Lab Med Online.  2017 Oct;7(4):206-210. 10.3343/lmo.2017.7.4.206.

Neutrophilic Leukemoid Reaction Associated with Malignancy Initially Suspected as Chronic Neutrophilic Leukemia

• So MK
• Park S
• Mun YC
• Seong CM
• Huh HJ
• Huh J

• KMID: 2389662
• DOI: http://doi.org/10.3343/lmo.2017.7.4.206

Abstract

Although neutrophilia can manifest from various causes, it is important to be able to distinguish chronic neutrophilic leukemia (CNL) from neutrophilic leukemoid reactions (NLR). In this paper, we describe four cases of leukocytosis with neutrophilia, including one case of CNL with a T618I mutation in colony stimulating factor 3 receptor (CSF3R) and three cases of NLR associated with malignancy or sepsis, which were initially suspected as CNL. Of the three NLR cases, one was associated with ovarian cancer, one with monoclonal gammopathy of undetermined significance and one with multiple myeloma with sepsis. This study demonstrated that confirming the clonality of myeloid cells with CSF3R T618I could contribute to making an accurate differential diagnosis between CNL and NLR in patients with solid cancers or plasma cell neoplasms caused by paraneoplastic syndromes and/or infection.

Keyword

Chronic neutrophilic leukemia; Neutrophilic leukemoid reaction; Colony stimulating factor 3 receptor; Paraneoplastic syndrome; Plasma cell neoplasm

MeSH Terms

Colony-Stimulating Factors
Diagnosis, Differential
Humans
Leukemia, Neutrophilic, Chronic*
Leukemoid Reaction*
Leukocytosis
Monoclonal Gammopathy of Undetermined Significance
Multiple Myeloma
Myeloid Cells
Neoplasms, Plasma Cell
Neutrophils*
Ovarian Neoplasms
Paraneoplastic Syndromes
Sepsis
Colony-Stimulating Factors

Figure

• 

  Fig. 1 Peripheral blood and bone marrow findings of a patient with chronic neutrophilic leukemia (case 1, A–D) and a patient with co-occurrence of neutrophilic leukemoid reaction and MGUS (case 3, E–H). They showed neutrophilia (A, E) and hypercellularity with myeloid hyperplasia in BM (B–D, F–H). A few plasma cells were noted (F, G). [PB, Wright stain, ×400 (A, E); BM aspiration, Wright stain, ×400 (B, F), ×1,000 (C, G); BM biopsy, H&E stain, ×100 (D, H)].

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