A case of granulocyte-colony-stimulating factor (g-csf) producing esophageal carcinoma

Abstract

The patient was a 59-year-old man who presented with hematemesis. Endoscopy revealed a bloody tumor in the middle esophagus. On admission, anemia and leucocytosis were found. The serum granulocyte-colony stimulating factor (G-CSF) level was high by enzyme immunoassay test. The patient had an esophagectomy via a right thoracotomy and a stomach tube reconstruction via a laparotomy (Ivor Lewis operation). On histopathology, well-differentiated squamous cell carcinoma that was for anti-G-CSF antibody positive on immunostaining was diagnosed. On pathology, the tumor was pT3, pN1, and pM0 : stage III according to the TNM classification. The serum G-CSF level dropped to within normal limits after the operation. Despite adjuvant chemotherapy, the patient had a lymph node recurrence that was treated with chemoradiotherapy. He died as a result of multiple lung metastases 4 years after the operation. Esophageal G-CSF producing carcinoma might have an aggressive behavior and, there fore, should be treated using multi-modal therapy.