A case of bladder tumor producing granulocyte colony-stimulating factor

A case of bladder tumor producing granulocyte colony-stimulating factor (G-CSF) is reported. A 78-year-old male presented with macroscopic hematuria. Cystoscopy demonstrated a large bladder tumor. Drip infusion pyelography and computerized tomography of the chest, abdomen and pelvis revealed right hydronephrosis, but did not reveal any metastasis. Total cystectomy and construction of bilateral cutaneous ureterostomy was performed. Histologically, the tumor consisted of sarcomatoid carcinoma with foci of transitional cell carcinoma (G3 > G2), showing marked infiltration of polymorphonuclear leukocytes. Immunohistochemical examination revealed a high concentration of G-CSF in the tumor specimen. Preoperatively, the white blood cell, count in the peripheral blood and serum G-CSF concentration were elevated, 45,400/mm3 and 73.4 pg/ml, respectively. After surgery these values became normal. This is the 19th reported case of G-CSF producing bladder tumor in Japan. The prognosis of the reported cases of G-CSF producing bladder tumor has been very poor. Fourteen of the reported 19 cases died within one year. This patient should be carefully followed up.     

Ureteral cancer producing granulocyte colony-stimulating factor: a case report

A 60-year-old man who underwent radical nephroureterectomy due to left ureteral cancer 22 months before (transitional cell carcinoma, pT4pN0Mx, grade 2, INF beta), was admitted to the hospital with the chief compliant of anorexia and body weight loss. The patient had severe leukocytosis and elevation of C-reactive protein, with no obvious focus of infection. Abdominal plain computed tomographic scan revealed left external ileac lymph node swelling. Positron emission tomography demonstrated left external ileac lymph node recurrence. Enzyme immunoassay of the serum demonstrated a markedly high concentration of granulocyte colony-stimulating factor (G-CSF; 790 pg/ml). Immunohistochemical examination of ureteral cancer cells with anti-G-CSF monoclonal antibody demonstrated G-CSF production in cancer cells. After diagnosed as lymph node recurrence of ureteral cancer producing G-CSF, the patient underwent radiotherapy (total 4000 Gy). CT after radiotherapy showed the complete disappearance of the lymph node swelling. To our knowledge, this is the second report of ureteral cancer proven to produce G-CSF in Japan.     

Squamous cell carcinoma of bladder producing granulocyte colony-stimulating factor (G-CSF): a case report

A case of bladder squamous cell cancer producing granulocyte colony-stimulating factor (G-CSF) is reported. A 55-year-old female presented with macroscopic hematuria and urinary frequency. Cystoscopy demonstrated a large bladder tumor. Computerized tomography and magnetic resonance imaging of abdomen and pelvis showed bladder muscular invasion, but did not reveal any metastasis. Laboratory examination showed leukocytosis of 23,600/mm3 and a high value of granulocyte colony-stimulating factor (G-CSF) 77 pg/ml in the peripheral blood. She was diagnosed with bladder tumor 52 months ago, but did not seek further medical attention. The leukocyte count at that point was 10,700/mm3. Radical cystectomy was performed. The histopathological diagnosis was well differentiated squamous cell carcinoma. Immunohistochemical examination was positive for G-CSF. After surgery the leukocyte count and value of G-CSF in the peripheral blood decreased to the normal range. There has been no recurrence of cancer for 10 months after surgery without any adjuvant therapy.     

Two cases of bladder tumor producing granulocyte colony stimulating factor

Two cases of bladder tumor producing granulocyte colony-stimulating factor (G-CSF) are reported. The first case was in a 79-year-old female patient. A large bladder tumor was diagnosed as right-sided hydronephrosis. The tumor consisted mostly of squamous cell carcinoma with a few transitional cells. Total cystectomy could not be performed because of direct invasion by the tumor into the pelvis. The patient died without aggressive treatment about 7 months after admission. Her leukocyte count consistently increased up to 76,200/mm3. The serum G-CSF levels were not analyzed. However, immunohistochemical examination revealed a high concentration of G-CSF in the tumor specimen. The other case was in an 80-year-old male patient. The patient, who had refused total cystectomy for bladder tumor (transitional cell carcinoma, grade 2, T2N0M0) 2 years earlier, underwent ureterocutaneostomy for obstructive renal insufficiency. Total cystectomy was not performed at this admission because of tumor invasion into the rectum and his advanced age. Radiotherapy was administered. However, he developed ileus caused by direct tumor invasion into the ileum. He died about 10 months after the urinary diversion. Leukocytosis, which improved transiently following radiotherapy, became more severe. The maximum leukocyte count was 49,500/mm3 just before death. The serum G-CSF levels during and after radiotherapy were 54 pg/ml and < 30 pg/ml, respectively. Immunohistochemical examination revealed the presence of G-CSF in the tumor. These findings suggest the production of G-CSF by the bladder tumor.     

