Yamashita Kaori, Yoshida Keita, Kubota Satoshi, Sakamoto Tetsushi, Shiseki Takahiro, Uematsu Hirotaka, Nakazawa Tadao, Inui Masashi
Department of Urology, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, JPN.
Department of Pathology, Tokyo Women's Medical University Yachiyo Medical Center, Yachiyo, JPN.
Cureus. 2025 May 4;17(5):e83447. doi: 10.7759/cureus.83447. eCollection 2025 May.
Granulocyte colony-stimulating factor (G-CSF)-producing bladder carcinoma has an aggressive clinical course. We report a case of G-CSF-producing bladder carcinoma in a 78-year-old Japanese man who had a bladder tumor with a diameter of 38 mm. Transurethral resection of the bladder tumor was performed. Pathological examination revealed a high-grade muscle-invasive urothelial carcinoma (pT2). The patient had three courses of neoadjuvant chemotherapy with a combination of gemcitabine and carboplatin and thereafter underwent robot-assisted radical cystectomy. The surgically resected bladder specimen contained a highly invasive tumor with necrosis. The tumor cells showed marked cytological atypia with brisk mitosis. The tumor had metastasized to a regional lymph node. Therefore, we pathologically diagnosed high-grade invasive urothelial carcinoma, stage pT3b pN1. Thirty-six days after radical cystectomy, computed tomography revealed local recurrence and para-aortic and bilateral common iliac lymph node metastasis (white blood cell count had increased to 46,970/µL). Fifty-seven days after radical cystectomy, the white blood cell count further increased to 83,700/µL, and the serum G-CSF level was 186 pg/mL (normal range, 10.5-57.5 pg/mL). G-CSF immunohistochemistry was performed, and diffuse cytoplasmic positivity for G-CSF was verified. Therefore, we considered that a leukemoid reaction had occurred because of G-CSF-producing bladder carcinoma. Seventy-seven days after radical cystectomy, the patient died because of the recurrence of bladder carcinoma (white blood cell count: 85,660/µL). If a clinician observes bladder carcinoma with an abnormal number of white blood cells despite the lack of a hematopoietic neoplasm or inflammation, G-CSF-producing bladder carcinoma should be considered.
产生粒细胞集落刺激因子（G-CSF）的膀胱癌具有侵袭性临床病程。我们报告一例78岁日本男性的产生G-CSF的膀胱癌病例，该患者有一个直径38mm的膀胱肿瘤。行经尿道膀胱肿瘤切除术。病理检查显示为高级别肌层浸润性尿路上皮癌（pT2）。患者接受了三个疗程的吉西他滨联合卡铂新辅助化疗，之后接受了机器人辅助根治性膀胱切除术。手术切除的膀胱标本包含一个伴有坏死的高度侵袭性肿瘤。肿瘤细胞显示出明显的细胞学异型性，有活跃的有丝分裂。肿瘤已转移至区域淋巴结。因此，我们病理诊断为高级别浸润性尿路上皮癌，分期为pT3b pN1。根治性膀胱切除术后36天，计算机断层扫描显示局部复发以及腹主动脉旁和双侧髂总淋巴结转移（白细胞计数已增至46,970/µL）。根治性膀胱切除术后57天，白细胞计数进一步增至83,700/µL，血清G-CSF水平为186 pg/mL（正常范围为10.5 - 57.5 pg/mL）。进行了G-CSF免疫组化检查，证实G-CSF呈弥漫性细胞质阳性。因此，我们认为由于产生G-CSF的膀胱癌发生了类白血病反应。根治性膀胱切除术后77天，患者因膀胱癌复发死亡（白细胞计数：85,660/µL）。如果临床医生观察到膀胱癌患者白细胞数量异常，尽管没有造血系统肿瘤或炎症，也应考虑产生G-CSF的膀胱癌。
