A Case of G-CSF-producing Gallbladder Cancer Presented with Elevated Level of Inflamatory Response

Abstract

The patient was a 67-year-old woman. She presented with pericardial pain and had elevated white blood cell and C-reactive protein levels. Following close examination, cholecystectomy in all layers and sampling of hilar lymph node 12c were performed on suspicion of gallbladder cancer. On postoperative day 8, both white blood cell count and C-reactive protein showed marked improvement. Pre-operative G-CSF activity was abnormally high but normalized post-operatively. The pathology showed an undifferentiated carcinoma-like adenocarcinoma, which was G-CSF-positive on immunostaining, and diagnosis of G-CSF-producing gallbladder cancer was made. Five years after surgery, the patient had no recurrence of G-CSF-producing gallbladder cancer, which has been reported to be a very rare disease with a poor prognosis. The diagnosis of G-CSF-producing tumours is based on a marked increase in white blood cell count, an increase in G-CSF activity, a decrease in white blood cell count and G-CSF activity with treatment and evidence of G-CSF production in tumour cells, all four of which were fulfilled in our case. In the present study, we report a case in which a tumour diagnosed as G-CSF-producing gallbladder cancer was resected and the patient survived for 5 years.