Kitade Hiroaki, Yanagida Hidesuke, Yamada Masanori, Satoi Sohei, Yoshioka Kazuhiko, Shikata Nobuaki, Kon Masanori
Department of Surgery, Kansai Medical University, Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan ; Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1191 Japan.
Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1191 Japan.
Surg Case Rep. 2015;1(1):46. doi: 10.1186/s40792-015-0048-y. Epub 2015 May 30.
Granulocyte-colony stimulating factor (G-CSF) producing pancreatic cancers are extremely rare. These tumors have an aggressive clinical course but no established treatment. We encountered a patient with a G-CSF-induced pancreatic cancer who was treated by surgical resection, followed by steroid treatment and chemotherapy. A 68-year-old Asian male presented at a local hospital with a 3-month history of fever, loss of appetite, and 10-kg weight loss. Laboratory data showed leukocytosis and elevation of C-reactive protein. Computed tomography (CT) revealed a 50-mm mass in the tail of the pancreas, but no signs of infective foci. He was transferred to our hospital for further evaluation. Contrast-enhanced CT showed rapid growth of this tumor over 1 week, and (18) F-2-fluoro-2-deoxyglucose positron-emission tomography/computed tomography (FDG PET/CT) showed FDG accumulation in the tail of the pancreas (SUV max, 17.1) but at no other sites in his body. Magnetic resonance imaging showed a heterogeneous mass, similar to that observed by CT. Three weeks later, the patient underwent a distal pancreatectomy with splenectomy. The resected specimen was 154 mm in diameter, a threefold increase from the initial image. Histopathological examination identified the tumor as an anaplastic carcinoma of the pancreas. Following surgery, his leukocyte count and body temperature were reduced. He recovered well and was discharged from our hospital on postoperative day 18. Immunohistochemical expression of G-CSF in the resected specimen and elevated serum G-CSF concentration confirmed that the mass was a G-CSF producing anaplastic carcinoma of the pancreas. Subsequently, the patient experienced a high fever and loss of appetite. CT showed recurrence of cancer in the abdominal cavity, for which he was started immediately on tegafur-gimeracil-oteracil potassium combination S-1 and steroid. Unfortunately, he died on postoperative day 83. To our knowledge, this patient was the first with a G-CSF producing anaplastic carcinoma of the pancreas to be treated by surgical resection, steroid and adjuvant chemotherapy.
产生粒细胞集落刺激因子（G-CSF）的胰腺癌极为罕见。这些肿瘤临床病程凶险，但尚无既定的治疗方法。我们遇到了一名由G-CSF诱发的胰腺癌患者，该患者接受了手术切除，随后进行了类固醇治疗和化疗。一名68岁的亚洲男性因发热、食欲不振和体重减轻10公斤的症状在当地医院就诊，病史为3个月。实验室数据显示白细胞增多和C反应蛋白升高。计算机断层扫描（CT）显示胰腺尾部有一个50毫米的肿块，但未发现感染灶迹象。他被转到我院作进一步评估。增强CT显示该肿瘤在1周内迅速生长，氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG PET/CT）显示胰腺尾部有FDG聚集（最大标准摄取值，17.1），但身体其他部位未见FDG聚集。磁共振成像显示为不均匀肿块，与CT所见相似。三周后，患者接受了胰体尾切除术加脾切除术。切除标本直径为154毫米，比最初影像增大了两倍。组织病理学检查确定肿瘤为胰腺未分化癌。手术后，他的白细胞计数和体温下降。他恢复良好，术后第18天从我院出院。切除标本中G-CSF的免疫组化表达以及血清G-CSF浓度升高证实该肿块为产生G-CSF的胰腺未分化癌。随后，患者出现高热和食欲不振。CT显示腹腔内癌症复发，为此他立即开始接受替吉奥联合S-1和类固醇治疗。不幸的是，他在术后第83天死亡。据我们所知，该患者是首例接受手术切除、类固醇和辅助化疗的产生G-CSF的胰腺未分化癌患者。
