A Case of Granulocyte-Colony Stimulating Factor-Producing Hepatocellular Carcinoma Confirmed by Immunohistochemistry

Granulocyte-colony stimulating factor (G-CSF) is a naturally occurring glycoprotein that stimulates the proliferation and maturation of precursor cells in the bone marrow into fully differentiated neutrophils. Several reports of G-CSF-producing malignant tumors have been published, but scarcely any in the hepatobiliary system, such as in hepatocellular carcinoma (HCC). Here, we encountered a 69-yr-old man with a hepatic tumor who had received right hepatic resection. He showed leukocytosis of 25,450/microL along with elevated serum G-CSF. Histological examination of surgical samples demonstrated immunohistochemical staining for G-CSF, but not for G-CSF receptor. The patient survived without recurrence for four years, but ultimately passed away with multiple bone metastases. In light of the above, clinicians may consider G-CSF-producing HCC when encountering patients with leukocytosis and a hepatic tumor. More cases are needed to clarify the clinical picture of G-CSF-producing HCC.

The role of collagen in hematopoiesis

Several types of collagen, including types I, III, IV, V and VI, are produced by bone marrow stromal cells. Current information indicates that changes in collagen production result in profound alterations in the capacity of hematopoietic precursors to proliferate and differentiate. Although not definitively established, collagen molecules may be involved in the establishment and conformation of the stroma-associated extracellular matrix and/or in adhesive interactions with progenitor cells. The dynamic role of collagen in hematopoiesis is indicated by the observation that collagen production and processing are regulated by several factors such as glucocorticoids, cytokines, collagenases and collagenase-inhibitory proteins.