Carcinosarcoma of the liver producing granulocyte‐colony stimulating factor

• Published in: Pathology international Vol. 56; no. 7; pp. 413 - 419
• Main Authors: Aita, Kumi, Seki, Kunihiko
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.07.2006
• Subjects: Actins - analysis; Aged; Biomarkers, Tumor - analysis; Carcinoma, Hepatocellular - blood; Carcinoma, Hepatocellular - pathology; Carcinosarcoma - blood; Carcinosarcoma - pathology; Desmin - analysis; Enzyme-Linked Immunosorbent Assay; Fatal Outcome; Granulocyte Colony-Stimulating Factor - blood; G‐CSF; hepatocellular carcinoma; Humans; Leukocytosis - pathology; Liver - diagnostic imaging; liver carcinosarcoma; Liver Neoplasms - blood; Liver Neoplasms - pathology; Male; Tomography, X-Ray Computed
• ISSN: 1320-5463; 1440-1827
• DOI: 10.1111/j.1440-1827.2006.01979.x

An autopsy case of carcinosarcoma of the liver producing granulocyte‐colony stimulating factor (G‐CSF) is reported. The patient, a 74‐year‐old Japanese man, presented with multiple liver masses. His serum G‐CSF was elevated to 286 pg/mL and a marked leukocytosis of 19 100/µL was observed. The patient had a rapidly aggravated clinical course and died 57 days after admission. Autopsy revealed a liver carcinosarcoma composed both of hepatocellular carcinoma (HCC) and sarcomatous elements immunoreactive with α‐smooth muscle actin and desmin. Immunohistochemistry revealed positive staining of G‐CSF in the cytoplasm of HCC, whereas none of the spindle cells was positively stained. Production of G‐CSF was also confirmed by enzyme‐linked immunosorbent assay, using the frozen tumor tissue taken at the autopsy. Similar to the majority of G‐CSF‐producing tumors in the literature, only the epithelial elements of the present case were immunopositive for G‐CSF. Although a monoclonal origin of carcinosarcomas has generally been proposed, heterologous differentiation from a single clone might lead to the production of G‐CSF only in the epithelial element in the present case. It is suggested that G‐CSF was associated with the high‐grade transformation of the epithelial elements, as well as the reported phenomenon of conventional HCC producing G‐CSF.