title: Granulocyte colony-stimulating factor-producing pancreatic anaplastic carcinoma in ascitic fluid at initial diagnosis: A case report.
abstract: Granulocyte colony-stimulating factor (G-CSF)-producing pancreatic tumors are extremely rare. These tumors have an aggressive clinical course and no established treatment. Here, we report an autopsy case of G-CSF-production in pancreatic anaplastic carcinoma (PAC). A 72-year-old woman presented with a large pancreatic head mass and multiple liver metastases. Laboratory data showed leukocytosis (leukocyte count 113.3 × 103/µL) and high serum G-CSF levels (441 pg/mL; normal range: <39.0 pg/mL). The ascitic fluid was submitted to our pathology laboratory at initial diagnosis. Cytopathology showed that smears from the ascitic fluid were highly cellular and contained numerous malignant cells, mainly in loose groupings. Occasional pseudoglandular formations and giant cells were also present. The malignant cells were round, and no spindle-shaped cells were visible. The nuclei were round to ovoid with coarsely granular chromatin and large prominent nucleoli. Upon immunocytochemistry, tumor cells were positive for G-CSF and vimentin; there was no E-cadherin expression. Histopathological examination of the tumor showed a mixed composition of adenocarcinomatous and sarcomatous regions. Upon immunohistochemistry, both components were positive for G-CSF. Few CD34-positive myeloblasts were observed in the bone marrow. Thus, we diagnosed this as a case of G-CSF production in PAC with leukocytosis. To the best of our knowledge, this is the first report on G-CSF expression immunocytochemically confirmed in PAC. Diagn. Cytopathol. 2017;45:463-467. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Kurume, Japan.|Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Kubota
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Kurume, Japan.|Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Yoshiki
authors.identifier: http://orcid.org/0000-0001-5292-2785
authors.initials: Y
authors.lastname: Naito
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kawahara
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Taira
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Yamaguchi
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yoshida
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Abe
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Yorihiko
authors.initials: Y
authors.lastname: Takase
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Fukumitsu
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Murata
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ishida
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Okabe
authors.affiliation: Department of Diagnostic Pathology, St. Mary's Hospital, Kurume, Japan.
authors.forename: Yoshizo
authors.initials: Y
authors.lastname: Kimura
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Tanigawa
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Mihara
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Masamichi
authors.initials: M
authors.lastname: Nakayama
authors.affiliation: Department of Pathology and Laboratory Medicine, Kurume University Medical Center, Kurume, kurume, Japan.
authors.forename: Rin
authors.initials: R
authors.lastname: Yamaguchi
authors.affiliation: Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Akiba
authors.affiliation: Department of Pathology, Kurume University School of Medicine, Kurume, Japan.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Yano
mesh_terms: D000368:Aged; D001202:Ascitic Fluid / Q000378:metabolism / Q000473:pathology*; D002277:Carcinoma / Q000175:diagnosis* / Q000235:genetics / Q000556:secondary; D017809:Fatal Outcome; D005260:Female; D015870:Gene Expression; D016179:Granulocyte Colony-Stimulating Factor / Q000235:genetics* / Q000378:metabolism; D006801:Humans; D007964:Leukocytosis / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000556:secondary; D010179:Pancreas / Q000378:metabolism / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology
chemical_list: D016179:Granulocyte Colony-Stimulating Factor
keywords: ascitic fluid; granulocyte-colony stimulating factor (G-CSF); pancreas; pancreatic anaplastic carcinoma