Granulocyte-Stimulating Factor Producing Gastric Carcinoma: Case Report and Literature Review

Takeshi Sunami, Hideo Hushitani, Kentaro Kimura, Kiyotaka Yukimoto, Ryugo Sawada, Kazutsugu Sakamoto and Takahumi Yamashita

Department of Surgery, Izumi City Hospital

A 81-year-old man with dyspnea on exertion and severe anemia was found in gastrointestinal endoscopy, and colonoscopic examination and biopsy, to have a poorly differentiated type 2 adenocarcinoma tumor in the gastric antrum and a well-differentiated type 2 adenocarcinoma tumor in the sigmoid colon. Abdominal computed tomography (CT) showed multiple space-occupying lesions (SOL) in the liver suspected of being multiple liver metastases, necessitating distal gastrectomy and sigmoidectomy. Pathological findings were T2 (SS), N1, P0 and M0 for gastric cancer and SS, N1, P0 and M0 for sigmoid colon cancer. No atypical cells were found in intraoperative liver biopsy for the SOL, which was found to have shrunk in abdominal CT a month after surgery. We thus decided on follow-up without chemotherapy. The SOL grew, however, and leukocytosis (28,700 /μl) was recognized. Suspecting liver metastasis, or liver abscess, we biopsied the SOL again, this time finding atypical cells the same as the gastric cancer specimen. Serum granulocyte-colony stimulating factor (G-CSF) was high at 256 pg/ml, and immunohistochemical staining for the primary lesion was positive for G-CSF, yielding a definitive diagnosis of G-CSF-producing gastric cancer with liver metastasis. Chemotherapy using TS-1 proved ineffective, however, and the man died 7 months after surgery.

Key words
granulocyte-colony stimulating factor, gastric cancer

Reprint requests
Takeshi Sunami Department of Surgery, Izumi City Hospital
4-10-10 Hutyu-cho, Izumi, 594-0071 JAPAN

Accepted
September 16, 2009

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