Granulocyte Colony-Stimulating-Factor-Producing Bladder Carcinoma: A Case Report and Literature Review.

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.