Published online May 6, 2020. doi: 10.12998/wjcc.v8.i9.1666
Peer-review started: February 13, 2020
First decision: February 16, 2020
Revised: April 4, 2020
Accepted: April 21, 2020
Article in press: April 21, 2020
Published online: May 6, 2020
Granulocyte colony-stimulating factor (G-CSF) is a cytokine produced in inflammatory environments that induces differentiation and proliferation of neutrophils in bone marrow. We report a rare case of aggressive G-CSF-producing squamous cell carcinoma of the tongue exhibiting fluorine-18 deoxyglucose (FDG) accumulation in primary lesion, metastatic lymph nodes, spleen, and bone marrow on positron emission tomography–computed tomography (PET/CT).
We report a 58-year-old female with a rapid enlarged lingual mass with partial necrosis. Blood test results from the initial examination revealed a leukocyte count of 21380/µL. On PET/CT, extensive FDG accumulation was observed in the tongue and bilateral cervical lymph nodes, with elevated FDG accumulation in the spleen and bone marrow although no distant metastases were observed. We performed partial glossectomy and bilateral neck dissection. Immunohistochemical staining with G-CSF antibodies on biopsy specimen and resected samples revealed that both specimens were G-CSF positive. This is a rare case of G-CSF producing tongue carcinoma with elevated FDG accumulation in the spleen and bone marrow.
In patients with the tongue cancer and hyperleukocytosis, where FDG accumulations in the spleen and bone marrow are observed using PET/CT and when these accumulations are not caused by metastasis, G-CSF-producing tumors, with associated poor prognosis, should be considered.
Core tip: Tongue cancer is the most common cancer of the head and neck. But progress usually is not rapid. In addition, there is no accompanying hyperleukocytosis and no fluorine-18 deoxyglucose (FDG) accumulation in the spleen and bone marrow. Here we report a rare granulocyte colony-stimulating factor (G-CSF)-producing tongue carcinoma with rapid progression, with hyperleukocytosis, and FDG accumulation in the spleen and bone marrow on positron emission tomography–computed tomography. From this case, G-CSF-producing tumors should be suspected in tongue cancer when hyperleukocytosis and FDG accumulation in the spleen or bone marrow on positron emission tomography–computed tomography because G-CSF producing tumor progress rapidly and have a poor prognosis.