ORCID: 0000-0003-0912-917X
We report the case of an 80-year-old woman who presented to the
emergency department with worsening chronic dyspnea and cervical
adenopathy. Her medical history included chronic lymphocytic leukemia
(CLL) treated with Venetoclax and a breast cancer in remission since 6
years.
The whole blood count (white blood cells, 13.5 G/L; hemoglobin, 13 g/dL;
platelets, 143 G/L) showed unusual interferences on the WDF scattergram
of the XN-series analyzer (Sysmex), with a high florescence cell
population (Figure. 1A ) without cytopenia.
The blood smear after May-Grünwald Giemsa staining (original
magnification x100 and x1000), showed 30% of discohesive, large,
atypical cells with abundant basophilic vacuolated cytoplasm, irregular
pseudolobed nuclei, with weak chromatin condensation and blue prominent
nucleoli (Figure. 1B and C ).
The flow cytometry analysis showed the presence of 11% of kappa
monotypic B cells with a phenotypic profile with a Matutes score of 5
consistent with the known CCL and no evidence of a circulating phase of
large cell lymphoma or blasts.
Altogether, these results ruled out hematological malignancies.
This case points toward a breast cancer recurrence with circulating
cancer cells (carcinocytemia) and lymphangitis carcinomatosis.
Unfortunately, the patient developed disseminated intravascular
coagulation and died shortly thereafter, before additional exploration.
Only few cases of carcinocythemia have been described in the
literature1–3. The most frequent primary neoplasm
associated with carcinocythemia is breast carcinoma. The proportion of
circulating metastatic cells vary from single cell to 80% of
circulating nucleated cells mimicking myeloid or lymphoid
neoplasm1,3. It is associated with poor prognosis and
survival with 85% of mortality in the literature series and 34.5%
reported cases of carcinocythemia were associated with intravascular
coagulation or thrombotic events, leading to death similar to our
case1.
This rare case of massive circulating metastatic cells highlights the
importance of careful differential diagnosis to make the distinction
between carcinocythemia and acute leukemia or lymphoma.