title: Radical esophagectomy for a 92-year-old woman with granulocyte colony-stimulating factor-producing esophageal squamous cell carcinoma: a case report.
abstract: BACKGROUND
  Granulocyte colony-stimulating factor (G-CSF)-producing esophageal squamous cell carcinoma (ESCC) has been considered to have a poor prognosis. We successfully treated a case of G-CSF-producing ESCC in a 92-year-old woman.
  
  
  METHODS
  A 92-year-old woman was admitted to our hospital with the complaints of choking while swallowing and dysphagia. Esophagogastroduodenoscopy and contrast-enhanced computed tomography revealed a type 2 esophageal cancer located 26-35 cm from the dental arch, with no distant metastasis. The patient was diagnosed with G-CSF-producing ESCC based on remarkable leukocytosis and high G-CSF levels. The patient underwent radical subtotal esophagectomy. Subsequently, the level of neutrophils (from 23,500/μL to 5000/μL) and the level of G-CSF (from 131 to <19.5 pg/mL) decreased significantly. Immunohistochemistry analysis of the resected tissue specimen showed positive staining for G-CSF in the cytoplasm of the tumor cells. Although the patient developed aspiration pneumonitis, after antibiotic treatment, she promptly recovered and was discharged.
  
  
  CONCLUSIONS
  Herein, we describe a case of successfully treated G-CSF-producing ESCC in a 92-year-old woman. Precise detection and safely performed immediate radical operation are considered essential to achieve a good clinical course.
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Mari
authors.initials: M
authors.lastname: Kitani
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan. yamagay-tky@umin.ac.jp.|Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya City, Saitama, Japan. yamagay-tky@umin.ac.jp.
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Yamagata
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Asami
authors.initials: A
authors.lastname: Tanabe
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Yagi
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Aikou
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kiyokawa
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Nishida
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Yamashita
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Nomura
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Seto
mesh_terms: D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology / Q000601:surgery*; D003287:Contrast Media / Q000008:administration & dosage; D003680:Deglutition Disorders / Q000209:etiology; D003724:Dental Arch; D016145:Endoscopy, Digestive System; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood* / Q000378:metabolism*; D006801:Humans; D007150:Immunohistochemistry; D007958:Leukocyte Count; D009367:Neoplasm Staging; D009504:Neutrophils; D061646:Operative Time; D011015:Pneumonia, Aspiration / Q000188:drug therapy; D011379:Prognosis
chemical_list: D000900:Anti-Bacterial Agents; D014408:Biomarkers, Tumor; D003287:Contrast Media; D016179:Granulocyte Colony-Stimulating Factor
keywords: Esophageal squamous cell carcinoma; Granulocyte colony-stimulating factor; Granulocyte colony-stimulating factor-producing esophageal squamous cell carcinoma