Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Oct 15, 2022; 14(10): 2077-2084
Published online Oct 15, 2022. doi: 10.4251/wjgo.v14.i10.2077
Disseminated carcinomatosis of the bone marrow caused by granulocyte colony-stimulating factor: A case report and review of literature
Kengo Fujita, Ayaka Okubo, Toshitsugu Nakamura, Nobumichi Takeuchi
Kengo Fujita, Ayaka Okubo, Nobumichi Takeuchi, Department of Medical Oncology, Ina Central Hospital, Nagano 396-8555, Japan
Toshitsugu Nakamura, Department of Diagnostic Pathology, Ina Central Hospital, Nagano 396-8555, Japan
Author contributions: Fujita K and Okubo A collected and interpreted clinical data, reviewed the literatures, and drafted a manuscript; Nakamura T was involved in pathological diagnosis and revised the manuscript critically for intellectual content; Takeuchi N was the patient’s primary oncologist and revised the manuscript critically for intellectual content; and all authors critically revised the report, commented on drafts of the manuscript, and approved the final report.
Informed consent statement: Informed written consent was obtained from the patient’s family members for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nobumichi Takeuchi, MD, PhD, Director, Doctor, Department of Medical Oncology, Ina Central Hospital, 1313-1 Ina, Nagano 396-8555, Japan. ntakeuti@inahp.jp
Received: May 21, 2022
Peer-review started: May 21, 2022
First decision: June 23, 2022
Revised: July 8, 2022
Accepted: August 21, 2022
Article in press: August 21, 2022
Published online: October 15, 2022
Processing time: 146 Days and 8.3 Hours
Abstract
BACKGROUND

Disseminated carcinomatosis of the bone marrow (DCBM) is a widespread metastasis with a hematologic disorder that is mainly caused by gastric cancer. Although it commonly occurs as a manifestation of recurrence long after curative treatment, the precise mechanism of relapse from dormant status remains unclear. Granulocyte colony-stimulating factor (G-CSF) can promote cancer progression and invasion in various cancers. However, the potential of G-CSF to trigger recurrence from a cured malignancy has not been reported.

CASE SUMMARY

A 55-year-old Japanese woman was diagnosed with Ewing sarcoma localized on the fifth lumbar vertebrae 6 years after curative gastrectomy for T1 gastric cancer. After palliative surgery to release nerve compression, pathological diagnosis of the resected specimen was followed by curative radiation and chemotherapy. During treatment, G-CSF was administered 32 times for severe neutropenia prophylaxis. Eight months after completing definitive treatment, she complained of severe back pain and was diagnosed as multiple bone metastases with DCBM from gastric cancer. Despite palliative chemotherapy, she died of disseminated intravascular coagulation 13 d after the diagnosis. Immunohistochemical examination of the autopsied bone marrow confirmed a diffuse positive staining for the G-CSF receptor (G-CSFR) in the relapsed gastric cancer cell cytoplasm, whereas the primary lesion cancer cells showed negative staining for G-CSFR. In this case, G-CSF administration may have been the key trigger for the disseminated relapse of a dormant gastric cancer.

CONCLUSION

When administering G-CSF to cancer survivors, recurrence of a preceding cancer should be monitored even after curative treatment.

Keywords: Disseminated bone marrow carcinomatosis; Gastric cancer; Granulocyte colony-stimulating factor; Cancer survivor; Immunostaining; Case report

Core Tip: Disseminated carcinomatosis of the bone marrow (DCBM) is a rare manifestation of recurrence of a treated cancer, mainly gastric cancer. We reported a case of DCBM 8 years after curative surgery for T1 gastric cancer. Immunostaining for granulocyte colony-stimulating factor (G-CSF) receptor was diffusely positive in the relapsed lesions, but it was negative in the primary lesion. The administration of G-CSF during treatment for Ewing sarcoma within 2 years before the relapse could have been the trigger for the gastric cancer recurrence. G-CSF administration in patients with history of cancer could be a risk factor for recurrence.