Issue: 2009 > May > case report

Granulocytosis and thrombocytosis in renal cell carcinoma: a pro-inflammatory cytokine response originating in the tumour

A.P. van Rossum, L.Th. Vlasveld, I.N. Vlasveld, P.M. Jansen, W.A. Dik, H. Hooijkaas, A. Castel


Background: In up to 20% of patients with renal cell
cancer (RCC) an inflammatory response consisting
of low-grade fever, weight loss and an elevated ESR
and CRP may occur with modest granulocytosis and
thrombocytosis. Clinical and experimental data suggest a
pathogenic role for tumour-derived cytokine production,
especially interleukin-6.
Case report: A 79-year-old female with RCC presented with low-grade fever, weight loss and overt granulocytosis and thrombocytosis. Radiological examination revealed a right-sided renal tumour.
During nephrectomy a gradient between the IL-6
levels in the renal artery and vein was demonstrated,
providing direct evidence for in vivo production of IL-6
by the tumour affected kidney, which was confirmed
by the demonstration of IL -6 in the tumour cells by
immunohistochemical staining and in the supernatant
of the homogenised tumour. Cytogenetic examination
revealed complex abnormalities including a gain of
chromosome 7. In addition we demonstrated production
of IL-1α, IL-1β, IL-8 and ICAM-1 in the tumour with
systemic elevated levels of IL-6 and IL-8 with secondary
increased serum G-CSF and TPO levels.
Conclusion: We have provided direct evidence for the
production of pro-inflammatory cytokines by renal
cancer cells in a patient with RCC and a profound
inflammatory response, with a central role of IL-6,
probably due to a gain of chromosome 7. The extreme
granulocytosis and thrombocytosis may have resulted
from the secondary systemic production of G-CSF and