Nasu Kaei, Inoue Chieko, Takai Noriyuki, Kashima Kenji, Miyakawa Isao
Department of Obstetrics and Gynecology, Faculty of Medicine, Oita University, Oita, Japan.
Obstet Gynecol. 2004 Nov;104(5 Pt 1):1086-8. doi: 10.1097/01.AOG.0000141552.87313.c8.
Marked leukocytosis is occasionally observed in patients with a malignant nonhematopoietic tumor. Granulocyte colony-stimulating factor (G-CSF) may be responsible for this phenomenon. We report a case of G-CSF-producing squamous cell carcinoma of the cervix that showed marked leukocytosis.
A 71-year-old Japanese woman was admitted for further investigation for leukocytosis. Her white blood cell (WBC) count had been gradually increasing over a period of 10 months. Laboratory data on admission revealed marked leukocytosis, with a WBC count of 30,400/microL, which consisted primarily of mature granulocytes (93%). Her serum G-CSF level was significantly elevated. However, there was no evidence of infection or hematopoietic disorders. Further examinations showed stage IIIb cervical cancer. The pathological diagnosis was squamous cell carcinoma of the nonkeratinizing type. Immunohistochemical staining of the biopsied specimens confirmed the production of G-CSF protein by the tumor cells. The patient was successfully treated by radiation therapy. Her WBC count returned to a normal level (3,700/microL). Her serum G-CSF level also decreased. The patient is alive without evidence of recurrence at 8 months after the treatment.
It is suggested that the leukocytosis manifested in this patient was due to G-CSF produced by the tumor. It was possible to use the WBC count and serum G-CSF levels as additional tumor markers.
恶性非造血肿瘤患者偶尔会出现明显的白细胞增多。粒细胞集落刺激因子（G-CSF）可能是导致这种现象的原因。我们报告一例产生G-CSF的宫颈鳞状细胞癌病例，该病例表现出明显的白细胞增多。
一名71岁的日本女性因白细胞增多入院进一步检查。她的白细胞（WBC）计数在10个月内逐渐升高。入院时的实验室数据显示明显的白细胞增多，白细胞计数为30400/微升，主要由成熟粒细胞组成（93%）。她的血清G-CSF水平显著升高。然而，没有感染或造血系统疾病的证据。进一步检查显示为IIIb期宫颈癌。病理诊断为非角化型鳞状细胞癌。活检标本的免疫组化染色证实肿瘤细胞产生G-CSF蛋白。患者接受放射治疗后成功治愈。她的白细胞计数恢复到正常水平（3700/微升）。她的血清G-CSF水平也下降。治疗后8个月，患者存活且无复发迹象。
提示该患者出现的白细胞增多是由肿瘤产生的G-CSF所致。将白细胞计数和血清G-CSF水平用作额外的肿瘤标志物是可行的。
