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Cytokines in inflammatory malignant fibrous histiocytoma presenting with
leukemoid reaction
MF Melhem, AI Meisler, R Saito, GG Finley, HR Hockman and RA Koski
Department of Pathology, University of Pittsburgh School of Medicine, PA.
Inflammatory malignant fibrous histiocytomas (IMFH) are rare tumors and are
frequently associated with leukocytosis. In rare cases, leukemoid reactions
were attributed to tumor production of unidentified hematopoietic factors.
In this study, we used immunohistochemical techniques to show cytokine
immunoreactivity in the malignant cells of two cases of IMFH presenting
with leukemoid reactions and compared them with two malignant fibrous
histocytomas, noninflammatory type. All four tumors stained positively for
stem cell factor (SCF), granulocyte colony-stimulating factor (G-CSF),
interleukin-2 (IL-2), IL-4, IL-5, interferon-alpha (IFN-alpha), and
insulin-like growth factor-I. Other cytokines detected only in the two IMFH
included IL-6, IL-7, IL-8, IFN- gamma, and keratinocyte growth factor.
Granulocyte-macrophage-CSF, IL- 3, and transforming growth factor-beta
staining was present in one of the two IMFH tumors and was not present in
the noninflammatory tumors. The immunohistochemical staining was localized
to the malignant cells, suggesting deregulated cytokine expression
consistent with their monocytic/histocytic origin. Expression of certain
cytokines in the IMFH may account for the local inflammatory infiltrate,
tumor fibrosis, and the aggressive nature of the malignant cells. We also
detected elevated serum levels of SCF, G-CSF, IL-6, and tumor necrosis
factor in one or both of the IMFH patients. These latter observations may
explain the bone marrow hypercellularity and other paraneoplastic symptoms,
including fever, malaise, and weight loss, observed in both patients.
Different cytokines present in the two IMFH tumors appear to be responsible
for the eosinophilic leukemoid reaction observed in one case and for the
granulocytic leukemoid reaction observed in the other patient. They may
also be responsible for expansion of the tumor-cell population, fibroblast
proliferation, and enhanced secretion of extracellular collagen.
Volume 82,
Issue 7,
pp. 2038-2044,
10/01/1993
Copyright © 1993 by The American Society of Hematology
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