title: Carcinosarcoma of the gallbladder producing alpha-fetoprotein and manifesting as leukocytosis with elevated serum granulocyte colony-stimulating factor: report of a case.
abstract: 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.
authors.affiliation: Department of Surgery, Osaka General Medical Center, 3-1-56 Mandai-Higashi, Sumiyoshi, Osaka, 558-8558, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Shimada
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Iwase
authors.forename: Toyokazu
authors.initials: T
authors.lastname: Aono
authors.forename: Sumio
authors.initials: S
authors.lastname: Nakai
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Takeda
authors.forename: Makoto
authors.initials: M
authors.lastname: Fujii
authors.forename: Masaru
authors.initials: M
authors.lastname: Koma
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nishikawa
authors.forename: Chu
authors.initials: C
authors.lastname: Matsuda
authors.forename: Masashi
authors.initials: M
authors.lastname: Hirota
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Fushimi
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: 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*
chemical_list: D000509:alpha-Fetoproteins; D016179:Granulocyte Colony-Stimulating Factor