Malignant hemangioendothelioma of the left calcaneus associated with fever and hematological abnormalities

 A case of a malignant hemangioendothelioma of the left calcaneus associated with unique system manifestations is reported here. The severe toxic manifestations included: high fever, anemia, leukocytosis, coagulation abnormalities, and other signs. Because of poor response to many antibiotic regimens, the confusion of diagnosis, and severe coagulation abnormalities with clinical signs that the life of the patient was endangered, below the knee amputation was performed. Pathological studies revealed a malignant hemangioendothelioma. A review of the case suggests that the signs and symptoms were possibly due to an immune response to the tumor rather than to secondary infection, although the latter possibility cannot be completely excluded.     

White blood cell response to uphill walking and downhill jogging at similar metabolic loads

Summary The object of this study was to determine whether leukocytosis would occur in response to eccentric exercise, to concentric exercise, and/or to possible increases in serum corticol levels. Eight men performed 2 bouts of exercise at 46% for 40 min. Subjects initially walked up a 10% grade (UW); 2 weeks later they jogged down a 10% grade (DJ), a form of eccentric exercise known to induce delayed onset muscle soreness (DOMS). Venous blood samples were drawn before and after each exercise bout (0, 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, and 5 h). Total and differential WBCc and serum cortisol levels were assessed. Results were analyzed using repeated measures ANOVA (2 × 11). Subjects experienced severe DOMS after DJ. There was a significant difference in TWBCc (p<0.0001) between UW and DJ. Post-hoc testing revealed no significant increase over baseline values for UW; after DJ there was a 46% increase over baseline values (p<0.05) initially seen at 1.0 h. These increases in TWBCc were predominantly a reflection of increases in neutrophils which were significant (p<0.0001) when compared to baseline values at 1.0, 1.5 and 2.0 h (∼60%). No significant neutrophil increases were seen after UW. Cortisol levels were similar for both groups pre-exercise (UW=367.1±38.6, DJ=320.2±44.16 mnol · L⁻¹ x±SE) and decreased similarly for both groups after exercise, and thus were not related to the post-exercise neutrophilia. In conclusion, the neutrophilia seen after the DJ appeared to be a response to differences in the exercise, not plasma cortisol levels. Thus a bout of eccentric exercise appears to induce a significant post-exercise increase in neutrophils seen between 1.0 and 2.0 h after the termination of exercise.     

Aggressive progression of granulocyte colony-stimulating factor producing squamous cell carcinoma of the esophagus: case report and literature review

We report a case of a 69-year-old man who was diagnosed to have granulocyte colony-stimulating factor (G-CSF)-producing esophageal squamous cell carcinoma, based on a histological examination of endoscopic biopsy specimens. A high serum level of leukocytes and G-CSF was noted. Moreover, immunohistochemical examination revealed that the tumor cells were positive for antibodies against G-CSF. Palliative radiation therapy was performed because of existing distant metastasis at the time of presentation, and the patient died of tumor progression 7 months after the initial diagnosis. To the best of our knowledge, only five cases with G-CSF-producing squamous cell carcinoma have been described in the English literature, including our present case. Because many cytokines induced by G-CSF-producing tumors contribute to tumor growth and aggressive inflammation, these patients might have a poor prognosis. G-CSF-producing tumor is extremely rare; however, we should consider a differential diagnosis for such disease when a patient shows a high leukocyte count with no evidence of systemic infection or hematological disease.     

骨髓增殖性疾病患者并发血栓性疾病的分析

目的 回顾性分析骨髓增殖性疾病患者血栓性疾病发生的危险因素。方法 收集北京航天总医院和北京天坛医院2007年8月至2012年2月收治的107例骨髓增殖性疾病（包括原发性血小板增多症和真性红细胞增多症）患者的临床资料和实验室检查结果,其中并发血栓性疾病的患者65例。对其临床特点、实验室检查结果（包括病史、年龄、白细胞数、JAK2V617F基因突变及骨髓分析）进行回顾并利用多元Logistic回归分析进行统计分析。结果 107例患者中男性64例,女性43例,年龄28岁至84岁。同时并发血栓性疾病的患者65例,其中缺血性卒中34例。65例血栓性疾病的患者中存在高白细胞（白细胞大于11.0×109／L）的41例（占63.1%）、JAK2V617F阳性39例（占60.0%）。两项比率均较非血栓组同类患者比率升高。血栓性疾病患者中60岁以上的老年人比例占72.3%,高于非血栓性疾病组,差异有显著性（χ2=0.014,P =0.009）。多因素Logistic回归分析显示存在高白细胞［比值比（odds ratio,OR）3.393,P＜0.05］、JAK2V617F基因阳性（OR 3.104,P＜0.05）及年龄大于60岁（OR 2.523,P＜0.05）是导致血栓发生的危险因素。结论 本研究显示骨髓增殖性疾病患者出现高白细胞血症、JAK2V617F基因阳性和（或）年龄大于60岁,可能是发生血栓性疾病的独立危险因素,尤其以发生缺血性卒中多见。     