A case of Bellini duct carcinoma producing granulocyte colony-stimulating factor (G-CSF)

A case of Bellini duct carcinoma producing granulocyte colony-stimulating factor (G-CSF) is reported. The patient was a 75-year-old female with the chief complaint of appetite loss. Abdominal ultrasonography and abdominal computed tomography revealed left renal pelvic tumor. Left radical nephrouretrectomy was performed. The histopathological report showed Bellini duct carcinoma. Immunohistochemical staining using the anti-G-CSF antibody showed positive staining in the cancer cells. Preoperatively, the white blood cell count and serum G-CSF concentration were elevated to 34,100/microliter and 334 pg/ml respectively. After operation these values became normal. However, these values were elevated again and CT scan revealed a left pulmonary metastasis 3 months after the operation. In spite of chemotherapy, she died of brain metastases 7 months after the operation.     

Bladder carcinoma producing granulocyte colony-stimulating factor (G-CSF): a case report

An 84-year-old male was admitted to our hospital with complaints of leg edema and general fatigue. He had undergone transurethral resection of transitional cell bladder cancer, grade 3, pT1b, one year previously. The computed tomographic scan revealed a hypoattenuating bladder tumor, protruding extravesically. Laboratory examination showed remarkable leukocytosis of 46,900/mm3 in the peripheral blood and high value of granulocyte colony-stimulating factor (G-CSF) 226 pg/ml (normal: less than 30 pg/ml). The resection of the tumor (partial cystectomy) was performed. The histological diagnosis was transitional cell carcinoma, grade 3. The production of G-CSF was confirmed by immunohistochemical examination in the recurrent tumor and the surgical sample from the transurethral resection. The leukocyte count in the peripheral blood decreased to the normal range after surgery. But leukocytosis recurred one month postoperatively and the computed tomographic scan revealed intrapelvic tumor recurrence. He died due to drastic progression of recurrent tumor at three months postoperatively.     

Bladder cancer producing granulocyte colony-stimulating factor (G-CSF): a case report

A case of bladder cancer producing granulocyte colony-stimulating factor (G-CSF) is reported. A 76-year-old male was admitted to our hospital with gross hematuria and leukocytosis. He was diagnosed with advanced bladder cancer. His white blood cell (WBC) count and serum granulocyte colony-stimulating factor (G-CSF) level were elevated (peak WBC 22,010/microliter, peak G-CSF 351 pg/ml), which immediately normalized after cystectomy. The histopathological diagnosis was transitional cell carcinoma, grade 3, pT4, pN1. Immunohistochemical examination was positive for G-CSF and G-CSF receptor. There has been no recurrence of cancer for more than 23 months since the operation without any additional therapy.     

Pleomorphic carcinoma of the lung producing granulocyte colony-stimulating factor: report of a case

We herein report a case of acute respiratory distress syndrome (ARDS) that appeared to be related to a granulocyte colony-stimulating factor (G-CSF)-producing lung cancer. A 77-year-old man with arterial sclerotic obstruction (ASO) underwent reconstructive surgery of the left femoral artery. He developed ARDS on the 5th postoperative day, which resolved following mechanical ventilation with steroid pulse treatment. Four months later, he was admitted with a fever and right arm pain. Chest computed tomography showed a malignant lesion in the right apical lung, and percutaneous needle biopsy demonstrated adenocarcinoma. Laboratory data revealed neutrophilia with elevated serum G-CSF levels. He underwent a right upper lobectomy with chest wall resection, and administration of sivelestat sodium to treat his postoperative pre-acute lung injury state. Pathology revealed a G-CSF-producing pleomorphic carcinoma. Retrospectively, a tumor shadow was noted on chest X-ray at the time of ARDS just after ASO surgery. The relationship between an abnormal G-CSF level and ARDS was considered, and the implications are herein discussed.     

Squamous cell carcinoma of the urachus producing granulocyte colony-stimulating factor

Urachal carcinoma is a rare cancer. This is the first report of a case of squamous cell carcinoma of the urachus producing granulocyte colony-stimulating factor. The patient underwent partial cystectomy with urachal remnant resection and pelvic lymphadenectomy. No evidence of tumor recurrence or metastasis was found at 17 months after surgery.     

Granulocyte colony-stimulating factor producing undifferentiated carcinoma of urinary bladder: a case report

A case of bladder cancer producing granulocyte colony-stimulating factor (G-CSF) is reported. A 94-year-old woman with a progressive, grade 3 undifferentiated carcinoma, showed marked leukocytosis (maximum 29,780/mm3) with an elevated G-CSF (420 pg/ml). Immunohistochemical examination with monoclonal antibody specific for G-CSF revealed positive staining. Further examination for epidermal growth factor receptor (EGF-R) and p53 were both positive and Ki67 index were 40.7%. These data suggested that this tumor had extremely aggressive growing nature, as the biological character is this.     

