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Case Reports
. 2012 Jun 19:4:35.
doi: 10.1186/1758-3284-4-35.

Granulocyte colony-stimulating factor-producing squamous cell carcinoma of the lower gingiva: a case report

Jun-ichi Kobayashi  1 , Akihiro Miyazaki, Takashi Yamamot, Kenji Nakamori, Rina Suzuki, Takeshi Kaneko, Naohiro Suzuki, Hiroyoshi Hiratsuka
Affiliations
Case Reports

Granulocyte colony-stimulating factor-producing squamous cell carcinoma of the lower gingiva: a case report

Jun-ichi Kobayashi et al. Head Neck Oncol. .

Expression of concern in

  • Comment: Head and Neck Oncology.
    BioMed Central. BioMed Central. BMC Med. 2014 Feb 5;12:24. doi: 10.1186/1741-7015-12-24. BMC Med. 2014. PMID: 24499430 Free PMC article. Review.

Abstract

The present study summarizes our experience in treating a patient with a suspected granulocyte colony-stimulating factor (G-CSF)-producing squamous cell carcinoma (SCC) of the lower gingiva, which is a rather rare entity. A 56-year-old woman underwent surgical excision of palate leukoplakia in 1996. In 2009, however, a leukoplakic superficial tumor was detected in the lower left gingiva, for which the patient underwent gingivectomy. This was subsequently diagnosed as SCC. The patient also underwent superselective arterial injection chemotherapy combined with radiotherapy, after local recurrence was observed. The patient was subsequently found to have bone metastasis. After chemotherapy combined with radiotherapy, the patient underwent segmental resection of the lower left jaw, left supraomohyoid neck dissection, and lower jaw reconstruction using titanium plates. Resection of the left femoral tumor and left total knee replacement were also performed. Computed tomography scan performed 1 month after the surgeries revealed multiple lung, liver, spine, and subcutaneous metastases. The patient also exhibited a sudden increase in her white blood cell (WBC) count and a fever that could not be alleviated, despite treatment with antibacterial drugs. A G-CSF-producing tumor was therefore suspected. Serum G-CSF level was high at 250 pg/ml. The patient's WBC count increased to 32 × 10(3)/ml and her general condition suddenly deteriorated, and she died as a result of multiple organ failure. A final diagnosis of G-CSF-producing SCC of the lower gingiva was made based on the patient's clinical course.

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Figures

Figure 1
Figure 1
(Upper) Intraoral photo at initial consultation: leukoderma and erosion were observed at left side lower canine, the first premolar equivalent to palate of gingiva (Lower) Intraoral photo at relapse: hemorrhagic leukoderma and erosion were observed at left side lower canine, the first premolar equivalent to palate of gingiva.
Figure 2
Figure 2
Panoramic radiograph at relapse. Bone absorption observed at left side lower canine, the first premolar equivalent to department gingiva.
Figure 3
Figure 3
CT scan at relapse. Osteolysis observed at left side lower canine, the first premolar, the second premolar equivalent to department gingiva.
Figure 4
Figure 4
(A) Flurodeoxyglucose (FDG)-PET/CT scan showed a dense accumulation in the left femur suggestive of tumor metastasis (B) Radiographic image of the left femur revealed bone absorption indicative of metastasis.
Figure 5
Figure 5
CT findings showed multiple metastases to the lungs.
Figure 6
Figure 6
CT findings showed metastases to the liver, spine, mediastinal lymph nodes, and abdominal subcutaneous tissue (indicated by the red circle).
Figure 7
Figure 7
Shift in WBC count, CRP, and body temperature.
Figure 8
Figure 8
G-CSF-positive cells were more pronounced in the biopsy tissue specimen obtained in July 2009 than in the surgical specimen obtained in January 2009.
See this image and copyright information in PMC

References

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