Gallbladder cancer accompanied by uncontrollable eosinophilia: report of a case

  • Masashi TsunematsuEmail author
  • Koichiro Haruki
  • Tadashi Uwagawa
  • Hiroaki Shiba
  • Katsuhiko Yanaga
Case report


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 


Author contributions

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.

Informed consent

Written informed consent was obtained from the patients for publication of this case report and any accompanying images.


  1. 1.
    Butt NM, Lambert J, Ali S et al (2017) Guideline for the investigation and management of eosinophilia. Br J Haematol 176:553–572CrossRefGoogle Scholar
  2. 2.
    Rothenberg ME (1998) Eosinophilia. N Engl J Med 338:1592–1600CrossRefGoogle Scholar
  3. 3.
    Ackerman SJ, Bochner BS (2007) Mechanisms of eosinophilia in the pathogenesis of hypereosinophilic disorders. Immunol Allergy Clin N Am 27:357–375CrossRefGoogle Scholar
  4. 4.
    Bain BJ (2000) Hypereosinophilia. Curr Opin Hematol 7:21–25CrossRefGoogle Scholar
  5. 5.
    Zhou WW, Guan YY, Liu XM (2015) Paraneoplastic eosinophilia in clear cell renal cell carcinoma. Chin Med J 128:2271–2272CrossRefGoogle Scholar
  6. 6.
    Abali H, Altundag MK, Engin H et al (2001) Hypereosinophilia and metastatic anaplastic carcinoma of unknown primary. Med Oncol 18:285–288CrossRefGoogle Scholar
  7. 7.
    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
  8. 8.
    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
  9. 9.
    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
  10. 10.
    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
  11. 11.
    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
  12. 12.
    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

Copyright information

© The Japan Society of Clinical Oncology 2019

Authors and Affiliations

  1. 1.Department of SurgeryThe Jikei University School of MedicineTokyoJapan

Personalised recommendations