Abstract
Background : Granulocyte-colony stimulating factor (G-CSF) -producing tumors have been reported in various organs and are associated with a poor prognosis. Herein, we describe a case of G-CSF-producing carcinoma of the urinary bladder.
Case : An 82-year-old woman presented with hematuria. A complete blood count revealed marked leukocytosis (WBC : 38700/μl) and cystoscopy showed a nodular tumor. Bladder washing cytology showed isolated large to giant-sized neoplastic cells with atypical nuclei and abundant cytoplasm, together with neutrophil emperipolesis in the carcinoma cells and dense neutrophil infiltration and necrosis in the background. These findings were suggestive of G-CSF-producing carcinoma. Histopathology of the urinary bladder specimen obtained by transurethral resection revealed findings consistent with conventional high grade urothelial carcinoma (UC) and pleomorphic large to giant-sized neoplastic cells. Both cell components showed positive immunohistochemical staining for G-CSF. A diagnosis of G-CSF-producing high-grade UC coexisting with a giant cell variant of UC was made. After the cystectomy, the WBC count showed a tendency to decrease and towards normal.
Conclusion : Dense neutrophil infiltration in the background and neutrophil emperipolesis in the carcinoma cells are key diagnostic features of G-CSF-producing carcinoma.
