Hepatocellular carcinoma producing granulocyte colony-stimulating factor: diagnosis and treatment

Abstract

Granulocyte colony-stimulating factor (G-CSF) is a naturally occurring glycoprotein that is synthesized by stromal cells in bone marrow. Several cases of G-CSF-producing malignant tumors in various organs have been reported, but it is extremely rare in hepatocellular carcinoma (HCC). Here, we report a rare case of HCC producing G-CSF. The patient presented with a continuous fever and had a huge liver mass in the right lobe with portal vein tumor thrombus (PVTT) in the right first branch. He had marked granulocytosis, and his serum level of G-CSF was elevated. A complete curative liver resection was performed after preoperative radiotherapy to PVTT. The pathological findings of the resected specimen revealed poorly/ moderately differentiated HCC, and immunohistochemical staining of G-CSF was negative the first time it was tested, but the second time, it was positive in the cytoplasm of other tumor cells of HCC. Only a few cases of G-CSF-producing HCC have been reported, and they resulted in rapid tumor growth, metastases, and poor prognosis. In our case with PVTT, there was no liver recurrence, although multiple lung metastases occurred at 8 months after curative resection. We should consider G-CSF-producing HCC and diagnose promptly when encountering liver tumor patients with leukocytosis, and we should perform multimodal treatment including radiation, radical surgery, and chemotherapy.

Imaging findings of granulocyte colony-stimulating factor-producing tumors: a case series and review of the literature

“…This marked uptake by tumors could be related to the tumors' large size, higher grade of malignancy, and marked inflammatory cell infiltration [7]. G-CSF-producing tumors are thought to be more common in less differentiated carcinomas [2][3][4]. The pathological findings of our cases and literature review also included 11 cases of poorly differentiated carcinoma and 4 cases of undifferentiated carcinoma or sarcoma.…”

“…Granulocyte colony-stimulating factor (G-CSF) is a glycoprotein that stimulates the proliferation and differentiation of neutrophil progenitor cells in bone marrow [1]. There have been many reported cases of G-CSF-producing tumors in various organs, particularly the lung [2][3][4][5]. G-CSF-producing tumors generally exhibit significant hyperplastic and metastatic properties and have a poor prognosis [2][3][4].…”

“…There have been many reported cases of G-CSF-producing tumors in various organs, particularly the lung [2][3][4][5]. G-CSF-producing tumors generally exhibit significant hyperplastic and metastatic properties and have a poor prognosis [2][3][4]. Leukocytosis and inflammatory reactions due to the produced G-CSF and other inflammatory cytokines by tumors can be mistaken for other diseases, such as infections [2,3,5].…”

“…G-CSF-producing tumors generally exhibit significant hyperplastic and metastatic properties and have a poor prognosis [2][3][4]. Leukocytosis and inflammatory reactions due to the produced G-CSF and other inflammatory cytokines by tumors can be mistaken for other diseases, such as infections [2,3,5]. Early accurate diagnosis of G-CSF-producing tumors is important for determining treatment strategies and improving prognosis [6].…”

“…To our knowledge, there have been no literature reviews related to imaging findings on G-CSF-producing tumors. In several previously reported cases of G-CSF-producing tumors, radiological examinations showed large necrotic masses [ 2 , 3 , 5 ]. However, the findings of large size and necrosis may also be present in less differentiated carcinomas and sarcomas, regardless of the tumors’ G-CSF-producing status.…”