title: A case of granulocyte colony-stimulating factor and interleukin 6 receptor-producing mediastinal mature cystic teratoma with somatic-type malignancy.
abstract: Mediastinal germ cell tumor with somatic-type malignancy is a rare neoplasm. We describe one such case in a 49-year-old Japanese man who had shown an elevated serum concentration of granulocyte colony-stimulating factor (GCSF) and leukocytosis without a shift to the left. Histologically, the tumor formed a teratomatous cyst whose wall contained benign epithelial components, well-differentiated tubular and mucinous adenocarcinoma, and poorly-differentiated pleomorphic carcinoma. Immunohistochemically, both the well differentiated adenocarcinoma and poorly differentiated pleomorphic carcinoma expressed GCSF. Immunohistochemistry and molecular analysis revealed that both components also produced interleukin 6 receptor (IL6R). We diagnosed this tumor as a GCSF- and IL6R-producing mediastinal mature cystic teratoma with somatic-type malignancy. The tumor showed immunohistochemical expression of activated signal transducer and activator of transcription 3. The patient died 6 months after developing systemic symptoms. For a GCSF-producing tumor, complete resection appears to offer the best outcome at present. For any patient presenting with leukocytosis without a shift to the left, a thorough analysis should be conducted, and the tumor diagnosed as early as possible.
authors.affiliation: Department of Surgical Pathology, Showa University Fujigaoka Hospital, Aoba-ku, Yokohama, Japan. nonkoamesho0324@yk9.so-net.ne.jp
authors.forename: Atsuko
authors.initials: A
authors.lastname: Masunaga
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.forename: Tsuyoki
authors.initials: T
authors.lastname: Kadofuku
authors.forename: Sanju
authors.initials: S
authors.lastname: Iwamoto
authors.forename: Mikio
authors.initials: M
authors.lastname: Masuda
authors.forename: Shuichi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Takashi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Akira
authors.initials: A
authors.lastname: Miyazaki
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mitsuya
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D015153:Blotting, Western; D017809:Fatal Outcome; D016179:Granulocyte Colony-Stimulating Factor / Q000096:biosynthesis*; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D008297:Male; D008479:Mediastinal Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D019947:Receptors, Interleukin-6 / Q000096:biosynthesis*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013276:Stomach Ulcer / Q000150:complications; D013724:Teratoma / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology
chemical_list: D014408:Biomarkers, Tumor; D019947:Receptors, Interleukin-6; D016179:Granulocyte Colony-Stimulating Factor