Bladder carcinoma producing granulocyte colony-stimulating factor (G-CSF): a case report

84歳男.著しい白血球増多症を呈し, 免疫染色にてG-CSF産生膀胱癌と診断した.白血球数の異常を認めていなかった時の標本で, 免疫組織化学的にG-CSFの産生能を指摘できた.白血球増多に腫瘍が産生するG-CSFが大きく関与していると思われるが, 白血球数との相関はなく, 他のサイトカイン等の関与があると考えられたAn 84-year-old male was admitted to our hospital with complaints of leg edema and general fatigue. He had undergone transurethral resection of transitional cell bladder cancer, grade 3, pT1b, one year previously. The computed tomographic scan revealed a hypoattenuating bladder tumor, protruding extravesically. Laboratory examination showed remarkable leukocytosis of 46, 900/mm3 in the peripheral blood and high value of granulocyte colony-stimulating factor (G-CSF) 226 pg/ml (normal: less than 30 pg/ml). The resection of the tumor (partial cystectomy) was performed. The histological diagnosis was transitional cell carcinoma, grade 3. The production of G-CSF was confirmed by immunohistochemical examination in the recurrent tumor and the surgical sample from the transurethral resection. The leukocyte count in the peripheral blood decreased to the normal range after surgery. But leukocytosis recurred one month postoperatively and the computed tomographic scan revealed intrapelvic tumor recurrence. He died due to drastic progression of recurrent tumor at three months postoperatively