRP level did not increase in parallel.
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Table 1 . Previously reported cases of paraneoplastic leukocytosis in thyroid cancers associated with granulocyte colony-stimulating factor..
Abbreviations: G-CSF, granulocyte colony-stimulating factor; F, female; M, male..
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