P3.03-057 Granulocyte Colony-Stimulating Factor-Producing Malignant Pleural Mesothelioma: Report of Two Cases: Topic: Mesothelioma Clinical

Abstract

Granulocyte-colony stimulating factor (G-CSF) is provided by normal monocytes, macrophages and neutrophils. There are some reports of G-CSF-producing lung cancer cases, however, G-CSF-producing malignant pleural mesothelioma (MPM) is extremely rare. G-CSF -producing MPM is characterized by fever and pleural thickness, it is often difficult to distinguish from other inflammatory disease including empyema. We describe two cases of G-CSF-producing MPM. A 38-year old man admitted to other hospital because of chest pain and fever. He had been treated as pleuritis without improvement of symptoms. He was referred to our hospital three months later. Laboratory data showed increased white blood cell (11400/μL) and C-reactive protein (CRP; 14.14 mg/dl). Chest CT revealed pleural thickening in the right thorax. We suspected possibility of pleural tumor. Video assisted pleural biopsy yielded a diagnosis of MPM. His serum G-CSF elevated to 64 pg/dl (<39). We performed extrapleural pneumonectomy. After surgery, the WBC and CRP decreased to normal level, fever was improved. Serum G-CSF decreased to 18 pg/dl. Immunohistochemical analysis showed positive stain for G-CSF of tumor cells. Two months after surgery, chest CT revealed local recurrence, laboratory examination showed increased WBC, CRP and G-CSF. He died respiratory failure due to rapid progression of tumor. A 75-year old man had been treated as pleuritis at other hospital. He was referred to our hospital to further examination. Laboratory data showed increased WBC (11000μ/L) and CRP (14.50 mg/dl). Chest CT revealed Pleural thickening in the left thorax. Video assisted pleural biopsy yielded a diagnosis of MPM. His serum G-CSF elevated to 359pg/dl. Immunohistochemical analysis showed positive stain for G-CSF of tumor cells. Palliative treatment was planned because his cardiopulmonary function was poor. He died after two months from diagnosis. Intractable pleuritis with inflammation could be malignant mesothelioma producing G CSF. Thoracoscopic biopsy is useful to correct sufficient specimen to diagnose malignancy mimicking acute empyema Prognosis of G-CSF-producing MPM is very poor. Prompt diagnosis is needed to adequate treatment. Improvement of fever and inflammation findings might be obtained when complete resection is performed.