Leukemoid reaction in lung cancer patients.

[a] Biopsy proven poorly differentiated large cell carcinoma of the lung in a 61 year old woman. CT image of the chest with intravenous contrast medium at the level of the aortic arch shows right lung tumor (arrow), 6 cm, with central necrosis. [B] Photomicrograph of the lung showing atypical large cells with abundant eosinophilic cytoplasm and enlarged nuclei consistent with large cell type, undifferentiated carcinoma. (Hematoxylin-eosin x 400). systemic symptoms including fatigue, weight loss, fever and night sweats associated with leukocytosis. In both cases, extensive studies to find causes other than lung cancer were negative, and leukemoid reaction with WBC levels above 100,000 cells/µl was observed during the course of their disease. Their prognosis was ominous, with tumors refractory to all treatments. A 61 year old woman, a smoker, presented with complaints of cough, fatigue, weight loss, night sweats, and fever up to 39ºC of 6 weeks duration. Superficial transitional cell carcinoma was diagnosed 9 years before her presentation. At that time, she was successfully treated with intravesical installation of Bacillus Calmette-Guérin. Her WBC level was 15,000 cells/µl, most of them mature neutrophils. Imaging studies showed WBC = white blood cells w orldwide, lung cancer is the most common and the deadliest form of cancer. The presenting symptoms of patients with lung cancer are determined by the sites involved, either primary lung, or metastases in bone, brain, liver, and adrenal glands. In addition, patients may exhibit various paraneoplastic manifestations , often preceding other clinical signs and symptoms. Prognostic factors for patients with lung cancer can be divided with regard to patient, tumor, and treatment-specific parameters. The three most important prognostic factors are classically considered stage, performance status, and weight loss. In addition, a range of prognostic bio-markers, including mutations involving genes that regulate cell cycle progression and apoptosis, as well as invasion and metastasis have been described in these patients. An increased level of white blood cells is often found either at the time of diagnosis or during the course of their disease [1]. It may be caused by one or more factors, such as concomi-tant infections, bone marrow metasta-sis, or administration of corticosteroids. However, patients with lung cancer may show leukocytosis without these conditions. Such patients are considered to have tumor-related leukocytosis, which may be caused by the unregulated production of hematopoietic cytokines. We report two cases of metastatic lung cancer presenting with severe a 6 cm mass …