Granulocyte-colony stimulating factor producing mucinous cystic neoplasm with an associated invasive carcinoma of the pancreas

Abstract

Abstract. The present case study documents an autopsy case of granulocyte-colony stimulating factor (G-CSF)-producing mucinous cystic neoplasm (MCN), with an associated invasive carcinoma of the pancreas. A 65-year-old woman presented to Omuta City Hospital (Omuta Japan) with a primary complaint of abdominal pain. Multiple liver nodules and a pancreatic cyst were detected upon abdominal computed tomography. Initially, liver abscess was suspected as the patient exhibited leukocytosis and elevated C-reactive protein level. However, the serum concentration of G-CSF was 98.8 pg/ml (normal, <39.0 pg/ml). At 6 weeks after admission, the patient succumbed to liver failure. At autopsy, a cystic lesion was identified in the pancreatic tail that contained bloody necrotic fluid. Microscopically, the cystic lesion was composed of columnar and mucin-producing epithelium associated with ovarian-type subepithelial stroma. The stroma exhibited positive immunostaining for vimentin, estrogen receptor and progesterone receptor. Calcification on the cystic wall was observed. The tumor invaded the pancreatic parenchyma and metastasized to the liver and lungs. The lesion was diagnosed as invasive adenocarcinoma arising in MCN. By contrast, liver nodules predominantly consisted of pleomorphic cancer cells with small foci of adenocarcinoma. Pancreatic and hepatic cancer cells were confirmed to be positive for G-CSF staining. The present case report indicates that G-CSF-producing MCNs may be associated with an aggressive clinical course, particularly when anaplastic changes are observed.

Swainsonine, an alpha-mannosidase inhibitor, may worsen cervical cancer progression through the increase in myeloid derived suppressor cells population

“…Moreover, we have shown that patients with cervical intraepithelial neoplasia exhibited an increase in the frequency of circulating CD66b + low density neutrophils, again indicating systemic effects of these lesions, even before progressing to cancer [17]. Besides HPV associated cancers, other types of solid tumors can induce leukocytosis, including pancreas, non-small lung and colorectal cancer [41–43]. Leukocytosis can lead to the accumulation of MDSC that inhibit T cell responses, and by extension hamper anti-tumor cell cytotoxic activity.…”

Imaging findings of granulocyte colony-stimulating factor-producing tumors: a case series and review of the literature

“…However, no studies have evaluated the pattern of necrosis in G-CSF-producing tumors, and further research is needed in this respect. There are many case reports of G-CSF-producing tumors initially treated with antibiotics because of misdiagnosis as abscesses [ 5 , 39 – 46 ]. In our cases 3 and 4, the imaging findings were very similar to liver abscess (Fig.…”

Estrogen Receptor Expression in DICER1-related Lesions is Associated With the Presence of Cystic Components

“…Renal lesions include aCN, [24][25][26][27][28][29][30] and the related lesion, MEST of the kidney, 24,26,27,[29][30][31][32][33] as well as angiomyolipoma with epithelial cysts. [34][35][36] There is also mucinous cystic neoplasm of the pancreas [37][38][39][40][41][42][43][44][45]65 and of the liver. 39,42,46,47 A common theme in these lesions is a female predominance and reference to the stroma around the cysts as being "ovarian" or "Müllerian" in appearance.…”

“…5,23 In contrast, a female predominance is also known to occur in a small number of pathologic lesions, not considered to be part of the DICER1 tumor predisposition syndrome, and not involving the female reproductive system. Most are renal lesions, including adult cystic nephroma (aCN), [24][25][26][27][28][29][30] mixed epithelial-stromal tumor (MEST) of the kidney, 24,26,27,[29][30][31][32][33] and angiomyolipoma with epithelial cysts; [34][35][36] but there are other non-renal lesions, including mucinous cystic neoplasm of the pancreas [37][38][39][40][41][42][43][44][45] and of the liver. 39,42,46,47 The strong predominance of female patients raises the question as to whether these lesions are, at least in part, hormonally driven.…”

“…Support for this concept comes from the expression of estrogen receptors (ERs) considered to be characteristic or even diagnostic for the previously mentioned entities. [24][25][26][27][28][29][30][31][32][33][34][35][36]38,39,[41][42][43][44][45][46][47] Furthermore, these studies show that it is the stromal/mesenchymal component of the lesions that expresses ER, as documented by immunohistochemistry.…”