title: Carcinosarcoma of the liver producing granulocyte-colony stimulating factor.
abstract: An autopsy case of carcinosarcoma of the liver producing granulocyte-colony stimulating factor (G-CSF) is reported. The patient, a 74-year-old Japanese man, presented with multiple liver masses. His serum G-CSF was elevated to 286 pg/mL and a marked leukocytosis of 19 100/microL was observed. The patient had a rapidly aggravated clinical course and died 57 days after admission. Autopsy revealed a liver carcinosarcoma composed both of hepatocellular carcinoma (HCC) and sarcomatous elements immunoreactive with alpha-smooth muscle actin and desmin. Immunohistochemistry revealed positive staining of G-CSF in the cytoplasm of HCC, whereas none of the spindle cells was positively stained. Production of G-CSF was also confirmed by enzyme-linked immunosorbent assay, using the frozen tumor tissue taken at the autopsy. Similar to the majority of G-CSF-producing tumors in the literature, only the epithelial elements of the present case were immunopositive for G-CSF. Although a monoclonal origin of carcinosarcomas has generally been proposed, heterologous differentiation from a single clone might lead to the production of G-CSF only in the epithelial element in the present case. It is suggested that G-CSF was associated with the high-grade transformation of the epithelial elements, as well as the reported phenomenon of conventional HCC producing G-CSF.
authors.affiliation: Molecular Pathology, Institute of Basic Medical Science, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukubashi, Ibaraki, Japan. kumiaita@md.tsukuba.ac.jp
authors.forename: Kumi
authors.initials: K
authors.lastname: Aita
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Seki
mesh_terms: D000199:Actins / Q000032:analysis; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000473:pathology; D002296:Carcinosarcoma / Q000097:blood* / Q000473:pathology; D003893:Desmin / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D017809:Fatal Outcome; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood*; D006801:Humans; D007964:Leukocytosis / Q000473:pathology; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000097:blood* / Q000473:pathology; D008297:Male; D014057:Tomography, X-Ray Computed
chemical_list: D000199:Actins; D014408:Biomarkers, Tumor; D003893:Desmin; D016179:Granulocyte Colony-Stimulating Factor