A case of granulocyte colony-stimulating factor-producing anaplastic carcinoma of the pancreas

We report the case of a 65-year-old man who was admitted to our hospital with high fever and anorexia. On admission, the peripheral leukocyte count and serum granulocyte colony-stimulating factor (G-CSF) were elevated to 27,900/mm3 and 165pg/ml, respectively. Abdominal computed tomography demonstrated a pancreatic tail tumor and para-aortic lymph node swelling. We performed an open para-aortic lymph node biopsy, and intraoperative pathological diagnosis revealed no lymph node metastasis. Therefore, we performed distal pancreatectomy, splenectomy, and partial gastrectomy. After the surgery, the leukocyte count and serum G-CSF decreased, but multiple liver metastases and an intra-abdominal recurrence were detected. We administered chemotherapy with TS-1 followed by gemcitabine, but the patient died on post-operative day 116. The autopsy showed anaplastic carcinoma of the pancreas and multiple metastases to the liver, lung, vertebrae, diaphragm, abdominal lymph nodes, and peritoneum. Carcinoma of the pancreas associated with G-CSF production is very rare. Here we present this case along with a review of the literature.