Preoperative anemia,leukocytosis and thrombocytosis identify aggressive endometrial carcinomas

Objectives

The objective of this study is to investigate preoperative hematological parameters for anemia, leukocytosis and thrombocytosis in relation to established prognostic factors and survival in endometrial cancer.

Methods

557 patients treated for endometrial carcinoma were prospectively included in a study focusing on the relationship between preoperative hemoglobin, leukocyte and platelet counts, and a panel of clinicopathological characteristics and outcome.

Results

Preoperative anemia was present in 15.8%, leukocytosis in 11.2% and thrombocytosis in 12.1%. Among patients with localized disease (FIGO stage I/II), 18.1% had anemia and/or thrombocytosis at diagnosis. Patients with advanced disease (high FIGO stage and lymph-node metastasis) had significantly lower hemoglobin count, higher leukocyte count and higher platelet count (all p < 0.008). Patients with anemia, leukocytosis and thrombocytosis had significantly shorter 5-year disease-specific survival of 61.3%, 66.0% and 61.0% respectively, compared to 87.7%, 86.3% and 87.3% for patients with normal counts (all p < 0.001). In multivariate Cox regression analysis, lower hemoglobin counts and higher platelet counts were independently associated with poor outcome adjusted for the standardly applied prognostic markers (p < 0.033).

Conclusion

Preoperative anemia, leukocytosis or thrombocytosis in women with endometrial carcinoma is associated with advanced disease and poor disease-specific survival.     

Cholangiocellular carcinoma that produced both granulocyte-colony-stimulating factor and parathyroid hormone-related protein

A 56-year-old man was admitted to our hospital because of consciousness disturbance. Abdominal computed tomography revealed a large low-density tumor in the left lobe of the liver. He presented with marked leukocytosis and hypercalcemia with high levels of serum granulocyte-colony-stimulating factor (G-CSF) and parathyroid hormone-related protein (PTH-rP). A diagnosis of cholangiocellular carcinoma (CCC) of the liver was confirmed by histological examination of an autopsy specimen. The tumor cells showed positivity for both G-CSF and PTH-rP with immunohistochemical staining. These results suggest that the tumor was producing both G-CSF and PTH-rP. This paraneoplastic G-CSF and PTH-rP production caused by CCC is very rare. Such cases must be followed up carefully, since tumors associated with paraneoplastic syndrome progress rapidly, resulting in a poor prognosis.     

Beobachtung einer Acenocoumarol induzierten Granulocytose

Summary A male patient had been treated with acenocoumarol for 9 years. Raised white cell count returned to normal, when acenocoumarol was substituted by heparin, but rose again after reexposure. An analysis of variance showed that this effect is mediated by neutrophils only. The rise is quick and may therefore be caused by a redistribution of white cells rather than by increased cell production.

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Abkürzungsverzeichnis Hb Hämoglobin - Hkt Hämatokrit     

Joint fluid leukocytosis of patient with rheumatoid arthritis computer analysis of possible explanative factors

Summary The relationship between joint fluid leukocytosis and some clinical and laboratory parameters (disease duration, ESR, maximal titres of rheumatoid factor and of antinuclear factors, blood leukocytosis and sex) was studied in 27 consecutive patients with seropositive rheumatoid arthritis. The concentration of leukocytes was significantly higher in the synovial fluid than in peripheral blood. Variations of joint fluid leukocytosis could, however, not be explained by disease duration, actual ESR, maximal rheumatoid factor or antinuclear factor titres, concentration of blood leukocytes, or sex. It is suggested that a possible correlation between joint fluid leukocytosis and the listed parameters of rheumatoid arthritis may be too complex for analysis by a linear multiple regression model in samples of the present size.     

Pertussis with severe pulmonary hypertension and leukocytosis treated with extracorporeal membrane oxygenation

Pertussis, or “whooping cough,” is a highly communicable disease caused by the coccobacillus Bordetella pertussis. Pertussis remains one of the most common causes of death from infectious diseases worldwide. We describe a 5-week-old infant girl who presented with severe pertussis infection associated with extreme leukocytosis and required prolonged extracorporeal membrane oxygenation (ECMO). Nitric oxide therapy resolved the pulmonary hypertension, and she was successfully weaned from ECMO and discharged home after 3 months. We report successful application of ECMO for severe pertussis-induced respiratory failure despite multiple grave prognostic indicators (<1 year age, leukocytosis, pulmonary hypertension) and discuss the role of extracorporeal life support in treating pertussis.     

