Granulocyte colony-stimulating factor産生尿管腫瘍の1例

Abstract

60歳男.患者は全身倦怠感, 体重減少を主訴とした.内視鏡補助下経腹式左腎尿管全摘出術が施行されたものの, 術後, 腎機能障害が認められ, 前立腺は軽度腫大, 弾性硬, 軽度圧痛を認めた.慢性前立腺炎疑い, 抗菌化学療法を開始したところ, 3週間後のPETではリンパ節は急激に腫大し, 18F-FDG異常集積を認めた.血清G-CSF濃度も異常高値を示し, G-CSF産生尿管癌外腸骨リンパ節再発と診断された.放射線療法を施行した結果, 治療開始後, 第22日目にはWBCは正常閾内となり, 21週間目の現在も, WBCおよびCRPは正常域内で, 再発や転移なく経過良好である

A 60-year-old man who underwent radical nephroureterectomy due to left ureteral cancer 22 months before (transitional cell carcinoma, pT4pN0Mx, grade 2, INF beta), was admitted to the hospital with the chief compliant of anorexia and body weight loss. The patient had severe leukocytosis and elevation of C-reactive protein, with no obvious focus of infection. Abdominal plain computed tomographic scan revealed left external ileac lymph node swelling. Positron emission tomography demonstrated left external ileac lymph node recurrence. Enzyme immunoassay of the serum demonstrated a markedly high concentration of granulocyte colony-stimulating factor (G-CSF; 790 pg/ml). Immunohistochemical examination of ureteral cancer cells with anti-G-CSF monoclonal antibody demonstrated G-CSF production in cancer cells. After diagnosed as lymph node recurrence of ureteral cancer producing G-CSF, the patient underwent radiotherapy (total 4000 Gy). CT after radiotherapy showed the complete disappearance of the lymph node swelling. To our knowledge, this is the second report of ureteral cancer proven to produce G-CSF in Japan.