[A case of middle ear carcinoma with high plasma G-CSF level]

Malignant tumors sometimes yield a variety of paraneoplastic syndrome. We report a case of middle ear cancer demonstrating unusual granulocytosis which was considered to belong to this syndrome. A patient, 67-year-old male, noticed left facial nerve palsy in June 1989, and was operated on under the diagnosis of chronic otitis media. However, middle ear tumor was suspected during the operation, which was confirmed to be squamous cell carcinoma. He was referred to our hospital for radiotherapy. Six months after irradiation, spontaneous liqorrhea due to the dural necrosis occurred. When intracranial repair of dura was performed, tumor invasion into the dura was noticed. Subtotal resection of the temporal bone with iridium implant was done in vain to control the recurrent tumor, which spread quickly to adjacent tissues. A month before the death, progressive granulocytosis without appreciable inflammatory signs started. Numbers of WBC rapidly increased, maximally reaching 88,300/cmm. Plasma G-CSF concentration was assayed at this time, showing about ten times as much as that of normal controls. It was thus postulated that production of this substance by the tumor was responsible for granulocytosis.