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An autopsy case of granulocyte colony-stimulating factor-producing pancreatic adenosquamous carcinoma

  • Noriko InomataEmail author
  • Atsuhiro Masuda
  • Toshinao Itani
  • Motohito Hayashi
  • Yukari Shimada
  • Kanna Adachi
  • Kimio Hashimoto
  • Yasuhiro Tanaka
  • Atsushi Tanaka
  • Takashi Kobayashi
  • Arata Sakai
  • Hideyuki Shiomi
  • Yuzo Kodama
Case Report
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Abstract

A 60-year-old female was admitted to hospital with a continuous fever, a decreased appetite, and abdominal pain. Laboratory tests showed an elevated peripheral leukocyte count (13,800/μl) and increased C-reactive protein (19.1 mg/dl) and carbohydrate antigen 19–9 (4057 U/ml) levels. Abdominal contrast-enhanced computed tomography showed multiple bulky hypovascular nodules in the liver, swelling of the paraaortic lymph nodes, and a hypovascular mass (diameter 3.0 cm) in the pancreatic body. The serum concentrations of granulocyte colony-stimulating factor (G-CSF) and interleukin-6 were 172 pg/μl and 541 pg/µl, respectively. Liver biopsy specimens revealed an adenosquamous carcinoma, which was positively immunostained for G-CSF. We diagnosed the patient with G-CSF-producing pancreatic cancer with multiple metastases. Four courses of gemcitabine with dexamethasone and one course of nab-paclitaxel and gemcitabine were administered. Although the pancreatic tumor and paraaortic lymph node metastases decreased in size, the liver metastases continued to grow. The patient died 4 months after the diagnosis of pancreatic cancer. An autopsy resulted in the tumor being diagnosed as poorly differentiated adenosquamous pancreatic carcinoma, which was histopathologically G-CSF-positive. Although G-CSF-producing pancreatic adenosquamous carcinomas are extremely rare, they have been encountered more frequently in recent years. In such cases, chemotherapy combined with dexamethasone might be effective at temporarily improving the patient’s condition.

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Human/animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

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For this article, formal consent is not required.

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Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  • Noriko Inomata
    • 1
    • 2
    Email author
  • Atsuhiro Masuda
    • 1
  • Toshinao Itani
    • 2
  • Motohito Hayashi
    • 2
  • Yukari Shimada
    • 2
  • Kanna Adachi
    • 2
  • Kimio Hashimoto
    • 3
  • Yasuhiro Tanaka
    • 4
  • Atsushi Tanaka
    • 4
  • Takashi Kobayashi
    • 1
  • Arata Sakai
    • 1
  • Hideyuki Shiomi
    • 1
  • Yuzo Kodama
    • 1
  1. 1.Division of Gastroenterology, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
  2. 2.Department of GastroenterologyNishi-Kobe Medical CenterKobeJapan
  3. 3.Department of PathologyNishi-Kobe Medical CenterKobeJapan
  4. 4.Department of Immune HematologyNishi-Kobe Medical CenterKobeJapan

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