Shimamatsu Kazuhide, Naito Yoshiki, Mihara Yutaro, Nakayama Masamichi, Tanigawa Masahiko, Abe Yushi, Nakamura Ken, Araki Toshihiro, Sakata Kenji, Noguchi Kazunori, Akiba Jun, Yano Hirohisa, Nakashima Osamu
Department of Pathology, Omuta City Hospital, Omuta, Fukuoka 836-8567, Japan.
Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka 830-0011, Japan.
Oncol Lett. 2018 Feb;15(2):2387-2392. doi: 10.3892/ol.2017.7572. Epub 2017 Dec 8.
The present case study documents an autopsy case of granulocyte-colony stimulating factor (G-CSF)-producing mucinous cystic neoplasm (MCN), with an associated invasive carcinoma of the pancreas. A 65-year-old woman presented to Omuta City Hospital (Omuta Japan) with a primary complaint of abdominal pain. Multiple liver nodules and a pancreatic cyst were detected upon abdominal computed tomography. Initially, liver abscess was suspected as the patient exhibited leukocytosis and elevated C-reactive protein level. However, the serum concentration of G-CSF was 98.8 pg/ml (normal, <39.0 pg/ml). At 6 weeks after admission, the patient succumbed to liver failure. At autopsy, a cystic lesion was identified in the pancreatic tail that contained bloody necrotic fluid. Microscopically, the cystic lesion was composed of columnar and mucin-producing epithelium associated with ovarian-type subepithelial stroma. The stroma exhibited positive immunostaining for vimentin, estrogen receptor and progesterone receptor. Calcification on the cystic wall was observed. The tumor invaded the pancreatic parenchyma and metastasized to the liver and lungs. The lesion was diagnosed as invasive adenocarcinoma arising in MCN. By contrast, liver nodules predominantly consisted of pleomorphic cancer cells with small foci of adenocarcinoma. Pancreatic and hepatic cancer cells were confirmed to be positive for G-CSF staining. The present case report indicates that G-CSF-producing MCNs may be associated with an aggressive clinical course, particularly when anaplastic changes are observed.
本病例研究记录了一例产生粒细胞集落刺激因子（G-CSF）的黏液性囊性肿瘤（MCN）尸检病例，并伴有胰腺浸润性癌。一名65岁女性因腹痛为主诉就诊于大牟田市立医院（日本大牟田）。腹部计算机断层扫描发现多个肝结节和一个胰腺囊肿。最初，怀疑为肝脓肿，因为患者出现白细胞增多和C反应蛋白水平升高。然而，G-CSF的血清浓度为98.8 pg/ml（正常，<39.0 pg/ml）。入院6周后，患者死于肝衰竭。尸检时，在胰尾发现一个囊性病变，其中含有血性坏死液。显微镜下，囊性病变由柱状和产生黏液的上皮细胞组成，并伴有卵巢型上皮下间质。间质波形蛋白、雌激素受体和孕激素受体免疫染色呈阳性。观察到囊壁有钙化。肿瘤侵犯胰腺实质并转移至肝脏和肺。该病变被诊断为起源于MCN的浸润性腺癌。相比之下，肝结节主要由多形性癌细胞组成，伴有小灶性腺癌。胰腺和肝癌细胞G-CSF染色均呈阳性。本病例报告表明，产生G-CSF的MCNs可能与侵袭性临床病程相关，尤其是当观察到间变改变时。
