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Paraneoplastic Leukemoid Reaction in a Case of Carcinoma Gall Bladder: A Rare Scenario

Jeetendar Paryani, Sameer Gupta, Arun Chaturvedi, Vijay Kumar, Naseem Akhtar, Parijat Suryavanshi and Shashi Singh Pawar

Paraneoplastic Leukemoid reaction may be defined as elevated WBC counts in association of solid malignancy when other causes like infection and hematological malignancies have been ruled out. The exact mechanism has not been fully elucidated. It is likely that various cytokines produced irregularly by the tumor cells, including granulocyte colony-stimulating factor (G-CSF), may underlie the pathogenesis.

We here describe a case report of 68-year-old man with locally advanced gall bladder presenting with extremely elevated WBC count. Infection, leukemia, bone marrow involvement were ruled out. Patient underwent surgery and after resection counts normalized. Patient had recurrence few months later which was accompanied by raised TLC.

There are many studies associating this rare phenomenon with lung urothelial melanomas and other malignancies but not with gall bladder cancer making this extremely rare occurrence. Therapeutic strategies for the neoplasm, like surgical excision, chemotherapy, and radiotherapy, frequently result in a decrease in the white blood cell count. Nevertheless, in such patients, the leukemoid reactions have been reported to correlate with an aggressive clinical course, lower survival time, occurring shortly before death.