Massive circulating metastatic cells: A case of carcinocythemia.

Importance of careful differential diagnosis to make the distinction between carcinocythemia and acute leukemia or lymphoma.

Células tumorales circulantes en una paciente con sospecha clínica de mieloma múltiple / Circulating tumor cells in a patient with clinical suspicious of multiple myeloma

Introducción: La circulación de células tumorales en la sangre periférica, conocido como carcinocitemia, es un fenómeno raro y muy poco comunicado en la literatura científica y su diagnóstico diferencial puede constituir un desafío en la práctica clínica. Objetivos: Describir las causas más frecuentes de carcinocitemia, los retos diagnósticos que representa y contribuir a elevar el índice de sospecha de esta entidad. Presentación del caso: Paciente femenina de 71 años de edad que acude por dolores óseos y palidez cutánea. En el examen de sangre periférica se observa células de gran tamaño que recordaron células plasmáticas. El inmunofenotipo por citometría de flujo fue sugestivo de mieloma múltiple isotipo IgM. El ultrasonido de mamas y la tomografía de tórax mostraron lesión tumoral en la mama izquierda. El estudio inmunohistoquímico de la biopsia de médula ósea fue compatible con adenocarcinoma de mamas. La paciente falleció sin haber comenzado tratamiento específico. Conclusiones: Se presenta paciente con células circulantes tumorales secundaria a adenocarcinoma de la mama donde la inmunohistoquímica de la biopsia de médula ósea descartó el diagnóstico de mieloma múltiple sospechado clínica, radiológicamente, por la morfología celular y el inmunofenotipo(AU)

Introduction: The circulating tumor cells in peripheral blood, known as carcinocythemia is a rare and poorly documented phenomenon, that can be a challenge diagnosis. Objectives: To describe the most frequents causes of carcinocythemia, the diagnosis challenges that it represents and to contribute raising awareness of this entity. Case presentation: Female patient, 71-year-old who complained bone pain and skin pale. The peripheral blood smear showed big size cells mimicking plasma cells. The immunophenotype by flow cytometry suggested IgM isotype multiple myeloma. Breast ultrasound and thorax tomography showed a tumor in the left breast. The bone marrow biopsy immunohistochemical was compatible with adenocarcinoma of breast. The patient died short after before receive specific treatment. Conclusions: We present a patient with circulating tumor cells secondary to breast adenocarcinoma where the bone marrow biopsy immunohistochemical ruled out multiple myeloma diagnosis suspected by clinical, image studies, cell morphology and immunophenotype(AU)

Carcinocythemia: A rare entity becoming more common? A 3-year, single institution series of seven cases and literature review.

INTRODUCTION: Carcinocythemia is a rare phenomenon defined as morphologically identifiable, circulating tumor cells in the peripheral blood. No modern case series of carcinocythemia exists in the literature. METHODS: Blood smears from carcinocythemia patients were reviewed and associated clinicopathologic findings described and compared to the literature. When available, bone marrows were examined. RESULTS: We identified 7 carcinocythemia cases over 3 years at our institution in 5 females and 2 males with a median age of 57 and compare them to 26 case reports in the literature (19 females, 10 males; median age 57). The primary neoplasms were carcinomas of breast (3 cases), lung, non-small cell (2 cases), prostate (1), and 1 case of unknown primary. Circulating tumor cells were associated with fragmentation hemolysis (2 cases), asplenic RBC changes (3 cases), and myeloid antigen expression by flow cytometry (2 cases) and were most commonly found at the feathered edge of the slide (6 cases) as single cells or in clusters. CONCLUSIONS: This represents the largest series of carcinocythemia reported. The identification of 7 cases at one institution over a 3-year period suggests carcinocythemia may becoming more common. Raising awareness of this entity and its associated clinicopathologic findings may help avoid diagnostic pitfalls in blood smear examinations and may guide timely clinical management.

Primary colonic signet ring cell carcinoma presenting carcinocythemia: an autopsy case.

Primary colorectal signet ring cell carcinoma (SRCC) is a rare but distinctive type of mucin-producing adenocarcinoma of the large intestine with still controversial clinicopathological features and prognosis. We encountered primary colonic SRCC in a 51-year-old Japanese man with extensive bone metastasis ultimately leading to carcinocythemia before the initiation of chemotherapy and surgical intervention. Three days before death, besides progressive disseminated intravascular coagulation that had been present on admission, hematological examination showed sudden leukocytosis with nonhematopoietic cells that subsequently turned out to be signet ring cells (SRCs). Carcinocythemia, the presence of circulating cancer cells in peripheral blood, is considered to be a rare but an ominous phenomenon occurring in the advanced stage of certain types of cancers, particularly mammary lobular carcinoma. It can be assumed that carcinoma cells lacking intercellular cohesiveness and polarized cell membrane organization, including SRCs as well as lobular carcinoma cells, can readily get access to the peripheral circulation; however, to our knowledge, this is the first report of primary colorectal SRCC that presented carcinocythemia. Extensive bone metastatic sites, in the present case, may have functioned as a reservoir of circulating SRCs.