Abstract A leukemoid reaction, or neutrophilic leukocytosis, is defined as a persistent leukocytosis with a white blood cell count exceeding 50 × 10 9 /L and a significant increase in neutrophilic precursors. The mechanism of leukemoid reaction results from granulocyte colony-stimulating factor secretion by tumor cells into the bone marrow. Leukemoid reactions are rare in kidney malignancy, though they are more commonly associated with malignancies of the pulmonary, nasopharyngeal, gastrointestinal tract, and hematologic malignancies like chronic myeloid leukemia. The presence of this reaction indicates a poor prognosis. We report two cases of renal malignancies presenting with leukemoid reactions. The first case involved a 56-year-old male with locally advanced squamous cell carcinoma (SCC) of the kidney exhibiting sarcomatoid features and a paraneoplastic leukemoid reaction. Despite palliative nephrectomy, chemotherapy, and radiotherapy, the patient developed progressive metastatic disease, culminating in bone marrow suppression and multiorgan failure. The second case involved a 55-year-old male with locally advanced renal cell carcinoma (RCC) with sarcomatoid differentiation presenting with leukemoid reaction. Due to poor general condition, the patient was managed with chemotherapy, targeted therapy, and supportive measures, but developed bone marrow suppression and succumbed shortly after treatment. Leukemoid reactions, although rare, may serve as markers of aggressive disease and poor prognosis in patients with RCC and SCC of the kidney. These cases highlight the rapid disease progression and therapeutic challenges associated with advanced renal malignancies presenting with paraneoplastic leukemoid reactions.
Suhail et al. (Thu,) studied this question.
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