Paraneoplastic Leukemoid reaction in soft tissue sarcoma: A case report and literature review

Abstract

Introduction: Paraneoplastic leukemoid reactions (PLRs) in the context of sarcomas represent a unique clinical entity that poses significant diagnostic challenges and adds valuable insights to the surgical literature. Characterized by an abnormal elevation of white blood cell count, these reactions are often associated with aggressive tumor biology and poor prognosis, emphasizing the need for heightened awareness among clinicians.

Case presentation: A 48-year-old male presented with a rapidly growing, ulcerated tumor on his thigh. Lab tests revealed an extreme leukocytosis with a white blood cell count of 92,860/mm3. Imaging and biopsy confirmed a high-grade spindle cell sarcoma.

Clinical discussion: After excluding other causes of leukocytosis, a PLR secondary to sarcoma was diagnosed. Despite initial antibiotic treatment, leukocytosis persisted, prompting a decision for surgical intervention. The patient underwent successful tumor resection, resulting in a significant decrease in leukocyte count and subsequent stable recovery, supported by adjuvant radiotherapy.

Conclusion: This case underscores the importance of recognizing PLRs in sarcoma patients as they can significantly impact clinical management and prognosis. It highlights the necessity of a multidisciplinary approach for accurate diagnosis and effective treatment. The case contributes to the surgical literature by detailing the diagnostic process and therapeutic interventions in managing such complex presentations, thereby providing key "take-away" lessons on the importance of considering PLRs in the differential diagnosis of leukocytosis in patients with malignancies.

Keywords: Case report; Paraneoplastic leukemoid reactions; Soft tissue sarcoma; Spindle cell sarcoma.

Fig. 1

(a) CT of the right thigh, in the axial section, reveals a tumor involving the vastus lateralis and vastus intermedius muscles. The imaging shows a hyperdense peripheral component and hypodense central areas within the tumor. (b) In the cut surface, the neoplasm appears fish-like, white-pink, with hemorrhagic areas.

Fig. 2

(a, 20x) In the microphotography, we identified a neoplasm of spindle cells, with long bundles, with a solid arrangement. Also, we can identify chronic inflammatory cells (plasma cells, eosinophils, and lymphocytes). (b, 40x) These cells show moderate atypia with vesicular, elongated nuclei, some larger and irregular. (c, 20x) The neoplasm was only diffusely positive for vimentin and CD10.