Tsunematsu Masashi, Haruki Koichiro, Uwagawa Tadashi, Shiba Hiroaki, Yanaga Katsuhiko
Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461 Japan.
Int Cancer Conf J. 2019 Nov 28;9(2):55-58. doi: 10.1007/s13691-019-00395-1. eCollection 2020 Apr.
A 48-year-old male was referred to our hospital for evaluation of motor speech disorders and difficulty in the movement of both the hands. The clinical diagnosis was Trousseau's syndrome due to advanced gallbladder cancer (cT3aN1M0). The patient received anticoagulation therapy and systemic chemotherapy (gemcitabine and cisplatin). Motor speech disorders and difficulty in movement of both hands were recovered. After 2 courses of chemotherapy, the primary tumor developed a massive hepatic invasion and the peripheral blood eosinophils increased gradually. The patient was admitted to our hospital for abdominal distension, fever, right upper quadrant pain, systemic edema, loss of appetite, and general malaise. The peripheral blood eosinophil count was markedly elevated to 45,900/μl (90.3%). The serum level of GM-CSF was high and there was no evidence of leukemia, allergic status and other diseases. The patient was diagnosed as paraneoplastic eosinophilia with advanced gallbladder cancer, which was suspected to produce GM-CSF. The patient received palliative support and died of disseminated intravascular coagulation 15 days after admission. We herein reported a fatal case of gallbladder cancer suspected of producing GM-CSF.
一名48岁男性因运动性言语障碍和双手活动困难被转诊至我院。临床诊断为晚期胆囊癌（cT3aN1M0）所致的特鲁索综合征。患者接受了抗凝治疗和全身化疗（吉西他滨和顺铂）。运动性言语障碍和双手活动困难得到恢复。化疗2个疗程后，原发肿瘤出现广泛肝转移，外周血嗜酸性粒细胞逐渐增多。患者因腹胀、发热、右上腹疼痛、全身水肿、食欲不振和全身乏力入院。外周血嗜酸性粒细胞计数显著升高至45900/μl（90.3%）。血清GM-CSF水平升高，且无白血病、过敏状态及其他疾病证据。患者被诊断为晚期胆囊癌伴副肿瘤性嗜酸性粒细胞增多症，怀疑由GM-CSF产生。患者接受了姑息支持治疗，入院15天后死于弥散性血管内凝血。我们在此报告一例疑似产生GM-CSF的胆囊癌致死病例。
