Extreme Leukocytosis And Leukemoid Reaction Associated With Adenocarcinoma Of The Lung: A Case Report And Review Of The Literature

Objective:The purposes of our study are to improve the recognition of the extreme leukocytosis and leukemiod reaction in lung cancer, to get to konw the clinical features, regularities and mechanism of such diseases, to reduce misdiagnosis and missed diagnosis.methods:Report a detailed case of lung adenocarcinoma with extreme leukocytosis and leukemoid reaction. According to lung cancer with leukemoid reaction (WBC>50 * 10 -9/L), to lung cancer, leukemoid reaction, leukocytosis as key words, we retrieve the domestic VIP database, Wanfang Database, Chinese Biomedical Literature Database (CBM), China Academic Journal (CNKI) since 1979, and 12 cases with complete informations are collected and analyzed retrospectively.Result:A man,62 years old, fever, neutrophil leukocytosis, bone marrow shows proliferation. A mass is in the right upper lobe. Anti-infection treatment is failed but chemotherapy is effective. The final diagnosis is lung cancer associated with extreme leukocytosis and leukemoid reaction.Extreme leukocytosis and leukemoid reaction in lung cancer(WBC>50 * 10 -9/L)occur in men more often than women, especially older man. The performances of the respiratory system mainly are cough, sputum, hemoptysis, chest pain. Systemic manifestations are mainly fever, clubbing, hepatomegaly. However lymphadenectasis, low back pain, lower extremity edema can also been found. Total number of leukocytes is between 58. 1*10-9/L and 108.3*10"9/L. Most of the WBC count are below 100*10-9/L, more than 100*10-9/L are rare. Most are neutrophil leukocytosis, with or without left shift. Hemoglobin can be reduced. Platelets and red blood cells can be normal. Bone marrow shows myeloid hyperplasia. Coarse particles, poisoning, vacuolar changes in granulocyte can be seen. Tumor cells can also been seen. Alkaline phosphatase activity can be increased. Right lesion is more common than the left lung lesion. More than half of lung cancer with leukemoid reaction can be happened in advanced stage, with pleural effusion or distant metastasis, such as liver, bone and bone marrow metastasis. Histological feature is that leukemoid reaction is much more common in adenocarcinoma than squamous cell carcinoma and large cell carcinoma. It is confirmed by the pathology and cytology. But rule out blood system malignant diseases, infection diseases, poisoning, drugs, bleeding and other factors. Common methods are surgical pathology, lung biopsy, lymph node biopsy, bronchoscopy, pleural effusion and sputum cytology. White blood cell will return to normal after excision or anti-cancer treatments. The average survival is less than 2 months, the prognosis is very poor.Conclusion:Lung cancer associated with extreme leukocytosis and leukemoid reaction is a kind of rare diseases, whose prognosis is poor. The mechanism is not very clear. It may be easily mistaken for lung infection disease. Diagnosis is based on pathology and cytology. But, firstly, rule out blood system malignant diseases, infection diseases, poisoning, drugs, bleeding and other factors. After chemotherapy or surgical removal of the tumor, leukemoid reaction can be disappeared.