A Case of Granulocyte Colony-stimulating Factor-producing Multiple Gastric Cancers with a Rapid Course

Abstract

A 78-year-old man presented with loss of appetite. Upper gastrointestinal endoscopy showed Type 1 gastric cancer in the anterior wall of the lower gastric corpus, which was diagnosed as poorly differentiated adenocarcinoma on biopsy. The preoperative white blood cell (WBC) count was elevated at 34,700/μL. Granulocyte colony-stimulating factor (G-CSF)-producing gastric cancer (cT4aN2M0, Stage III) was suspected, and distal gastrectomy was performed. Histopathological tests showed the presence of pT4aN3aM0, Stage IIIB multiple gastric cancers comprising Type 1 gastric cancer (por1>tub1, SE, N3a, M0, CY0) and Type 0-IIc gastric cancer (tub1, M, N0, M0). Immunohistological staining was positive for anti-G-CSF antibodies, and a diagnosis of G-CSF-producing multiple gastric cancers was made. Although the WBC count normalized rapidly postoperatively, it again rose to 50,100/μL on postoperative Day 76, and contrast-enhanced computed tomography showed local recurrence. The patient's condition rapidly deteriorated, and he died on postoperative Day 84. A case of G-CSF-producing multiple gastric cancers with a rapid course is reported, together with a discussion of the literature.