急性脊髓损伤脑脊液中炎性因子IL-6、IL-8的表达

目的了解急性脊髓损伤(SCI)后脑脊液中炎性因子白介素(IL)-6和IL-8的表达情况,探索其与SCI程度的关系。方法急性SCI患者31例,均在脊髓休克恢复后按Frankel分级进行神经功能评价,分为A级组4例、B级组7例、C级组12例、D级组8例。所有患者均在48 h内行手术减压植骨融合内固定治疗,随访6个月。在患者受伤后12、24、36、48、72 h行腰椎穿刺术并收集脑脊液,采用ELISA法检测IL-6和IL-8的浓度。结果 Frankel分级A级组1例死亡,3例神经功能无明显改善;其他组均有一定比例的患者神经功能改善。IL-6和IL-8在SCI早期(12 h)即出现高表达,且SCI越严重IL-6和IL-8升高越明显,损伤程度最严重的A级组IL-6和IL-8的表达分别为其他组的2.4~9.1倍和2.0~17.8倍;IL-6和IL-8的峰值分别在36 h和24 h;其中IL-6升高幅度更大、更持久,浓度变化大,且与SCI程度相关,损伤程度最严重的A级组IL-6在24、36、48 h的表达与12 h时的比值分别为3.6、5.6、4.7,而其他组的相应比值范围为0.74~2.40。结论急性SCI早期脑脊液中IL-6和IL-8浓度变化可在一定程度上作为判断SCI程度的指标,对帮助临床判断是否进行早期手术治疗有一定的参考价值。     

A case of squamous cell carcinoma of the head and neck producing granulocyte-colony stimulating factor with marked leukocytosis

In squamous cell carcinoma of the head and neck (SCCHN), tumor cells have been shown to secrete detectable amounts of various cytokines, such as interleukin (IL)-6, IL-10, and transforming growth factor (TGF)-beta. These tumor-derived factors might be responsible for promoting malignancy. Here, we describe a SCCHN patient with tumor produced G-CSF and characterized by marked leukocytosis. In this 45-year-old man, severe leukocytosis developed in parallel with aggressive tumor growth. G-CSF production by the tumor was confirmed by immunohistochemistry (IHC). Serum G-CSF levels were elevated. The leukocyte counts and the blood G-CSF level decreased following a course of radiotherapy. Tumor cells were also positive for G-CSF receptor, suggesting autocrine growth regulation by G-CSF. Moreover, the tumor cells were also investigated by IHC with anti-p53, anti-P-glycoprotein (P-gp), anti-thymidylate synthase (TS), and anti-dihydropyrimidine dehydrogenase (DPD), which molecules are thought to contribute the acquisition of therapeutic resistance. The tumor cells were positively stained for TS and DPD, but neither p53 nor P-gp. These results suggest that a variety of molecules may be responsible for acquisition of high malignancy.     

Prognostic Significance of Preoperative Anemia,Leukocytosis and Thrombocytosis in Chinese Women with Epithelial Ovarian Cancer

Malignant tumors are often accompanied by increased risk of hematological abnormalities. However, fewstudies have reported any prognostic impact of preoperative thrombocytosis, leukocytosis and anemia in epitheliaovarian cancer (EOC). This study aimed to investigate preoperative hematological parameters for anemia,leukocytosis and thombocytosis in relation to established prognostic factors and survival in EOC cases. A totalof 816 Chinese women treated for EOC were retrospectively included in the study focusing on the relationshipbetween preoperative hemoglobin, leukocyte and platelet counts, and a panel of clinicopathologic characteristicsand outcome. Preoperative anemia was present in 13.4%, leukocytosis in 16.7% and thrombocytosis in 22.8% .Additionally, EOC patients with low differentiation grade, advanced stage, lymph node (LN) metastasis, residualdisease ≥ 1cm, ascites volume >1,000ml, serum cancer antigen 125 (CA125) >675U/ml, and disease recurrencehad the higher prevalence of preoperative anemia, leukocytosis and thrombocytosis (all p<0.05). Moreover,EOC patients with older age or postmenopausal EOC patients had the higher prevalence of thrombocytosis(28.7% vs 17.3% or 26.0% vs 17.7%). Furthermore, in a Cox proportional hazard model, thrombocytosis wasan independent factor for progression-free survival (PFS) and overall survival (OS) (p<0.001). Conclusively,preoperative anemia, leukocytosis or thrombocytosis in EOC patients is closely associated with more malignantdisease phenotype and poorer prognosis. Significantly, thrombocytosis may independently predict the diseasespecificsurvival for EOC patients.