Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2020; 8(9): 1666-1673
Published online May 6, 2020. doi: 10.12998/wjcc.v8.i9.1666
Granulocyte colony-stimulating factor-producing squamous cell carcinoma of the tongue exhibiting characteristic fluorine-18 deoxyglucose accumulation on positron emission tomography–computed tomography: A case report
Hiroaki Shimamoto, Yuka Hirota, Yoshihisa Kashima, Naoya Kinoshita, Misaki Yokokawa, Tohru Ikeda, Hiroyuki Harada
Hiroaki Shimamoto, Yoshihisa Kashima, Naoya Kinoshita, Misaki Yokokawa, Hiroyuki Harada, Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
Yuka Hirota, Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
Tohru Ikeda, Oral Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
Author contributions: Shimamoto H and Harada H were the patient’s oral and maxillofacial surgeons, reviewed the literature and contributed to manuscript drafting; Kashima Y, Kinoshita N and Yokokawa M were the patient’s oral and maxillofacial surgeons, reviewed the literature and drafted the manuscript; Hirota Y and Ikeda T performed the pathological analysis and reviewed the literature and drafted the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hiroaki Shimamoto, DDS, PhD, Assistant Professor, Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 1130033, Japan. hiroaki.osur@tmd.ac.jp
Received: February 13, 2020
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
Abstract
BACKGROUND

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).

CASE SUMMARY

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.

CONCLUSION

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.

Keywords: Tongue cancer, Granulocyte colony-stimulating factor, Hyperlukocytosis, Positron emission tomograph, Case report

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.