Carcinosarcoma of the gallbladder producing alpha-fetoprotein and manifesting as leukocytosis with elevated serum granulocyte colony-stimulating factor: report of a case.
A 69-year-old man was referred to our hospital for investigation of leukocytosis and a persistent fever of 38 degrees C, but we could find no evidence of a specific infection. The leukocyte count was 18,000/mm(3), and the serum granulocyte colony-stimulating factor (G-CSF) and alpha-fetoprotein (AFP) levels were both elevated, at 66.3 pg/ml and 1,495 ng/ml, respectively. Computed tomography (CT) showed a gallbladder tumor and we performed extended cholecystectomy. Postoperatively, the fever subsided and the leukocyte count, serum G-CSF and AFP level normalized. Histologically, the tumor was a carcinosarcoma of the gallbladder. Immunohistochemical staining of the tumor cells was positive for AFP, but negative for G-CSF. This is the first report of a carcinosarcoma of the gallbladder producing AFP. The laboratory findings and clinical course strongly suggested that the tumor produced not only AFP, but also G-CSF.
Shimada
Kazunori
K
Department of Surgery, Osaka General Medical Center, 3-1-56 Mandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
Iwase
Kazuhiro
K
Aono
Toyokazu
T
Nakai
Sumio
S
Takeda
Shin-ichi
S
Fujii
Makoto
M
Koma
Masaru
M
Nishikawa
Kazuhiro
K
Matsuda
Chu
C
Hirota
Masashi
M
Fushimi
Hiroaki
H
Tanaka
Yasuhiro
Y
D000368:Aged; D002296:Carcinosarcoma / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood*; D006801:Humans; D007964:Leukocytosis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000378:metabolism*
D000509:alpha-Fetoproteins; D016179:Granulocyte Colony-Stimulating Factor