A Case of Granulocyte-Colony Stimulating Factor Producing Gastric Carcinoma

Yoshitaka Uji, Toshiomi Kusano, Hiroya Iida, Hiroyuki Yuzawa, Takashi Takao, Masamori Shimabukuro and Kazuyuki Tachibana

Department of Surgery, Digestive Disease Center, Tenjin-kai Koga Hospital

A 67-year-old female complaining of epigastralgia was admitted to our hospital. Upper gastrointestinal endoscopy revealed the presence of a type-2 gastric cancer. Preoperative laboratory data indicated anemia, leukocytosis (27,700/μL) and a high level of granulocyte-colony stimulating factor (G-CSF). The patient underwent both a total gastrectomy and a pancreaticosplenectomy. The surgical stage grouping was T4, N0, H0, P0, CY0, M0, and Stage IIIA. Regarding the pathological diagnosis, most of the tumor was a poorly differentiated adenocarcinoma, while part of the tumor was a squamous cell carcinoma. After the operation, the patient's leukocyte count and serum G-CSF level both improved. Multiple liver metastases were detected three months after surgery. Hepatic arterial infusion was performed, but the hepatic metastases progressed nevertheless. The patient died on postoperative day 170. At the time of autopsy, metastases were detected in the lung, small intestine and general lymph nodes. An immunohistochemical examination using anti-G-CSF antibody revealed a negative reaction in both the primary and metastatic tumor cells. However, this case was diagonosed as a G-CSF producing gastric cancer based on the laboratory findings and clinical course.

Key words
granulocyte-colony stimulating factor, gastric carcinoma

Reprint requests
Yoshitaka Uji Department of Surgery, Shiga University of Medical Science
Tsukinowacho, Seta, Otsu, 520-2192 JAPAN

Accepted
December 16, 2005

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