A Case of G‐CSF-producing Invasive Apical Cancer Resected following Preoperative Adjuvant Therapy

Abstract

The patient was a 47-year-old male with the chief complaints of right shoulder pain and fever. A 10-cm mass was found to be present in the right pulmonary apical region on chest X‐ray examination. The mass was diagnosed as a G‐CSF-producing invasive apical cancer and the patient underwent chemoradiotherapy followed by right upper lobectomy with combined resection of the chest wall, and lymph node dissection. A very small nodule was noted in the right frontal lobe on brain MRI before surgery, and the final diagnosis was pT3N0M1, stage IV lung adenocarcinoma. For the brain metastasis, gamma knife treatment and chemotherapy were performed after surgery, and there was no recurrence during 16 months after surgery. The prognosis for G‐CSF-producing lung cancer and invasive apical cancer is poor. This was a rare and difficult case of lung cancer showing both characteristics of lung cancer.

Thoracic surgery - heart and lung transplantation - cardiovascular surgery

References

• 1 Asano S, Urabe A, Okabe T, Sato N, Kondo Y. Demonstration of granulopoietic factor(s) in the plasma of nude mice transplanted with a human lung cancer and in the tumor tissue.  Blood. 1977;  49 845-852
• 2 Mizuguchi S, Inoue K, Iwata T, Kawata Y, Izumi N, Tsukioka T et al. The case of a lung adenocarcinoma producing granulocyte-colony stimulating factor (G-CSF) accompanied by arthritis.  Jpn J Chest Surg. 2005;  19 117-122
• 3 Depierre A, Milleron B, Moro-Sibilot D, Chevret S, Quoix E, Lebeau B et al. Preoperative chemotherapy followed by surgery compared with primary surgery in resectable stage I (except T1N0), II, and III a non-small cell lung cancer.  J Clin Oncol. 2002;  20 247-253
• 4 Betticher D C, Hsu Schmitz S F, Totsch M, Hansen E, Joss C, von Briel C et al. Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage IIIA pN2 non-small cell lung cancer: a multicenter phase II trial.  J Clin Oncol. 2003;  21 1752-1759
• 5 Rusch V W, Giroux D J, Kraut M J, Crowley J, Hazuka M, Winton T et al. Induction chemoradiation and surgical resection for superior sulcus non-small cell lung carcinomas: long-term results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160).  J Clin Oncol. 2007;  25 313-318
• 6 Pourel N, Santelmo N, Naafa N, Serre A, Hilgers W, Mineur L et al. Concurrent cisplatin/etoposide plus 3D-conformal radiotherapy followed by surgery for stage IIB (superior sulcus T3N0)/III non-small cell lung cancer yields a high rate of athological complete response.  Eur J Cardiothorac Surg. 2008;  33 829-836