Hypereosinophilia in Solid Tumors—Case Report and Clinical Review

Abstract

BackgroundRenal cell cancer may cause various paraneoplastic syndromes; however, paraneoplastic hypereosinophilia occurs exceedingly rare. Thus far, only two cases of clear cell renal cell carcinoma (CCRCC) associated with hypereosinophilia have been reported. In this paper, we present a case of paraneoplastic hypereosinophilia associated with renal cell carcinoma and a review of the reported cases of hypereosinophilia in solid tumors.MethodsThe review is based on an electronic literature search performed in the PubMed database in September 2020 with the following key terms: eosinophilia & neoplasm; eosinophilia & cancer; eosinophilia & paraneoplastic syndrome. Papers were included based on screening the titles and/or abstracts. We also included the case of our patient in the analysis.Case presentationA 68-year-old Caucasian female patient with recurrent CCRCC was admitted to our Clinic for exacerbating dyspnea and chest and right upper abdominal pain, accompanied by confusion. Preliminary blood tests showed an increased white blood cell count of 40,770/μl, and an increased eosinophil count of 6,530/μl indicating eosinophilia. Several tests were carried out to rule out the noncancer causes of hypereosinophilia. The temporal appearance of eosinophilia and the recurrence of CCRCC without any other apparent potential causes led to the diagnosis of paraneoplastic hypereosinophilia. Despite treating with high doses of corticosteroids, only a transient decrement in eosinophil count was observed along with further deterioration of the patient’s condition. The patient succumbed to the disease 6 months following the tumor surgery and 2 months after the diagnosis of hypereosinophilia and tumor recurrence.ConclusionOur observations are in agreement with the majority of reports showing that the occurrence of eosinophilia following tumor resection may indicate a poor prognosis, tumor recurrence, and rapid disease progression.

Paraneoplastic Hypereosinophilia in Poorly Differentiated Adenocarcinoma of the Lung

“…Though most often seen in hematologic malignancies, significant eosinophilia in the setting of lung adenocarcinoma has been described as a rare paraneoplastic syndrome [3][4][5]. The presence of this paraneoplastic phenomenon, with increased serum eosinophils, has been recognized as a poor prognostic feature reflecting advanced disease and dissemination with a more rapid disease progression than expected [2][3][4][5]. We report on an 81-year-old female with hypereosinophilia associated with poorly differentiated lung adenocarcinoma.…”

“…It is well-documented that lung and bronchus cancers are the leading cause of cancer death in the United States in both male and female patients, and lung adenocarcinoma accounts for the highest prevalence of lung cancers [1,2]. Though most often seen in hematologic malignancies, significant eosinophilia in the setting of lung adenocarcinoma has been described as a rare paraneoplastic syndrome [3][4][5]. The presence of this paraneoplastic phenomenon, with increased serum eosinophils, has been recognized as a poor prognostic feature reflecting advanced disease and dissemination with a more rapid disease progression than expected [2][3][4][5].…”

Laboratory Workup of Hypereosinophilia

“…Solid tumors like carcinomas arising from lung, GIT, hepatobiliary system, thyroid, and genitourinary system 15 Other rare causes: Graft versus host disease, 17 adrenal insufficiency, 18 atheroembolic disease, 19 Gleich syndrome (episodic angioedema with eosinophilia (EAE) 20 Abbreviations: ADA, adenosine deaminase; CVID, common variable immunodeficiency; GIT, gastrointestinal tract; HE/HES, hypereosinophilia/hypereosinophilic syndrome; HIV, HIV, human immunodeficiency virus; MHC II, major histocompatibility complex II; NSAIDs, nonsteroidal anti-inflammatory drugs. Lymphocyte variant HES.…”

“…Solid tumors like carcinomas arising from lung, GIT, hepatobiliary system, thyroid, and genitourinary system 15…”

“…Reactive eosinophilia is predominantly mediated by IL-5 (along with IL-3 and IL-4) and is caused by atopic dermatitis, asthma and seasonal allergic disorders (rhinitis/hay fever), dermatological disorders like Wells syndrome (nonallergic granulomatous dermatitis), druginduced (includes drug reaction with eosinophilia and systemic symptoms/DRESS), helminthic and fungal infections, primary gastrointestinal eosinophilic disorders, connective tissue disorders, rheumatological diseases, atheroembolic disease, Gleich syndrome, lymphoproliferative disorders, solid malignancies, and the lymphocytic variant of HE. The major secondary causes [7][8][9][10][11][12][13][14][15][16][17][18][19][20] are summarized in ►Table 1.…”