Granulocyte colony-stimulating factor-producing cholangiocellular carcinoma

Area of Science:

• Hepatobiliary Medicine
• Oncology
• Medical Imaging

Background:

• A 61-year-old female presented with epigastric pain, fever, and laboratory evidence of severe inflammatory reactions.
• Computed tomography (CT) revealed a left hepatic lobe tumor and lymphadenopathy.
• (18)F-fluorodeoxy-glucose positron emission tomography (FDG-PET) demonstrated high tumor uptake and spinal metastasis.

Observation:

• Elevated leukocyte count and FDG-PET findings suggested a granulocyte colony-stimulating factor (G-CSF)-producing tumor.
• Serum G-CSF levels were significantly elevated (213 pg/mL).
• The patient underwent liver trisegmentectomy, bile duct resection, and lymph node dissection.

Findings:

• Histological examination confirmed a poorly differentiated adenocarcinoma with lymph node metastasis.
• Immunohistochemical staining revealed G-CSF positivity in tumor cells, diagnosing it as G-CSF-producing cholangiocellular carcinoma.
• Post-surgery, inflammatory markers and G-CSF levels transiently improved.

Implications:

• The tumor exhibited rapid progression and recurrence in the remnant liver one month post-operation.
• The patient succumbed to the disease three months after surgery.
• G-CSF-producing cholangiocarcinoma is a rare entity with a poor prognosis, necessitating careful consideration of surgical treatment for advanced stages.