A Case of Granulocyte-Colony Stimulating Factor Producing Multiple Gastric Carcinoma

Takaaki Eto, Shintaro Kuroda, Makoto Takahashi, Hideto Sakimoto, Kei Koide, Takayuki Kadoya, Narihiro Akimoto, Kiyohiko Dohi and Toshihiro Nishida*

Department of General Surgery and Department of Pathology*, Chugoku Rosai General Hospital

An 82-year-old man referred for weight loss and an elevated leucocyte count of 18,050/μl was found in an upper gastrointestinal series and endoscopic findings of the stomach to have well-differentiated type 1 adenocarcinoma in the posterior wall of the upper body of the stomach and poorly-differentiated giant type 3 adenocarcinoma extending from the lower body of the stomach to the pyloric ring. Laboratory tests on admission showed a leucocyte count of 16,620/μl and serum granulocyte-colony stimulating factor (G-CSF) of 35 pg/ml, both being elevated. Under a diagnosis of G-CSF producing gastric carcinoma, we conducted total gastrectomy in January 2005. The surgical finding was T4, N1, HO, PO, CYO, MO, Stage IIIB. Postoperatively, the leucocyte count decreased to 6,950/μl and serum G-CSF to 10 pg/ml. Immunohistochemical staining using anti-G-CSF antibody showed gastric carcinoma to be positive at both sites. G-CSF of the homogenate of the gastric carcinoma was 48 pg/ml for the well-differentiated type and 190 pg/ml for the poorly-differentiated type with gastric carcinoma at both sites producing G-CSF. The gastric carcinoma at both sites differed in histological type without continuity. The definitive diagnosis was G-CSF producing multiple gastric carcinoma. Some 26 cases of G-CSF producing gastric carcinoma have been reported in Japan with no report of G-CSF producing multiple gastric carcinoma, making our case extremely rare.

Key words
granulocyte-colony stimulating factor, multiple gastric carcinoma, immunohistochemical staining

Reprint requests
Takaaki Eto Department of General Surgery, Chugoku Rosai General Hospital
1-5-1 Hiro Tagaya, Kure, 737-0193 JAPAN

Accepted
October 19, 2005

To read the PDF file you will need Abobe Reader installed on your computer.