An autopsy case of granulocyte-colony-stimulating-factor-producing extrahepatic bile duct carcinoma

Figure 1 Chest radiography revealed massive plural effusion and a tumor elevating smoothly from the left chest wall (arrowheads), near which the fifth rib could not be traced.

Figure 2 Chest CCT depicted a mass with necrosis inside the tumor (arrows) and enhancement of its border (arrowheads), and extrapleural tumor and pleural effusion.

Figure 3 Bone scintigraphy showed an abnormal opaque uptake in the left third to fifth ribs (arrows).

Figure 4 Abdominal CT revealed a gradually enhanced tumor in the distal bile duct (arrows), without any regional lymph node or liver metastasis.

Figure 5 MRCP revealed stenosis (arrow heads) of the distal common bile duct.

Figure 6 Histological examination of the resected chest wall showed scattered atypical cells among numerous inflammatory cells (A). Immunohistochemistry for pan-cytokeratin as an epithelial cell marker (B) and vimentin as a mesenchymal cell marker (C) both showed positivity in these atypical cells.

Figure 7 Histological examination revealed a poorly differentiated adenocarcinoma with sarcomatous change in the distal bile duct, which slightly invaded into the pancreas (A), and cancer cells showed positive immunohistochemical staining for G-CSF (B).