Objective: The goal of this article was to investigate the diagnosis, treatment and mechanisms of the leukemoid reaction (LKR) associated with transitional cell carcinoma.
Methods: A 64-year-old male patient presented with anuria. Color ultrasound imaging revealed a large bladder tumor. Digital radiography and computerized tomography of the chest, abdomen and pelvis revealed only bilateral hydronephrosis, but did not reveal any metastasis. The preoperative white blood cell count in the peripheral blood consistently increased to 58,400/mm3 while neutrophil granulocyte count was 54,900/mm3, without fever. Radical cystectomy and construction of bilateral cutaneous ureterostomy was performed. The histological diagnosis was transitional cell carcinoma, grade 3. Granulocyte colony-stimulating factor (G-CSF) staining was positive in tumor cells.
Results: After surgery, the leukocyte value became nearly normal. At 3 months later, patient was admitted to our hospital with the complaints of the left leg edema, diagnosed as pelvic lymph node metastasis. Patient died of systemic metastasis within 6 months after the cystectomy.
Conclusions: Bladder cancer associated with LKR, though rare, is considered highly malignant, difficult to diagnose and as having poor prognosis.
