Anaplastic carcinoma of the pancreas producing granulocyte-colony stimulating factor: a case report

A 63-year-old man was admitted to our hospital with body weight loss (-10 kg during months) and upper abdominal pain from 3 weeks. Abdominal computed tomography demonstrated a pancreatic tumor 10 cm in size and multiple low-density areas in the liver. On admission, the peripheral leukocyte count was elevated to 91,500/mm3 and the serum concentration of granulocyte-colony stimulating factor was 134 pg/mL (normal, < 18.1 pg/mL). Based on liver biopsy findings, the tumor was classified as an anaplastic pleomorphic-type carcinoma. Immunohistochemical staining showed that pancreatic carcinoma cells were positive for granulocyte-colony stimulating factor. The patient developed interstitial pneumonia, probably caused by granulocyte-colony stimulating factor, and died 11 days after admission.This is a rare case report of anaplastic pleomorphic-type carcinoma of the pancreas producing granulocyte-colony stimulating factor and confirmed by immunohistochemistry.The granulocyte-colony stimulating factor (G-CSF)-producing tumor was first reported in 1977 by Asano et al. in lung cancer [1]. Since that study, further G-CSF-producing lung carcinomas have been reported, but G-CSF-producing pancreatic carcinomas have been very rare [2-7]. Moreover, there have been only a few cases which have reported positive immunostaining for G-CSF in cancer cells [6,7]. We present a case of an anaplastic pancreatic carcinoma with G-CSF production that was confirmed with immunohistochemistry.A 63-year-old man was admitted to our hospital with body weight loss (-10 kg during 6 months) and upper abdominal pain. His blood pressure was 123/71 mmHg, pulse was 92 bpm. Physical examination revealed upper left quadrant pain but soft in his abdomen. The tumor was palpable in the upper left abdomen.Laboratory examination findings were as follows: Peripheral leukocyte count was 91,500/mm3 (87.5% neutrophils, 0% eosinophils, 1.5% lymphocytes, 1% monocytes), hemoglobin was 10.3 g/dL, and platelet count was 38.3