A CASE OF GRANULOCYTE-COLONY STIMULATING FACTOR PRODUCING CARCINOSARCOMA OF THE ESOPHAGUS

This paper describes a case of granulocyte-colony stimulating factor (G-CSF) producing carcinosarcoma of the esophagus. A 63-year-old man visited another hospital because of general fatigue and was pointed out hyperleukocytosis (the white blood cell count: 130, 000/mm3). The patient was referred to the department of hematological medicine in our hospital for close examination. On admission blood G-CSF level was 286pg/ml, and there was a tumor of 0-I type in the Im of the esophagus. With a suspection of G-CSF producing tumor, the patient was transferred to the department. Total resection of the thoracic esophagus and anastomosis of the cervical esophagus with the stomach via anterothoracic route were carried out. Histopathologically the tumor was so-called carcinosarcoma of sm, n(-), P10, M0 and in stage 0. G-CSF levels at two portions which were selected at random were 1, 340, 000 and 1, 310, 000pg/g wet weight, respectively. With immunohistological staining by using mono-clonal antibody for G-CSF, localization of G-CSF was proved in the tumor cells. After the operation, necrosis occurred in the oral-side of the elevated stomach, for which a jejunal interposition with vascular anastomosis reconstruction was conducted. Thereafter, both white blood cell count and blood G-CSF were normalized. The definite diagnosis of G-CSF producing tomor of esophagus was made.