Paraneoplastic production of granulocyte colony-stimulating factor in a bladder carcinoma

We report the case of a 51-year-old female with poorly differentiated bladder carcinoma who presented with leukocytosis and hypercalcemia. Granulocyte colony-stimulating factor was noted to be twice the normal level. Paraneoplastic leukocytosis in bladder carcinoma is rare, is often associated with paraneoplastic hypercalcemia, and appears to represent a particularly aggressive form of the disease.     

A case of bladder tumor producing granulocyte-colony stimulation factor and parathyroid hormone-related protein

A 68-year-old woman presented with urinary pain and frequency. Cystoscopy, intravenous pyelography and magnetic resonance imaging showed a huge bladder mass and hydronephrosis of the left kidney. Transurethral resection of bladder tumor (TUR-Bt) was done. Histopathological findings of TUR-biopsy was high grade transitional cell carcinoma. Post operatively, the laboratory examination showed marked leukocytosis with a maximum of 99,600/mm3 in the peripheral blood and a high level of granulocyte colony stimulating factor (G-CSF), 70 pg/ml in the serum (normal: less than 9.8 pg/ml). Serum calcium level increased gradually and parathyroid hormone-related protein (PTH-rP) revealed high, 8.4 pMol/l (normal: less than 0.6 pMol/l). The tumor cells were positive for G-CSF and PTH-rP immunohistochemical staining. She died of the disease 46 days after the operation. This is the third case of G-CSF and PTH-rP producing bladder tumor in the literature.     

Urothelial cancer producing granulocyte colony-stimulating factor: possible induction of splenomegaly

Approximately 33% of patients with renal cell carcinoma will present with metastases. Patients have a reported 35% 5-year survival rate in instances in which nephrectomy and surgical resection of a solitary metastasis have been performed. Laparoscopic partial nephrectomy has become an increasingly viable option in the treatment of some renal cancers. We report a case in which a patient had a solitary lung nodule in the workup for a renal mass. This patient underwent combined thoracoscopic and laparoscopic resection of both the lung nodule and the renal mass in the same setting.     

Simultaneous production of granulocyte colony-stimulating factor and parathyroid hormone-related protein in bladder cancer

A case of bladder cancer with simultaneous production of granulocyte colony-stimulating factor (G-CSF) and parathyroid hormone-related protein (PTHrP) is reported. An 81-year-old male patient was admitted to the Saitama Medical School for treatment of gross hematuria, leukocytosis and hypercalcemia and diagnosed as having advanced bladder cancer. Immediately after a cystectomy was carried out, his white cell count and serum calcium levels returned to normal. However, the tumors recurred locally and the recurrence was accompanied by an increase in the serum G-CSF and PTHrP levels with a recurrent elevation of white cell count and the serum calcium level. The production of G-CSF and PTHrP in the tumor cells was confirmed by immunohistochemistry.     

Treatment of intra-abdominal infection with granulocyte colony-stimulating factor.

Polymicrobial infection is a significant cause of mortality in critically ill patients. Antibiotics and surgical intervention are useful but limited in their effectiveness for combating mixed infections. New prophylactic and therapeutic approaches are required to improve survival in critically ill patients. Neutrophils are a known primary host defense mechanism against bacterial infection. We evaluated the use of a neutrophil growth factor, recombinant human granulocyte colony-stimulating factor (G-CSF), to improve survival in a well-established sepsis model, cecal ligation and puncture (CLP). When administered beginning 4 days before CLP with injections continuing for 14 days after CLP, mice that received 10, 100, or 1000 ng of G-CSF had significantly improved survival compared with the control group. When treatment began at the time of CLP and continued for 7 days after CLP, G-CSF treatment resulted in a dose-dependent improvement in survival in groups that received 100, 500, or 1000 ng. The interaction of G-CSF and conventional antimicrobial therapy was evaluated by administration of G-CSF plus gentamicin. Mice received 100 ng of G-CSF beginning on day 1 before CLP with injections continuing for 3 days after CLP. Gentamicin-treated mice received a single 15 mg/kg injection of gentamicin at the time of CLP. Mice that received G-CSF alone or gentamicin alone had significantly improved survival compared with controls. Mice that received G-CSF plus gentamicin had improved survival compared with control mice and compared with mice that received G-CSF alone but not compared with mice that received gentamicin alone.(ABSTRACT TRUNCATED AT 250 WORDS)