文献病例65-分泌粒细胞集落刺激因子的胆囊癌导致骨髓弥漫FDG摄取

64岁男性，腹胀，FDG PET/CT MIP图显示右上腹见一局灶摄取FDG增高及骨髓弥漫摄取FDG，CT示胆囊见一巨大密度不均匀软组织密度肿块，增强后边缘强化，侵犯肝、十二指肠、横结肠。盆腔骨可见骨髓密度增高。实验室检查white blood cell count of 17,600/mL (88% segmented neutrophils) and a serum C-reactive protein level of 11.92 mg/dL.

Based on the imaging findings and laboratory data, we suspected a granulocyte colony-stimulating factor (G-CSF)–producing gallbladder cancer.

The serum level of G-CSF was elevated to 189 pg/mL (reference range, <39 pg/mL), and immunostaining of the biopsy specimen showed that the tumor cells were positive for G-CSF.

最终诊断为分泌粒细胞集落刺激因子的胆囊癌

G-CSF is a glycoprotein that stimulates the proliferation and differentiation of neutrophil progenitor cells in the bone marrow.1 G-CSF–producing tumors arise mainly from the lungs but can occur in various organs including the gallbladder.

Most of the G-CSF–producing tumors are poorly differentiated to undifferentiated tumors and have a poor prognosis regardless of the primary site.

Increased FDG uptake in the bone marrow correlates with increased neutrophils in the peripheral blood due to G-CSF and interleukin 6.

 Kohno et al reported that CT attenuation of the pelvic bone marrow increased inparallel with tumor progression and serum white blood cell count, and that histopathologically, the bone marrow showed hyperplastic without any signs of neoplastic disease.