Leukemoid reaction is defined as leukocytosis exceeding 50,000 cells/mm3. When it occurs in a patient with a malignancy, secondary causes such as infections, drugs, hematologic diseases and hemorrhage need to be ruled out. After excluding such causes, paraneoplastic leukemoid reaction can be considered as a diagnosis of exclusion. Paraneoplastic leukemoid reactions have been described in association with lung, gastrointestinal, genitourinary and head and neck cancers. However, pancreatic cancer with leukemoid reaction has been rarely reported. We diagnosed a case of a 55-year-old Korean woman with extreme leukocytosis associated with advanced pancreatic cancer.
Carcinoma, Pancreatic Ductal/complications/*diagnosis ; Female ; Humans ; Leukocytes/cytology ; Leukocytosis/*complications ; Magnetic Resonance Imaging ; Middle Aged ; Pancreatic Neoplasms/complications/*diagnosis ; Positron-Emission Tomography ; Tomography, X-Ray Computed

Xanthogranulomatous lesion is a rare condition in which lipid-laden histiocytes are deposited at various locations in the body. Xanthogranulomatous pancreatitis (XGP) associated with an intraductal papillary mucinous tumor (IPMT) is extremely rare. In this study, we described a case of XGP associated with IPMT and include a review of the literature. A pancreatic cystic mass was detected in a 72-yr-old woman by abdominal computed tomography. Pylorus-preserving pancreaticoduodenectomy was performed and diagnosis of XGP combined with intraductal papillary mucinous carcinoma in situ was made. After 13 months of follow-up, the patient is in good health without any evidence of tumor recurrence. Although XGP associated with IPMT is rare, we suggest that such cases should be brought to the attention of clinical investigators, as it may produce clinical features that mimic pancreatic cancer.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; Aged ; Carcinoma in Situ/*diagnosis/pathology/surgery ; Carcinoma, Pancreatic Ductal/*diagnosis/pathology/surgery ; Carcinoma, Papillary/*diagnosis/pathology/surgery ; Diagnosis, Differential ; Female ; Granuloma/complications/*diagnosis ; Humans ; Magnetic Resonance Imaging ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Pancreaticoduodenectomy ; Pancreatitis/complications/*diagnosis ; Tomography, X-Ray Computed ; Xanthomatosis/complications/*diagnosis