Hepatocellular carcinoma producing granulocyte-colony stimulating factor accompanied with peritonitis carcinomatosa

Abstract

A 67-year-old man was diagnosed as having hepatocellular carcinomas (HCCs) caused by alcoholic liver cirrhosis 7 years ago. He had received radiofrequency ablation therapy and several transcatheter arterial embolization therapy several times. In April 2013, he was admitted to our hospital due to high fever, and computed tomography (CT) demonstrated multiple HCCs, ascites and multiple metastatic nodules in both lungs. Laboratory tests showed a white blood cell (WBC) count of 8,500/μL. The patient was clinically diagnosed as HCCs with metastasis in both lungs with spontaneous bacterial peritonitis. Antibiotic medication showed no effect and he died on 20th day after admission. Finally, WBC count had increased up to 47,800/|iL and serum G-CSF was very high (1750 pg/m/). Positive reaction of anti-G-CSF antibody was observed in immunohistochemical staining of the tumor tissue from autopsy specimen. It is suggested that G-CSF was associated with the high-grade transformation of the tumor tissue.