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A case of granulocyte-colony-stimulating factor-producing gallbladder cancer with lymph node metastasis together with a literature review

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Abstract

The granulocyte-colony-stimulating factor (G-CSF) glycoprotein stimulates precursor cell proliferation and differentiation in the bone marrow. Various G-CSF-producing tumors have been reported; they showed early progression and an extremely poor prognosis. Here, we report a case of G-CSF-producing gallbladder cancer with lymph node metastasis. In addition, we reviewed 30 previous case reports of G-CSF-producing gallbladder cancers to elucidate the characteristics and most appropriate treatment. During a routine visit to her local doctor for monitoring of diabetes and hypertension, a 68-year-old female was found to have an elevated white-blood-cell (WBC) count and C-reactive protein (CRP) level, and a gallbladder mass. Laboratory tests revealed a high serum G-CSF level, and imaging revealed a tumor of the gallbladder with regional lymphadenopathy. We diagnosed a G-CSF-producing gallbladder cancer and performed liver resection of segment IVa/V: regional lymph node dissection with extrahepatic bile duct resection. Pathologically, the tumor was a poorly differentiated squamous cell carcinoma. G-CSF immunostaining for tumor cells was positive. She is alive without recurrence at 16 months after surgery. If a patient exhibits a gallbladder tumor, with an elevated WBC count and CRP level but no symptoms of infection, a G-CSF-producing gallbladder cancer should be suspected; radical resection should be performed immediately after diagnosis.

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Abbreviations

ADC:

Apparent diffusion coefficient

CHA:

Common hepatic artery

CRP:

C-reactive protein

CT:

Computed tomography

FDG:

Fluorodeoxyglucose

G-CSF:

Granulocyte colony-stimulating factor

MRI:

Magnetic resonance imaging

PCT:

Procalcitonin

PET:

Positron emission tomography

PTHrP:

Parathyroid hormone-related protein

SCC:

Squamous cell carcinoma

TS-1:

Tegafur/Gimeracil/Oteracil

UICC:

Union for International Cancer Control

US:

Ultrasonography

WBC:

White blood cell

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Acknowledgements

The authors would like to thank Ms. Yuki Takata for assistance with immunostaining, and Textcheck Inc. for English-language editing.

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Authors and Affiliations

  1. Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan

    Taiji Tohyama, Hirotaka Hosobe, Teruki Kobayashi, Takayoshi Murakami, Yoshimi Fujimoto, Tatsuro Hayashi & Takamasa Matsumoto

  2. Department of Radiology, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan

    Toru Asakawa

  3. Department of Pathology, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan

    Masako Omori

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  1. Taiji Tohyama
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Correspondence to Taiji Tohyama.

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Tohyama, T., Hosobe, H., Kobayashi, T. et al. A case of granulocyte-colony-stimulating factor-producing gallbladder cancer with lymph node metastasis together with a literature review. Clin J Gastroenterol 16, 732–742 (2023). https://doi.org/10.1007/s12328-023-01816-8

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