A CASE OF GRANULOCYTE COLONY-STIMULATING FACTOR PRODUCING HEPATOCELLULAR CARCINOMA WITH A SOLITARY MEDIASTINAL LYMPH NODE METASTASIS

Abstract

Although a few cases of granulocyte colony-stimulating factor (G-CSF) producing tumor have been reported recently, hepatocellular carcinoma (HCC) that produces G-CSF remains a rarity. At the same time, HCC with a solitary mediastinal lymph node metastasis in seldom observed. This is a report of a valuable case of HCC in which both of these peculiarities co-existed. A 68-year-old man visited a physician with pyrexia and general fatigue, and was referred to the nospital with a diagnosis of hepatic tumor. The elevation of serum α-fetoprotein level and the results of various imaging studies ledus to the diagnosis of HCC. After admission, further evaluation was carried out to identify the cause for the high fever exceeding 38°C and leukocytosis, and serum G-CSF level was found to be overtly elevated, hence the diagnosis of G-CSF producing HCC. Following an extended left hepatolobectomy, the pyrexia became convalescent and leukocyte-count decreased until the 7th postoperative day, when the fever and leukocytosis resumed. Further imaging studies revealed acute enlargement of a solitary mediastinal lymph node, and it was eventually diagnosed as node metastasis. Which had not been detected preoperatively. There being no evidence of other metastatic lesions, re-operation was performed to resect the metastatic node. Once again, the patient recovered from pyrexia and leukocytosis postoperatively. Histological examination of the liver tumor revealed poorly differentiated HCC, and the mediastinal node was confirmed to have been the metastasis. Furthermore, the immunostaining using anti-G-CSF antibody was positive not only for the primary liver tumor, but also for the metastatic node. These findings confirmed that the HCC secreted G-CSF and elicited pyrexia and granulocytosis.