原発性ヘモクロマトーシスに合併したｇｒａｎｕｌｏｃｙｔｅ‐ｃｏｌｏｎｙ　ｓｔｉｍｕｌａｔｉｎｇ　ｆａｃｔｏｒ産生肝細胞癌の１例

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  • A Case of Granulocyte-colony Stimulating Factor (G-CSF)-Producing Hepatocellular Carcinoma with Hemochromatosis.

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A 71-year-old man was admitted to the hospital because of a right flank pain and a high-grade fever with leucocytosis. On admission, imaging tests demonstrated a large tumor suggesting a hepatic abscess in the right lobe. Treatments including intravenous antibiotics and ultrasonography-guided percutaneous transhepatic drainage were started. Because he rapidly became worse, however, a diagnostic laparotomy was performed 18 days after admission. Laparotomy disclosed that a tumor measuring approx. 5 cm in diameter was situated in the hepatic segments 5 and 8 with innumerable small metastatic nodules scattering in the entire liver. Operative pathologic examination gave a diagnosis of poorly differentiated hepatocellular carcinoma (HCC) with a severe infiltration of neutrophils. The serum G-CSF level determined postoperatively increased to as high as 139 pg/ml, and an immunohistochemical staining of the specimen obtained during surgery confirmed the existence of many G-CSF-positive cells in the tumor tissue. The patient died from hepatic failure secondary to HCC on the 13th postoperative day. Our review of the literature suggested that a G-CSF-producing HCC is extremely rare and highly malignant, and no therapeutic methods are available even now. Therefore, further accumulation of cases may be required for establishing the diagnosing as well as treatment strategies for this particular pathology.

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