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

Shigeshi Kohno,Sei Nakao,Tatsuki R Kataoka,Akihiro Furuta,Kaori Togashi,Masahiro Tanabe,Hiroyoshi Isoda,Koji Tokunaga,Shigeki Arizono

doi:10.1007/s11604-021-01130-8

Abstract

Granulocyte colony-stimulating factor (G-CSF)-producing tumors have an aggressive clinical course. Here, we report five cases of G-CSF-producing tumors and review the literature, focusing on imaging findings related to tumor-produced G-CSF. In addition to our cases, we identified 30 previous reports of G-CSF-producing tumors on which 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT, bone scintigraphy, or evaluation of bone marrow MR findings was performed. White blood cell count, serum C-reactive protein, and serum interleukin-6 were elevated in all cases for which these parameters were measured. G-CSF-producing tumors presented large necrotic masses (mean diameter 83.2 mm, range 17–195 mm) with marked FDG uptake (mean maximum standardized uptake value: 20.09). Diffuse FDG uptake into the bone marrow was shown in 28 of the 31 cases in which FDG-PET/CT was performed. The signal intensity of bone marrow suggested marrow reconversion in all seven MRI-assessable cases. Bone scintigraphy demonstrated no significant uptake, except in two cases with bone metastases. Splenic FDG uptake was increased in 8 of 10 cases in which it was evaluated. These imaging findings may reflect the effects of tumor-produced G-CSF. The presence of G-CSF-producing tumors should be considered in patients with cancer who show these imaging findings and marked inflammatory features of unknown origin.

Highlights

Granulocyte colony-stimulating factor (G-CSF) is a glycoprotein that stimulates the proliferation and differentiation of neutrophil progenitor cells in bone marrow [1]
Several previous studies have reported imaging findings related to tumorproduced G-CSF, such as diffuse 18F-fluorodeoxyglucose (FDG) uptake of bone marrow on FDG positron emission tomography (PET)/CT [7]
Spinal MRI showed that the signal intensity of the bone marrow was lower than that of an age-matched healthy woman on T1-weighted images (T1WI) and T2-weighted images (T2WI) (Fig. 3c, d)

Summary

Introduction

Granulocyte colony-stimulating factor (G-CSF) is a glycoprotein that stimulates the proliferation and differentiation of neutrophil progenitor cells in bone marrow [1]. Laboratory tests showed marked leukocytosis (WBC count, 33,000/μL; neutrophils, 89%) and elevated CRP (9.2 mg/dL) and serum G-CSF (214 pg/mL) levels. Laboratory tests at admission showed marked leukocytosis (WBC count, 24,400/ μL; neutrophils, 84%) and elevated CRP (13.0 mg/dL) and serum G-CSF (549 pg/mL) levels. Laboratory tests performed at admission showed marked leukocytosis (WBC count, 34,900/μL; neutrophils, 97%) and elevated levels of CRP (8.4 mg/dL), G-CSF (452 pg/ mL), and interleukin-6 (IL-6; 81.4 pg/mL). FDG-PET/CT demonstrated marked FDG uptake in the esophageal tumor, lymph nodes, and liver metastases, with diffuse uptake in the bone marrow and increased uptake in the spleen (Fig. 3b). Spinal MRI showed that the signal intensity of the bone marrow was lower than that of an age-matched healthy woman on T1-weighted images (T1WI) and T2WI (Fig. 3c, d). The patient died 16 months after admission because of tumor progression

Literature review

75 M Occult primary NA

Findings

Conclusion