G-CSF-producing malignant pleural mesothelioma: an autopsy case report with literature review

Our plain-English summary of G-CSF-producing malignant pleural mesothelioma: an autopsy case report with literature review, by K. Oka, G. Sarashina, N. Yonekawa, et al (International Journal of Surgical Pathology, 2012).

The study

• Authors: K. Oka, G. Sarashina, N. Yonekawa, O. Watanabe, Y. Miyao, T. Hashimoto, Y. Yatabe
• Journal: International Journal of Surgical Pathology
• Published: 2012;20(3):272-5
• Type of article: Case report, Review
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This study reports a 54-year-old man who was a carpenter by occupation. He suffered from left chest and back pain and left pleural effusion. Peripheral blood showed granulocytosis and high serum titers of granulocyte-colony stimulating factor (G-CSF) and CYFRA. He died 20 months later. At autopsy, a pleural tumor located around the left lung and thickening of the pericardium, diaphragm, and esophagus by tumor infiltration was seen. The tumor proliferated in papillary and solid alveolar patterns by neoplastic cells. They were positive for calretinin, D2-40, CK5/6, HBME-1, G-CSF, CK19, and E-cadherin. He was diagnosed with G-CSF-producing epithelioid malignant pleural mesothelioma.

In plain English

This article was an autopsy case report with a review of previously published cases. It described a 54-year-old man in Japan who worked as a carpenter and had left chest and back pain and fluid around the left lung. His blood showed a high white blood cell count (64 200/µL) and raised serum levels of granulocyte-colony stimulating factor (G-CSF), 136 pg/mL against a normal range below 39 pg/mL, and of CYFRA. Two needle biopsies did not give a firm diagnosis. Chemotherapy had no effect, and he died 20 months after symptoms began. At autopsy, a tumor surrounded the left lung, and tumor had infiltrated the pericardium, diaphragm and esophagus. Tumor cells stained positive for mesothelioma markers and for G-CSF. The diagnosis was G-CSF-producing epithelioid malignant pleural mesothelioma. No asbestos bodies were found in sputum, biopsy or autopsy material, and the article did not report an asbestos exposure history for this patient. The authors' table listed 11 reported cases, including this one. All were Japanese men aged 45 to 76, and all died 10 days to 20 months later.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Autopsy case report of one patient, with a literature review of previously reported cases of G-CSF-producing malignant mesothelioma
• Who was studied: One 54-year-old man, a carpenter, treated at Mito Saiseikai General Hospital in Japan. The literature review tabulated 11 cases (10 previously reported plus this one).
• Exposure: The article did not report an asbestos exposure history or fiber type for this patient; it gives only his occupation as carpenter. No asbestos bodies were seen in his sputum, biopsy or autopsy material. In the review table, four earlier cases are marked as having no asbestos exposure.
• Main results:
  • In this patient, blood tests showed a white blood cell count of 64 200/µL, with 96.0% stab and segmented leukocytes, and a serum G-CSF level of 136 pg/mL (normal range below 39 pg/mL).
  • In this patient, serum CYFRA was 128 ng/mL (normal range below 3.5 ng/mL).
  • The first core needle biopsy was diagnosed as nonspecific fibrous pleuritis. The second was diagnosed as suspicious for malignant pleural mesothelioma or pseudomesotheliomatous adenocarcinoma of the lung.
  • Chemotherapy with cisplatin, gemcitabine and vinorelbine had no effect, and the patient died 20 months after the first symptoms.
  • At autopsy, a pleural tumor around the left lung weighed 1750 g and measured 23.8 × 12.8 × 14.6 cm.
  • The tumor had infiltrated and thickened the pericardium, diaphragm and esophagus. There were metastases to the left clavicle and to the paraesophageal lymph nodes.
  • Tumor cells were positive for calretinin, D2-40, CK5/6, HBME-1, G-CSF, CK19 and E-cadherin.
  • Tumor cells were negative for CEA, Ber-EP4, MOC31, B72.3, WT1, thrombomodulin and TTF-1, among other stains.
  • No asbestos bodies were observed in the autopsy material.
  • In the literature review of 11 G-CSF-producing malignant mesothelioma cases, including this one, all patients were men aged 45 to 76 years (mean 59 years).
  • In the reviewed cases, serum G-CSF ranged from 36.0 to 217 pg/mL, and all patients died 10 days to 20 months later.
  • All reviewed cases were Japanese men; the authors stated it was unclear why.
• The authors' conclusion: The authors concluded that this patient's marked granulocytosis, high serum G-CSF level and G-CSF expression by tumor cells were compatible with a G-CSF-producing tumor. They diagnosed G-CSF-producing epithelioid malignant pleural mesothelioma. Based on other reported cases, they suggested such tumors may produce several cytokines.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Autopsy, Pleural Effusion, Pericardium, Diaphragm, Calretinin, Podoplanin (D2-40), HBME-1.

Related studies

• Pseudomesotheliomatous carcinoma of the pleura: an autopsy case of metastasis from a G-CSF-producing anaplastic carcinoma of the pancreas — Y. Hattori, K. Sentani, et al. (2018)
• A case of primary lung squamous cell carcinoma mimicking malignant mesothelioma producing granulocyte colony stimulating factor with chemotherapy (cisplatin and gemcitabine)-associated thrombotic thrombocytopenic purpura (TTP); An autopsy case report — Y. Suzuki, K. Kanazawa, et al. (2019)
• Post-irradiation pericardial malignant mesothelioma: an autopsy case and review of the literature — M. Bendek, M. Ferenc, et al. (2010)
• Heterologous sarcomatoid pleural mesothelioma with osteosarcomatous differentiation: a report of autopsy case that accomplished trimodality therapy and review of the literature — H. Itano, T. Takeda, et al. (2020)
• Interleukin-5-producing malignant pleural mesothelioma with eosinophilic pleural effusion — E. Takeuchi, N. Takahashi, et al. (2020)
• Asbestos bodies in human lungs at autopsy — D. Cauna, R.S. Totten, et al. (1965)

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