The Prognostic Value of Pre-Treatment Leukocytosis in Patients with Previously Treated,Stage IIIB/IV Non-Small Cell Lung Cancer Treated with the IGF-1R Pathway Modulator AXL1717 or Docetaxel; a Retrospective Analysis of a Phase II Trial

Background: The aim of the present study was to investigate any prognostic value of pre-treatment anemia, leukocytosis and thrombocytosis in patients with advanced pretreated NSCLC. Methods: A randomized, multicenter phase II study comparing the IGF-1R modulator AXL with standard docetaxel in the treatment of previously treated stage IIIB or IV NSCLC patients was conducted in 2011-2013. Clinical and laboratory data were collected, including serum values for hemoglobin (Hgb), white blood cells (WBC) and platelets (Plt) at baseline. These hematological parameters were studied in relation to overall survival using Kaplan–Meier product-limit estimates and multivariate Cox proportional hazards regression models. Results: The median overall survival for all patients was 8.9 months. Patients with leukocytosis (WBC > 9 x 109/L) had a significantly shorter median overall survival (4.2 months) as compared with those with a WBC ≤ 9 x 109/L at baseline (12.3 months) with a corresponding of HR 2.10 (95% CI: 1.29-3.43). Patients with anemia (Hgb < 110 g/L) had a non-significant (p = 0.097) shorter median overall survival (6.1 months) as compared with their counterparts with Hgb ≥ 110 g/L at baseline (9.4 months). As for thrombocytosis (Plt > 350 x 109/L), there was no statistically significant impact on overall survival. Leukocytosis retained its prognostic significance in a multivariate model where other clinical factors such as age, sex and WHO performance status were taken into consideration (HR: 1.83, 95% CI: 1.06-3.13, p = 0.029). Conclusion: Pre-treatment leukocytosis is a strong and independent prognostic marker for shorter overall survival in previously treated stage IIIB or IV NSCLC patients receiving docetaxel or AXL1717. Combined use of pre-treatment leukocytosis assessments together with established prognostic factors such as performance status could be of help when making treatment decisions in this clinical setting.     

Diagnosis of acute lymphoblastic leukemia from intracerebral hemorrhage and blast crisis. A case report and review of the literature

Intracerebral hemorrhage (ICH) contributes significantly to the morbidity and mortality of patients suffering from acute leukemia. While ICH is often identified in autopsy studies of leukemic patients, it is rare for ICH to be the presenting sign that ultimately leads to the diagnosis of leukemia. We report a patient with previously undiagnosed acute precursor B-cell lymphoblastic leukemia (ALL) who presented with diffuse encephalopathy due to ICH in the setting of an acute blast crisis. The diagnosis of ALL was initially suspected, because of the hyperleukocytosis observed on presentation, then confirmed with a bone marrow biopsy and flow cytometry study of the peripheral blood. Furthermore, detection of the BCR/ABL Philadelphia translocation t(9:22)(q34:q11) in this leukemic patient by fluorescent in situ hybridization permitted targeted therapy of the blast crisis with imatinib (Gleevec). Understanding the underlying etiology of ICH is pivotal in its management. This case demonstrates that the presence of hyperleukocytosis in a patient with intracerebral hemorrhage should raise clinical suspicion for acute leukemia as the cause of the ICH.     

高白细胞性急性白血病首次化疗方案及剂量与预后的关系

探讨高白细胞性急性白血病首次化疗方案，化疗剂量与预后的关系。方法：分为早期病死组２３例，非早期病死组３９例，对两组进行回顾性对照分析。结果；化疗剂量，化疗方案是早期病死重要的影响因素。常规剂量化疗，发生早期病死的相对危险约 小剂量化疗的２０倍；含有蒽环类抗生素的化疗方案化疗，发生早期病死的相对危险度约为其它化疗方案化 的２倍。     

电针双向调节白细胞数量的作用与脾血窦基膜小孔活动的关系

目的:探讨脾脏血窦基膜小孔参与电针双向调节外周血白细胞的过程。方法:实验家兔75只,随机分成5组:白增治疗组、白增对照组、白减治疗组、白减对照组和正常对照组,每组15只。家兔耳缘静脉分别注射大肠杆菌菌液和环磷酰胺,复制白细胞增多症模型和白细胞减少症模型,每天耳缘静脉采血,测外周血白细胞计数。治疗取"大椎"、双侧"足三里"、双侧"膈俞",电针20 min,每天1次,共5 d。治疗结束后,切取脾脏,制作脾脏的电镜标本,扫描电镜下观察脾血窦基膜小孔,显微图像分析软件计算脾血窦基膜小孔口径面积。结果:两治疗组与各自模型对照组比较,白细胞数恢复较快(P<0.05,P<0.01);白减治疗组较白减对照组脾血窦基膜小孔口径增大(P<0.05);白增治疗组较白增对照组脾血窦基膜小孔口径缩小(P<0.05)。结论:外周血白细胞数量降低或升高时,电针可以调整白细胞数量趋向正常水平,该作用与脾脏血窦基膜小孔相应的增大或缩小有关。