Carcinocythemia with Microfilaria: Two Diverse Pathologies in One Case

Introduction:

Carcinocythemia means circulating tumor cells in peripheral blood. It is a very rare finding I routine practice. The first ever case was reported in 1869 by Ashworth, but it was not till 1976 that the terminology carcinocythemia was coined by Cary et al [1,2]. Only a handful of cases have been reported in literature [3]. We present one such rare case which had an additional finding of micro-filaria in it.

Case Report:

A 60-year-old male patient, hailing from Eastern Ghats of India, presented to the emergency with sudden onset paresis of bilateral lower limbs, hemoptysis, abdominal distention, and urine retention, constipation and persistent chest pain. On evaluation the power of bilateral lower limb was ¼.

He was a known case of Stage IV adenocarcinoma of lungs with bilateral adrenal metastasis. He had received four cycles of PEM + Carboplatin followed by 3 cycles of Carboplatin and Paclitaxel. Last dose of chemotherapy was administered fifteen days prior to presentation.

The patient was not responding to chemotherapy.

He was receiving blood transfusion.

The peripheral smear of the patient revealed circulating tumor cells along with micro-filaria. Cell block was prepared from the sample but unfortunately did not reveal much for special staining. The species of filaria was that of Wuchereria bankrofti. Interestingly, the patient lacked eosinophilia. The total count was 11,000/cumm; Hemoglobin: 8.2gm/dl and Platelet count was 2,10,000/cumm. The counter had flagged for atypical lymphocytes.

The patient deteriorated fast and expired within few hours of presentation. Thus, further evaluation was not possible.

Conclusion:

Carcinocythemia is a rare phenomenon but as a hemato-pathologist vigilance is mandated while evaluating peripheral blood smears to detect such extra-ordinary findings.

References:

1. Ashworth T. A case of cancer in which cells similar to those in the tumors were seen in the blood after death. Aust Med J. 1869;14:146-149.

2. Carey RW, Taft PD, Bennett JM, et al. Carcinocythemia (carcinoma cell leukemia). An acute leukemia-like picture due to metastatic car- cinoma cells. Am J Med. 1976;60(2):273-278.

3. Ronen S., Kroft S.H.,Olteanu H., Hosking P.R.,Harrington A.M.Carcinocythemia: A rare entity becoming more common? A 3-year, single institution series of seven cases and literature review. Int J Lab Hematol. 2019;41:69-79.

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