Abstract
BackgroundRapid lethal exacerbation and recurrence featuring acute leukemoid reaction (ALR) after retrolaparoscopic radical nephrectomy (RN) is a relatively rare clinical incident. Performing the reoperation for the patient and analyzing the tissue-based genetic mutation information postoperatively are a skill-demanding and meaningful task, which have been even more rarely reported.Case presentationWe present a case with a large right renal mass (13.0 × 10.0 × 8.0 cm). This 71-year-old male patient underwent the retrolaparoscopic RN in our department. The operation was technically precise and successful with final pathological diagnosis of hybrid (clear cell and papillary type) renal cell carcinoma (RCC). However, 10 days after the patient was discharged, he was readmitted with the chief complaint of high fever with severe right flank pain. CT scanning revealed that right retroperitoneal hematoma and the blood routine showed the dramatic elevation of white blood cell count (WBC). Even though the immediate broad-spectrum antibiotics were administered without delay and subsequent percutaneous puncturing and drainage was performed, the patient’s condition still exacerbated rapidly. In spite of the reoperation of hematoma evacuation, the patient died of multiple organ failure 10 days after the reoperation. The pathological result of reoperation showed the necrotic and hematoma tissue blended with RCC tumor cells (nuclear grading III), and both of the postoperative tissue-originated comprehensive genomic profiling by using the specimens from the RN and reoperation respectively indicated significant mutations of some oncogenes which might have potential relevance with ALR. Besides, both of the immunohistochemical (IHC) staining results from primary surgical renal mass and reoperative resected tissue revealed the positive expressions of granulocyte colony-stimulating factor (G-CSF).ConclusionsALR may be a predictor of poor prognosis in patients with RCC, and comprehensive genomic profiling as well as the alterative expression of G-CSF can help to provide potential valuable genetic etiological information and evidence for guiding the potential effective molecular-targeting therapy.
Highlights
Rapid lethal exacerbation and recurrence featuring acute leukemoid reaction (ALR) after retrolaparoscopic radical nephrectomy (RN) is a relatively rare clinical incident
ALR may be a predictor of poor prognosis in patients with renal cell carcinoma (RCC), and comprehensive genomic profiling as well as the alterative expression of granulocyte colony-stimulating factor (G-CSF) can help to provide potential valuable genetic etiological information and evidence for guiding the potential effective molecular-targeting therapy
Given some cases of G-CSF-producing RCC with leukemoid reactions have been reported previously [14, 15], the IHC for assessment of G-CSF expression in the renal tumor and in the specimen from the reoperation were performed on formalin-fixed paraffin-embedded tissue blocks
Summary
ALR associated with overexpression of G-CSF may be a predictor of poor prognosis in patients with RCC, and comprehensive genomic profiling can help to provide potential valuable genetic etiological information and evidence for guiding the potential effective moleculartargeting therapy
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