A 58-year-old male patient had symptoms of intermittent cough and hemoptysis with no incentives in June 2014, and accompanying chest tightness and shortness of breath. He was first admitted to a local hospital, where computed tomography of the chest showed a left lung mass, suggesting a probability of tuberculosis. Therefore, he was treated for tuberculosis, but had no significant relief of symptoms. He then visited our hospital, where he underwent computed tomography-guided biopsy; the pathology results showed poorly differentiated adenocarcinoma (left lung). He then underwent surgery for resection of the mass; pathological examination showed poorly differentiated peripheral pulmonary carcinoma with the tumor being composed of mononuclear and multinucleated tumor giant cells with significant atypia. Immunohistochemistry showed: creatine kinase (CK) (-), P63 (-), thyroid transcription factor (TTF)-1 (-), CK18 (+), Napsin A (-), CK (+), vimentin (+), smooth muscle actin (SMA) (-), desmin (-), epidermal growth factor receptor (EGFR) (++), Ki-67 (+60%), epithelial membrane antigen (EMA) (+); the consideration is sarcomatoid carcinoma (giant cell carcinoma). The patient received two courses of chemotherapy in our hospital after surgery, gemcitabine 1.4 D1and 8 + cisplatin 30 mg D1-4 and tolerated it well.
However, the patient's white blood cells (WBCs) increased gradually without fever or use of medications, such as granulocyte colony-stimulating factor (G-CSF) and steroids, after the end of the second course (Figure 1), and neutrophils accounted for ~93%. While his hemoglobin and platelets were within the normal range. We initially used antibiotics empirically, which was ineffective. Next, a bone marrow biopsy was performed; the results showed myeloid and erythroid focal hyperplasia and significant partial immature myeloid cell proliferation (Figure 2). Immunohistochemistry showed individual lymphocytes CD3 (+), individual lymphocytes CD20 (+), erythroid CD235a (+), megakaryocytes CD61 (+), CD34 (-), individual monocytes CD14 (+), individual plasma cells CD138 (+), a large number of myeloid myeloperoxidase (MPO) (+) (Figure 3). Finally, the patient was diagnosed with leukocytosis, then he and his family refused further chemotherapy, so we put the patient on "hydroxyurea" to control the leukocytosis. The patient died of multiple organ failure 2 months after being diagnosed with leukocytosis. This study was approved by the Ethics Committee of The Affiliated Cancer Hospital of Zhengzhou University.