G-CSF producing lung cancer with pancoast's syndrome ; a case report

Abstract

A 54-year-old man was admitted to our hospital because of fever and a left apical abnormal shadow on chest X-ray. The original diagnosis was acute pneumonia, so antibiotics were started, but high fever persisted. His laboratory date revealed marked leukocytosis (>20, 000/μl), and a high erythrocyte sedimentation rate (>100 mm (1hr)) and CRP (>10 mg/dl) despite medical treatment. No malignant findings could be obtained in any cytological studies. Open thoracotomy was performed on the 54th hospital day. As the superior sulcus tumor invaded the chest wall, complete resection of the tumor was impossible. Immunohistochemical examination demonstrated that the tumor was poorly differentiated adenocarcinoma with cytoplasm positively stained by mouse anti-G-CSF monoclonal antibodies. Although 5 courses of anticancer chemotherapy and radiation therapy were undertaken, left adrenal metastasis and Pancoast's syndrome developed. He died one year after the thoracotomy. During the course of anticancer therapy, the ALP level changed in parallel with the white blood cell count.