Peripheral Blood Eosinophilia: An Unusual Presentation of Bone Marrow Involvement in a Patient with Relapsed Thyroid Papillary Carcinoma

Hye Ryoung Sul; Seok Jin Kim; Dong Il Kim; Shin Gon Kim; Dong Seop Choi; Yun Jeong Jo; Byung Soo Kim

doi:10.5045/kjh.2005.40.4.274

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Sul, Kim, Kim, Kim, Choi, Jo, and Kim: Peripheral Blood Eosinophilia: An Unusual Presentation of Bone Marrow Involvement in a Patient with Relapsed Thyroid Papillary Carcinoma

Case Report

Korean J Hematol 2005;40(4):274-277.

Published online: 21 December 2005

DOI: https://doi.org/10.5045/kjh.2005.40.4.274

Peripheral Blood Eosinophilia: An Unusual Presentation of Bone Marrow Involvement in a Patient with Relapsed Thyroid Papillary Carcinoma

Hye Ryoung Sul, M.D.¹, Seok Jin Kim, M.D.¹, Dong Il Kim, M.D.¹, Shin Gon Kim, M.D.¹, Dong Seop Choi, M.D.¹, Yun Jeong Jo, M.D.², Byung Soo Kim, M.D.¹

¹Department of Internal Medicine, Korea University Medical Center, Seoul, Korea

²Department of Laboratory Medicine, Korea University Medical Center, Seoul, Korea

Correspondence to: Byung Soo Kim, M.D., Ph.D. Division of Oncology and Hematology, Department of Internal Medicine, Korea University Medical Center 126-1, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-705, Korea Tel: +82-2-920-5488, Fax: +82-2-920-6520 E-mail: kbs0309@korea.ac.kr

Received 27 October 2005 Revised 25 November 2005 Accepted 30 November 2005

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Peripheral blood eosinophilia is a well-known paraneoplastic manifestation, but its underlying mechanism is still unclear. Bone marrow metastasis may be a cause of malignancy-associated eosinophilia. However, there is limited evidence of the relationship between bone marrow metastasis and eosinophilia. Herein, we present a unique case of peripheral blood eosinophilia associated with bone marrow invasion in a patient having a history of papillary thyroid carcinoma. A 68-year old woman showed peripheral blood eosinophilia (91,525/mm³). Since the time she was initially diagnosed as having papillary thyroid carcinoma, eosinophilia had never been found and the other causes of eosinophilia were excluded. A bone marrow study revealed cancer cell infiltration; multiple lymphadenopathies and liver metastasis were also detected. We treated her with steroid; however, her eosinophilia did not respond to steroid and the patient died due to disease progression. Although peripheral blood eosinophilia and bone marrow metastasis are rare findings in patients with papillary thyroid carcinoma, we suggest that eosinophilia might be a sign of the bone marrow metastasis of papillary thyroid carcinoma.

Keywords: Thyroid, Bone marrow metastasis, Eosinophilia

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Fig. 1.

This figure shows many eosinophils. They are mature form eosinophils, and no blast forms (×100, Giemsa stain, peripheral blood smear).

Fig. 2.

This figure shows bone marrow with eosinophilic infiltration. Infiltrated eosinophils are mature form (X400, H & E stain).

Fig. 3.

This figure shows bone marrow with malignant carcinoma cell infiltration. Malignant cells are high N/C ratio and small irregular nucleus (X400, H & E stain).

Fig. 4.

Abdominal pelvic CT. This shows multiple liver metastasis and adrenal metastasis.

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