Cholangiocellular Carcinoma with Pyrexia and Leukocytosis

A rare case of cholangiocellular carcinoma presenting with pyrexia and remarkable leukocytosis is reported. A 78-year-old man was admitted to our hospital for remittent high fever and leukoctosis. Computed tomography(CT)and ultrasonography(US)showed a low density lesion and hypoechoic lesion in the caudate lobe of the liver, respectively. A diagnosis of liver abscess was made, and percutaneous transhepatic drainage was tried unsuccessfully. A needle biopsy specimen at that time revealed undifferentiated carcinoma. Because multiple mass lesions throughout the liver detected by additional CT scan after admission, radical surgery was abandoned. He developed jaundice and died with clinical manifestations of multiple organ failure 32 days after admission. At autopsy, an expansive solid tumor occupied the caudate lobe, and multiple lesions scattered throughout both lobes of the liver were found. However, neither tumor embolism, direct invasion into the portal vein, nor dilatation of the intrahepatic bile duct was evident. Histological and immunochemical examiantions revealed poorly differentiated adenocarcinoma of the liver, and the tumor was finally diagnosed as cholangiocellular carcinoma. Specimens from the liver showed remarkable leukocyte infiltration and focal necrosis in Glison's sheath; the bone marrow showed hyperplasia. Enzyme immunoassay of the serum demonstrated abnormal levels of granulocyte colony-stimulating factor(129 pg/ml). These clinical findings indicate that granulocyte colonystimulating factor might originate from cholangiocellular carcinoma and elicit pyrexia and granulocytosis.