A 48-year-old male was referred to our hospital for evaluation of motor speech disorders and difficulty in the movement of both the hands. The clinical diagnosis was Trousseau’s syndrome due to advanced gallbladder cancer (cT3aN1M0). The patient received anticoagulation therapy and systemic chemotherapy (gemcitabine and cisplatin). Motor speech disorders and difficulty in movement of both hands were recovered. After 2 courses of chemotherapy, the primary tumor developed a massive hepatic invasion and the peripheral blood eosinophils increased gradually. The patient was admitted to our hospital for abdominal distension, fever, right upper quadrant pain, systemic edema, loss of appetite, and general malaise. The peripheral blood eosinophil count was markedly elevated to 45,900/μl (90.3%). The serum level of GM-CSF was high and there was no evidence of leukemia, allergic status and other diseases. The patient was diagnosed as paraneoplastic eosinophilia with advanced gallbladder cancer, which was suspected to produce GM-CSF. The patient received palliative support and died of disseminated intravascular coagulation 15 days after admission. We herein reported a fatal case of gallbladder cancer suspected of producing GM-CSF.
Eosinophilia Gallbladder cancer GM-CSF
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MT wrote the manuscript. KH and HS contributed to writing the manuscript. TU and KY supervised the study and initially revised the manuscript. MT, KH, HS and TU served as attending physicians of the present patients. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interest.
Written informed consent was obtained from the patients for publication of this case report and any accompanying images.
Butt NM, Lambert J, Ali S et al (2017) Guideline for the investigation and management of eosinophilia. Br J Haematol 176:553–572CrossRefGoogle Scholar
Zhou WW, Guan YY, Liu XM (2015) Paraneoplastic eosinophilia in clear cell renal cell carcinoma. Chin Med J 128:2271–2272CrossRefGoogle Scholar
Abali H, Altundag MK, Engin H et al (2001) Hypereosinophilia and metastatic anaplastic carcinoma of unknown primary. Med Oncol 18:285–288CrossRefGoogle Scholar
Anagnostopoulos GK, Sakorafas GH, Kostopoulos P (2005) Disseminated colon cancer with severe peripheral blood eosinophilia and elevated serum levels of interleukin-2, interleukin-3, interleukin-5, and GM-CSF. J Surg Oncol 89:273–275CrossRefGoogle Scholar
Simon HU, Yousefi S, Schranz C et al (1997) Direct demonstration of delayed eosinophil apoptosis as a mechanism causing tissue eosinophilia. J Immunol 158:3902–3908PubMedGoogle Scholar
Sonoda Y, Arai N, Ogawa M (1989) Humoral regulation of eosinophilopoiesis in vitro: analysis of the targets of interleukin-3, granulocyte/macrophage colony-stimulating factor (GM-CSF), and interleukin-5. Leukemia 3:14–18PubMedGoogle Scholar
Takeda H, Nishikawa H, Tsumura T et al (2014) Prominent hypereosinophilia with disseminated intravascular coagulation as an unusual presentation of advanced gastric cancer. Intern Med 53:563–569CrossRefGoogle Scholar
Vassilatou E, Fisfis M, Morphopoulos G et al (2006) Papillary thyroid carcinoma producing granulocyte-macrophage colony-stimulating factor is associated with neutrophilia and eosinophilia. Hormones 5:303–309CrossRefGoogle Scholar
Takeuchi S, Baghdadi M, Tsuchikawa T et al (2015) Chemotherapy-derived inflammatory responses accelerate the formation of immunosuppressive myeloid cells in the tissue microenvironment of human pancreatic cancer. Cancer Res 75:2629–2640CrossRefGoogle Scholar