Abstract
The present study summarizes our experience in treating a patient with a suspected granulocyte colony-stimulating factor (G-CSF)-producing squamous cell carcinoma (SCC) of the lower gingiva, which is a rather rare entity.A 56-year-old woman underwent surgical excision of palate leukoplakia in 1996. In 2009, however, a leukoplakic superficial tumor was detected in the lower left gingiva, for which the patient underwent gingivectomy. This was subsequently diagnosed as SCC. The patient also underwent superselective arterial injection chemotherapy combined with radiotherapy, after local recurrence was observed. The patient was subsequently found to have bone metastasis. After chemotherapy combined with radiotherapy, the patient underwent segmental resection of the lower left jaw, left supraomohyoid neck dissection, and lower jaw reconstruction using titanium plates. Resection of the left femoral tumor and left total knee replacement were also performed. Computed tomography scan performed 1 month after the surgeries revealed multiple lung, liver, spine, and subcutaneous metastases. The patient also exhibited a sudden increase in her white blood cell (WBC) count and a fever that could not be alleviated, despite treatment with antibacterial drugs. A G-CSF-producing tumor was therefore suspected. Serum G-CSF level was high at 250 pg/ml.The patient's WBC count increased to 32 × 103/ml and her general condition suddenly deteriorated, and she died as a result of multiple organ failure. A final diagnosis of G-CSF-producing SCC of the lower gingiva was made based on the patient's clinical course.
Highlights
Solid malignancies are sometimes accompanied by leukocytosis and other leukemoid symptoms, the mechanism of which is attributed to the production of granulocyte colony-stimulating factor (G-CSF) by the tumor cells themselves [1,2]
The present study describes our experience in treating a patient who was thought to have a G-CSF-producing squamous cell carcinoma (SCC) of the lower gingiva, after
It is known that solid malignancies are rarely accompanied by leukocytosis and other leukemoid symptoms, the mechanism of which is attributed to the production of G-CSF by the tumor cells themselves [1,2]
Summary
Solid malignancies are sometimes accompanied by leukocytosis and other leukemoid symptoms, the mechanism of which is attributed to the production of granulocyte colony-stimulating factor (G-CSF) by the tumor cells themselves [1,2]. In December 2008, a leukoplakic superficial tumor appeared at left side lower canine, the first premolar equivalency department buccal marginal gingiva. In January 2009, the patient underwent an excisional biopsy, with resection of the lower left gingiva tumor. Panoramic radiography revealed resorption of the lower jaw (Figure 2), and CT showed clear destruction of the lower left jaw, but without lymph node enlargement, which could be suggestive of metastasis to the neck (Figure 3). The patient was clinically diagnosed with a lower left gingiva tumor. An imaging study indicated that the tumor had metastasized to the left femur (Figure 4A and 4B); 300 mg/day of tegafur-uracil (UFT) in combination with radiotherapy, consisting of bilateral irradiation of 45 Gy in 15 fractions, was applied to the metastasis. Staining of biopsy tissue in July of the same year revealed the G-CSF-positive tumor cells to be more pronounced (Figure 8). Immunostaining of the resected specimen in January 2009 confirmed the presence of G-
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