2006 Volume 39 Issue 6 Pages 653-659
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.
