[Bladder carcinoma producing granulocyte colony stimulating factor (G-CSF). A case report]

Problems in early diagnosis of bladder cancer in a spinal cord injury patient: report of a case of simultaneous production of granulocyte colony stimulating factor and parathyroid hormone-related protein by squamous cell carcinoma of urinary bladder

BACKGROUND

Typical symptoms and signs of a clinical condition may be absent in spinal cord injury (SCI) patients.

CASE PRESENTATION

A male with paraplegia was passing urine through penile sheath for 35 years, when he developed urinary infections. There was no history of haematuria. Intravenous urography showed bilateral hydronephrosis. The significance of abnormal outline of bladder was not appreciated. As there was large residual urine, he was advised intermittent catheterisation. Serum urea: 3.5 mmol/L; creatinine: 77 umol/L. A year later, serum urea: 36.8 mmol/l; creatinine: 632 umol/l; white cell count: 22.2; neutrophils: 18.88. Ultrasound: bilateral hydronephrosis. Bilateral nephrostomy was performed. Subsequently, blood tests showed: Urea: 14.2 mmol/l; Creatinine: 251 umol/l; Adjusted Calcium: 3.28 mmol/l; Parathyroid hormone: < 0.7 pmol/l (1.1 - 6.9); Parathyroid hormone-related protein (PTHrP): 2.3 pmol/l (0.7 - 1.8). Ultrasound scan of urinary bladder showed mixed echogenicity, which was diagnosed as debris. CT of pelvis was interpreted as vesical abscess. Urine cytology: Transitional cells showing mild atypia. Bladder biopsy: Inflamed mucosa lined by normal urothelial cells. A repeat ultrasound scan demonstrated a tumour arising from right lateral wall; biopsy revealed squamous cell carcinoma. In view of persistently high white cell count and high calcium level, immunohistochemistry for G-CSF and PTHrP was performed. Dense staining of tumour cells for G-CSF and faintly positive staining for C-terminal PTHrP were observed. This patient expired about five months later.

CONCLUSION

This case demonstrates how delay in diagnosis of bladder cancer could occur in a SCI patient due to absence of characteristic symptoms and signs.

Bladder cancer producing granulocyte colony-stimulating factor: a case report

A rare case of bladder cancer producing granulocyte colony-stimulating factor (G-CSF) is reported. A 63-year-old man with a progressive, grade 3 transitional cell bladder carcinoma, showed marked leukocytosis (maximum 181,800/mm3) and an elevated serum G-CSF to 131.7 pg/mL. After radical cystectomy and neoadjuvant chemotherapy, the tumor recurred locally. Immunohistochemical examination with monoclonal antibody specific for G-CSF revealed positive staining in the local recurrent tumor. To our knowledge, there have been only seven cases reported of bladder cancer producing G-CSF.

Serum granulocyte colony-stimulating factor levels in patients with urinary bladder tumour and various urological malignancies

OBJECTIVES

To measure the serum levels of granulocyte colony-stimulating factor (G-CSF) in patients with urinary bladder tumour (UBT) or various urological malignant tumours, and to assess G-CSF production by tumour cells.

PATIENTS AND METHODS

Peripheral blood was obtained, before operation or anti-cancer therapy, from 141 patients with UBT, 37 patients with other urological malignant tumours (21 with renal cell carcinoma, nine with renal pelvic or ureteric tumours, five with prostatic cancer, and two with testicular cancer), 38 patients with benign urological diseases (21 with benign prostatic hypertrophy, 11 with urolithiasis and six with a varicocele), and from 15 healthy donors. The serum G-CSF levels were quantified using an enzyme immunoassay.

RESULTS

Of 141 patients with UBT, 13 showed elevated serum G-CSF levels above the sensitivity of the assay (30 pg/mL) with a mean value of 328 pg/mL. The serum levels in normal healthy donors and in patients with prostatic cancer, testicular cancer or varicocele were < 30 pg/mL, while the levels were > 30 pg/mL in two of nine patients with renal pelvic or ureteric tumour (mean 754 pg/mL) and in one of 21 patients with renal cell carcinoma (40 pg/mL). The levels of serum G-CSF in several patients with benign prostatic hypertrophy or urolithiasis were also elevated, but the mean levels were low. The serum G-CSF levels in patients with UBT correlated with the increase of grade and the progression of the stage of UBT. Furthermore, patients with UBT and an undetectable level of serum G-CSF had higher disease-specific survival rates at the 5-year follow-up when compared with those with an elevated level of serum G-CSF. There was a positive correlation between serum G-CSF levels and white blood cell counts. T24 and J82 UBT cell lines and freshly separated tumour cells derived from the patient whose serum G-CSF level was high produced G-CSF.

CONCLUSION

These results suggest that elevated serum G-CSF level might be associated with a poor prognosis in patients with UBT and be due to the production of G-CSF by UBT cells.