A Case of Triple Negative Advanced Breast Cancer Suggested as a G-CSF Producing Tumor

Abstract

A 64-year-old woman was diagnosed with triple-negative breast cancer, with a tumor measuring approximately 4 cm in the left C section and metastasizing to the bilateral axillary lymph nodes. Various chemotherapy regimens were sequentially administered as neoadjuvant chemotherapy. However, she did not respond to the treatment. This prompted her visit to our hospital for further treatment. No mutation was found in the BRCA gene, and PD-L1 expression was negative. Neither Lynparza nor Tecentriq could be used. She was then hospitalized for acute cholecystitis, and treatment with antibiotics was started. However, there was no improvement after conservative treatment, and subsequently, cholecystectomy was performed. At that time, the liver was entirely occupied by metastatic lesions. She developed disseminated intravascular coagulation (DIC) after surgery and was treated, but white blood cells and neutrophil counts continued to rise despite the management of DIC. As a result, serum G-CSF levels were measured and G-CSF staining was performed on needle biopsy specimens. G-CSF staining was positive, and serum G-CSF levels were normal, which could be attributed to the dilution of the sample because due to volume overload. She died 27 days after surgery due to liver failure, which resulted from multiple liver metastases. Hence, her breast cancer was considered to have been considered to produce G-CSF.