Granulocyte Colony-Stimulating Factor–Producing Cholangiocellular Carcinoma

A 61-year-old female was admitted to our hospital with epigastric pain and fever. The laboratory data showed severe inflammatory reactions. Computed tomography revealed an irregular tumor in the left hepatic lobe and swelling of lymph nodes. ¹⁸F-fluorodeoxy-glucose positron emission tomography (FDG-PET) showed high uptake by the tumor, with diffuse uptake in the spine. Based on the elevated leukocyte count and FDG-PET findings, the patient was diagnosed with a granulocyte colony-stimulating factor (G-CSF)-producing tumor (G-CSF, 213 pg/mL). We performed left trisegmentectomy of the liver, bile duct resection, and lymph node dissection. Histologically, the tumor was a poorly differentiated adenocarcinoma with some lymph nodes metastasis. Immunohistochemical staining of the tumor cells was positive for G-CSF. Therefore, the tumor was diagnosed as G-CSF–producing cholangiocellular carcinoma. The inflammatory reactions and serum G-CSF level transiently improved immediately after surgery. However, 1 month later, the leukocyte count and serum G-CSF level increased again, and recurrence was observed in the remnant liver. The patient died 3 months after the operation. G-CSF–producing cholangiocellular carcinoma is rare. This tumor progresses rapidly, and surgical treatment for advanced condition should be carefully selected.Key words: Granulocyte colony-stimulating factor, Cholangiocellular carcinoma, FDG-PET, Immunohistochemistry, LeukocytosisGranulocyte colony-stimulating factor (G-CSF)-producing tumors were first reported in 1977.¹ G-CSF-producing cholangiocellular carcinomas (CCCs) are rare, with only 5 other reported cases. We herein report a surgical case of G-CSF–producing CCC with early recurrence and include bibliographic comments.     

Computer-aided measurement of mandibular cortical width on dental panoramic radiographs for identifying osteoporosis

Aim: To develop a computer‐aided diagnosis system to continuously measure mandibular inferior cortical width on dental panoramic radiographs and evaluate the system’s efficacy in identifying postmenopausal women with low‐skeletal bone mineral density. Methods: Mandibular inferior cortical width was continuously measured by enhancing the original X‐ray image, determining cortical boundaries, and evaluating all distances between the upper and lower boundaries in the region of interest. The system’s efficacy in identifying osteoporosis at the lumbar spine and the femoral neck was evaluated for 100 women (≥50 years): 50 in the development of the tool and 50 in its validation. Results: The sensitivity and specificity of the cortical measurements for identifying the development patients were 90% (95% confidence interval shown in parentheses) (63.0–87.0) in women with low spinal bone mineral density, and 81.8% (70.1–91.8) and 69.2% (56.2–81.8) in those with low femoral bone mineral density, respectively. Corresponding values in the validation patients were 93.3% (85.9–100) and 82.9% (71.4–92.7) at the lumbar spine, and 92.3% (84.5–99.5) and 75.7% (63.0–87.0) at the femoral neck, respectively. Conclusion: Our new computer‐aided diagnosis system is a useful procedure in triage screening for osteoporosis.