2019 Volume 52 Issue 11 Pages 637-645
A 68-year-old woman was referred to our hospital because her high inflammatory response and liver mass lesion which was suspected liver abscess became worse despite undergoing antimicrobial treatment for a month. CT showed a solid tumor adjacent to the cystic lesion in segment 6 of the liver. Laparoscopic right lateral sectorectomy of the liver was performed under the diagnosis of liver cancer accompanied with infectious cyst. The pathological diagnosis was hepatic adenosquamous cell carcinoma. The patient was discharged on the 21st postoperative day but was readmitted on the 41st postoperative day due to elevated white blood cell count and C-reactive protein. CT scan revealed multiple nodules with marginal enhancement in the remnant liver. Antimicrobial treatment was performed for 2 weeks as a diagnostic treatment to differentiate between liver abscesses and tumor recurrence. As a result, white blood cell count was elevated further and liver nodules also increased in size. The remnant liver volume was also significantly increased. The patient was given a diagnosis of granulocyte colony-stimulating factor (G-CSF) producing hepatic cholangiocellular carcinoma based on elevated serum G-CSF and IL-6 levels and negative results for several microbial examinations. G-CSF producing hepatic cholangiocellular carcinoma is rare and sometimes difficult to distinguish from liver abscess, and progresses rapidly, resulting in a poor prognosis. It is important to consider G-CSF producing tumor as a differential diagnosis in the case of a malignant tumor accompanied by an extensive inflammatory response without microbial infection, or unnatural liver hypertrophy.
