A Case of Gallbladder Carcinoma Accompanied with High Levels of Serum Granulocyte Colony-Stimulating Factor and Alpha-Fetoprotein

A 79-year-old female was transferred to our department with suspected liver tumor. Laboratory examinations showed leukocytosis (9,530/μl) and high levels of serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and alpha-fetoprotein (AFP). Ultrasonography and computed tomography demonstrated a solitary tumor in the right lobe of the liver, and the gallbladder was not detected. A needle biopsy specimen of the liver tumor revealed moderately differentiated adenocarcinoma and we diagnosed suspected gallbladder carcinoma with liver infiltration. Fever of 37℃ to 38.5℃ persisted from 5 days after transfer and the leukocyte count in the peripheral blood increased to a maximum of 3.7 x 10^4 /μl during observation. The serum granulocyte colony-stimulating factor (G-CSF) level was high (122 pg/ml) and bone marrow aspiration showed hyperplasia of the mature neutrophils. There was no evidence of infection. Conservative therapy was given, and the patient died after 17 weeks. Immunohistochemically, the moderately differentiated adenocarcinoma cells at necropsy showed positive staining for CEA, and negative staining for AFP. These clinical findings indicated that the high level of G-CSF might have originated from the gallbladder carcinoma, though infection can not be ruled out as a possible cause