Three cases of granulocyte colony-stimulating factor-producing urinary upper tract carcinomas.

This report presents three cases of urinary upper tract carcinomas producing granulocyte colony-stimulating factor (G-CSF), with high blood leukocyte counts and poor prognoses. Case 1 was a 73-year-old man who underwent nephroureterectomy for left renal pelvic carcinoma. Pathologically, urothelial carcinoma (UC), high-grade, was observed, and immunohistochemical analysis showed positive staining for G-CSF. Progressive disease (PD) was observed despite administration of systemic chemotherapy for disease relapse, and the patient died 4.5 months after the operation. Case 2 was a 74-year-old man who had left renal pelvic carcinoma with para-aortic lymph-node metastases. The serum G-CSF was elevated (169 pg/ml). The patient refused any aggressive treatment, and died 2.3 months after his first visit to the hospital. Case 3 was a 75-year-old woman who had left renal pelvic carcinoma with adrenal metastasis. Biopsy confirmed the diagnosis as UC with squamous differentiation, and the serum G-CSF was elevated (138 pg/ml). Systemic chemotherapy was administered. However, the patient showed PD, and died 6.9 months after her first visit to the hospital. Effective treatment strategies are warranted for carcinomas producing G-CSF. Elucidation of the actions of G-CSF on both the carcinoma cells and the tumor microenvironment may contribute to the development of useful strategies.