Abstract
The patient presented with a right axillary tumor and numbness of the upper limb had been treated for a right axillary lymph node swelling and hyperleukocytosis with a diagnosis of axillary lymphadenitis at a neighboring hospital. The tumor lesion did not respond to the therapy and the patient was referred to our hospital. When the patient was first seen, the right axillary tumor was 6 × 5 cm in diameter, elastic-hard, clearly demarcated, and ill-movable. A fine needle aspiration biopsy revealed a suspected diagnosis of lymph node metastasis of adenocarcinoma. Despite various examinations, the primary lesion was still unknown. A FDG PET/CT showed diffuse abnormal accumulations of FDG in the right axillary tumor and bone tissues in the body trunk. The measurement revealed a high serum level of granulocyte-colony stimulating factor (G-CSF). The removal of the tumor succeeded normalization of the increased white blood cell count and high serum G-CSF level. Immunohistochemistry using anti-G-CSF monoclonal antibody did not prove the existence of G-CSF. Adjuvant chemotherapy was not added. The patient has been free from recurrence, as of about two years after the operation.
We present a case of metastatic axillary adenocarcinoma of unknown primary site suggestive of G-CSF production.
