A case of resected anaplastic carcinoma of the pancreas producing granulocyte-colony stimulating factor with literature review

Abstract

Background: Granulocyte colony-stimulating factor (G-CSF)-producing tumors have been reported in various organs, and the prognosis of patients with G-CSF-producing pancreatic cancers is particularly dismal. In this report, we present a case of G-CSF-producing anaplastic carcinoma of the pancreas (ACP), characterized by early postoperative recurrence and rapid, uncontrolled growth.

Case presentation: A 74-year-old man presented to our hospital with complaints of abdominal fullness and pain after eating. On admission, it was observed that the peripheral leukocyte counts and serum G-CSF levels were significantly elevated (23,770/µL and 251 pg/mL, respectively). Computed tomography of the abdomen revealed a pancreatic head tumor involving the superior mesenteric vein. Pathologically, ultrasound-guided fine-needle aspiration confirmed ACP. Subsequently, we performed a subtotal stomach-preserving pancreaticoduodenectomy with portal vein reconstruction and partial transverse colon resection. On postoperative day (POD) 7, the leukocyte count decreased from 21,180/μL to 8490/μL; moreover, computed tomography revealed liver metastasis. Therefore, mFOLFILINOX chemotherapy was initiated on POD 30. However, the tumor exhibited rapid progression, and the patient died on POD 45.

Conclusions: G-CSF-producing ACP is rare, and the prognosis of patients is extremely poor. Basic research is required to develop effective drugs against G-CSF-producing tumors, and large-scale studies using national databases are needed to develop multidisciplinary treatment methods.

Keywords: Anaplastic carcinoma; Granulocyte-colony stimulating factor; Pleomorphic-type; Undifferentiated carcinoma.

Fig. 1

Preoperative images. A Abdominal CT in the coronal section revealed a well-demarcated cystic tumor with slight enhancement of the peripheral portion of the pancreatic head. B MRI revealed a pancreatic head tumor with SMV invasion. C Diffusion-weighted magnetic resonance imaging showing reduced tumor diffusion. D Diffusion-weighted images showing a pancreatic head mass with a high signal intensity

Fig. 2

Macroscopic and microscopic findings of the tumor. A Macroscopic appearance of the resected specimen. A gray and dark reddish mass measuring 65 mm in diameter with hemorrhage and necrosis was found in the pancreatic head. B Histological findings of the tumor showed a diffuse proliferation with necrosis. C Tumor cells were poorly cohesive, large, pleomorphic with abundant eosinophilic cytoplasm. The tumor showed a neutrophilic infiltration. D Tumor showed a vascular invasion. E Immunohistochemical staining for anti-G-CSF antibody in formalin-fixed paraffin-embedded resected specimen. Anaplastic cancer cells were positive for G-CSF

Fig. 3

Postoperative enhanced abdominal computed tomography findings. A CT showing an 8 mm nodule on the hepatic segment 4 on POD 7. B Tumor in liver segment 4 increased to 85 mm on POD 41. Multiple intrahepatic liver metastases were also observed

Fig. 4

Kaplan–Meier curve for G-CSF producing ACP cases. Survival curve for previous resected cases of G-CSF producing ACP are shown. Median survival time was only 58 days