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Case report
Paraneoplastic leukemoid reaction in a localised squamous cell oesophageal cancer with paracrine G-CSF production
  1. Omar Azzam1,
  2. Chandra Hewavitharana Hewavitharana2,
  3. Soraya Fermoyle3 and
  4. David Prentice1
  1. 1Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
  2. 2Department of Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
  3. 3Department of Anatomical Pathology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  1. Correspondence to Dr Omar Azzam; omarazzamwa{at}


A 51-year-old-man presented with symptoms and baseline investigations suggestive of an infective process. Most strikingly, there was a pronounced neutrophil predominant leucocytosis. Lack of a clinical and biochemical response to empirical antibiotic therapy, prompted imaging for a deep-seated infective process, incidentally uncovering a gastro-oesophageal junction tumour. Resection of the tumour was followed by rapid resolution of the leucocytosis. He remains in clinical remission since tumour resection and adjuvant chemotherapy. Cancer-associated leukemoid reactions in non-disseminated tumours are rare. The role of polymorphonuclear (PMN) leucocytes both in the peripheral blood and the tumour itself is discussed herein. There is increasing recognition of the importance of the non-cancer cellular components of the tumour microenvironment. Myeloid suppressor cells are a subset of PMN leucocytes which play a role in tumour progression.The role of these cells and granulocyte colony-stimulating factor is highlighted in this case.

  • oesophageal cancer
  • radiology
  • pathology
  • immunology

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  • Contributors OA and DP were involved in drafting and revision of the submitted manuscript, and attest to the accuracy and integrity of the provided data/material. SF provided the histopathology images and related captions. CHH provided the radiology image and related caption.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.