A Case of Granulocyte-colony Stimulating Factor Producing Gastric Cancer

Abstract

An 88-year-old man complaining of dyspnea and pedal edema was admitted to the hospital for severe anemia and leukocytosis. Upper gastrointestinal endoscopy and biopsy revealed a type-1 gastric cancer, moderately differentiated tubular adenocarcinoma, in the lower gastric body. The preoperative laboratory data revealed leukocytosis (30,500/μl) and high level of the serum granulocyte-colony stimulating factor (G-CSF) (119pg/ml). The most likely diagnosis was G-CSF-producing gastric cancer. Total gastrectomy was performed for bleeding control. Pathological findings were tub2, pT4a (SE), ly3, v3 pN3b (16/34), pPM0, pDM0, M1(LYM), and Stage IV ; tumor cells were positive in G-CSF immunological staining. The leukocyte count decreased after the surgery. G-CSF-producing gastric cancer was thus diagnosed. Despite best supportive care, he died of progression of liver and lymph node metastases 9 months after the surgery.