Marked granulocytic proliferation induced by granulocyte colony-stimulating factor in the spleen simulating a myeloid leukemic infiltrate.
The authors describe a patient with a long-standing history of systemic lupus erythematosus and leukopenia who received multiple intermittent doses of recombinant granulocyte colony-stimulating factor (G-CSF) and who underwent splenectomy because of a clinical impression of sequestration of granulocytes by the spleen. Histologic evaluation of the spleen revealed marked granulocytic hyperplasia with an increase in immature myeloid precursors, morphologically indistinguishable from a myeloid leukemic infiltrate. A postsplenectomy bone marrow aspirate and biopsy revealed a normocellular bone marrow with active hematopoiesis and trilineage maturation. The bone marrow aspirate cultured cells showed no numeric or structural chromosomal abnormality. Extramedullary hematopoiesis after receipt of G-CSF was previously reported, but, to our knowledge, ours is the first report of morphologic changes virtually identical to a leukemic infiltrate in spleen after G-CSF treatment. We describe the histologic and immunohistochemical findings in the spleen, compare our observations with those of others reported in the literature, and postulate a possible mechanism for this phenomenon.
Vasef
M A
MA
Department of Pathology, University of Iowa College of Medicine, Iowa City, USA. mohammad-vasef@uiowa.edu
Neiman
R S
RS
Meletiou
S D
SD
Platz
C E
CE
D000328:Adult; D002455:Cell Division / Q000187:drug effects; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000009:adverse effects* / Q000627:therapeutic use; D006098:Granulocytes / Q000166:cytology / Q000187:drug effects* / Q000473:pathology; D006801:Humans; D007951:Leukemia, Myeloid / Q000139:chemically induced* / Q000473:pathology; D017254:Leukemic Infiltration / Q000139:chemically induced*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D011994:Recombinant Proteins; D013154:Spleen / Q000166:cytology / Q000187:drug effects* / Q000473:pathology
D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor