A leukemoid reaction in a patient with a dedifferentiated liposarcoma

Abstract

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The patient was a 63-year-old man who in 1992 went to an outside hospital with vague abdominal discomfort. A computed tomography (CT) scan demonstrated a 4-cm mass near the tail of the pancreas. Laboratory studies revealed a white blood cell count (WBC) of 22,600/mL. The mass was excised, including a distal pancreatectomy and splenectomy. Postoperatively, the patient's WBC normalized. Histology was read as a nonspecific inflammatory process.

In 1996 he went to the outside hospital with an episode of upper gastrointestinal bleeding and ongoing melena. His laboratory findings revealed a WBC count of 33,000/mL and a hemoglobin level of 4 g/dL. Upper endoscopy demonstrated a mass eroding into the greater curvature of the stomach. After stabilization, a subtotal gastrectomy with partial excision of a retroperitoneal mass was performed. Histology demonstrated a low-grade malignant fibrous histiocytoma (MFH). The patient recovered, but his WBC remained elevated. A CT scan demonstrated a residual 14-cm retroperitoneal mass. The tumor was thought to be unresectable, and the patient was offered no further therapy.