A case of tongue carcinoma producing G-CFS/PTHrP appearing after recurrence

Abstract

Simultaneous production of granulocyte-colony stimulating factor (G-CSF) and parathyroid hormone-related protein (PTHrP) is rare in oral tumors. We report a case of tongue carcinoma, wherein the production of G-CSF and PTHrP was suspected after recurrence. A 72-year-old male with a tumor on the right side of the tongue was referred to our department. He was diagnosed with tongue squamous cell carcinoma with right neck lymph node metastasis (T3N1M0, Stage Ⅲ). Tumor resection and neck dissection were performed and neoadjuvant chemotherapy was initiated. However, recurrence of the oral carcinoma on the floor of the mouth and left mandibular region was recognized 2 months after surgery. Chemoradiotherapy was planned considering his general condition. During treatment, laboratory findings showed leukocytosis without infection. Soon afterward, hyperkalemia without bone invasion was also observed. The levels of G-CSF and PTHrP in serum were high. Finally, the effects of treatment proved to be limited. The patient's condition grew worse and he died 8 months after initial treatment. We examined tissue specimens taken at the primary and recurrent carcinoma by immunohistochemical staining with monoclonal anti-G-CSF antibody. All tissue reacted positively. These results suggested that this was a case of tongue carcinoma producing both G-CSF and PTHrP.