Clinical and Molecular Hepatology

"Paraneoplastic"

Case Report

A case of leukemoid reaction in a patient with sarcomatous hepatocellular carcinoma: Hyun Phil Shin, Jung Won Jeon, Jae Jun Park, Jae Myung Cha, Kwang Ro Joo, Joung Il Lee, Gou Young Kim, So Young Kang; Korean J Hepatol 2011;17(3):226-228.
Published online September 30, 2011; DOI: https://doi.org/10.3350/kjhep.2011.17.3.226

Abstract
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A leukemoid reaction is defined as reactive leukocytosis exceeding 50,000/mm³, with a significant increase in early neutrophil precursors, and can be a paraneoplastic manifestation of various malignant tumors. A 71-year-old male patient complained of decreased appetite, fatigue, and abdominal fullness. He had a palpable, firm liver, and laboratory investigations suggested leukemoid reaction. Liver dynamic computed tomography revealed a hypervascular mass, and an ultrasound-guided fine-needle aspiration of the mass confirmed hepatocellular carcinoma (HCC) with a sarcomatoid component. The leukocyte count of the patient had increased to 147,800/mm³, and he died 10 days after admission. This is a rare case of leukemoid reaction in a patient with sarcomatous HCC.

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Original Article

The Incidence and Clinical Significance of Paraneoplastic Syndromes in Patients with Hepatocellular Carcinoma: Uh Young Huh, M.D., Jin Hyuk Kim, M.D., Byung-Ho Kim, M.D., Ki Deuk Nam, M.D., Jae Young Jang, M.D., Nam Hoon Kim, M.D., Sang Kil Lee, M.D., Kwang Ro Joo, M.D., Seok Ho Dong, M.D., Hyo Jong Kim, M.D., Young Woon Chang, M.D., Joung Il Lee, M.D., and Rin Chang, M.D.; Korean J Hepatol 2005;11(3):275-283.

Abstract
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Background/Aims
Patients with hepatocellular carcinoma (HCC) may manifest paraneoplastic syndromes such as hypercholesterolemia, hypoglycemia, hypercalcemia and erythrocytosis. This study was aimed at evaluating the incidence and clinical significance of paraneoplastic syndromes in Korean HCC patients. Methods: The medical records of 165 HCC patients who were diagnosed and died in the Kyung Hee University Hospital, were reviewed retrospectively. The following variables were analyzed: age, gender, hepatitis markers, platelet, liver function test, α-fetoprotein (AFP), Child-Pugh score, tumor features, and the duration of their survival. Results: In total, paraneoplastic syndromes were presented in 43.6% of the HCC patients during the course of their disease. Hypercholesterolemia was solely presented in 14.5%, hypoglycemia in 12.7% and hypercalcemia in 7.8%. The patients who presented with more than 2 syndromes were 8.5%. While 80% of erythrocytosis (4/5) and 51.6% of hypercholesterolemia (16/31) was presented at the time of HCC diagnosis, hypoglycemia and hypercalcemia mainly occurred as terminal events. The patients with paraneoplastic syndromes were younger and had higher rates of portal vein thrombosis, bi-lobar tumor involvement and tumor more of more than 10cm in diameter, compared to those patients without them. The proportion of patients with a serum AFP more than 400ng/mL tended to be higher in the patients with paraneoplastic syndromes. The HCC patients with paraneoplastic syndromes, except for erythrocytosis, had a shorter survival than those patients without them. Conclusions: Paraneoplastic syndromes are not infrequently presented in HCC patients, especially at an advanced stage, and the survival of these patients is relatively shorter. (Korean J Hepatol 2005;11:275-283)

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