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A G-CSF-secreting adrenal carcinoma with rhabdoid-like differentiation causing leukocytosis

Nature Reviews Urology volume 6, pages 392–397 (2009)Cite this article

Abstract

Background. A 57-year-old African American man presented to a tertiary care center with a 6-month history of fatigue and worsening abdominal pain. He had lost 9.1 kg in weight in the 3 months leading up to presentation, and described subjective fevers and night sweats for 1 month with a nonproductive cough and blurred vision for several weeks before presentation. He had chronic renal insufficiency, sleep apnea, hypertension, and peripheral vascular disease.

Investigations. Physical examination, complete blood count, peripheral blood smear, leukocyte alkaline phosphatase score, bone marrow biopsy, CT of the chest, abdomen, and pelvis, MRI of the abdomen and pelvis, measurement of plasma and urine metanephrines, 24 h urine testing for cortisol and 17-ketosteroids, measurement of serum granulocyte colony-stimulating factor (G-CSF) level, histopathologic examination and immunohistochemical staining of resected tumor.

Diagnosis. G-CSF-secreting adrenal carcinoma with rhabdoid-like differentiation.

Management. En bloc surgical resection of kidney, suprarenal mass and spleen was performed, followed by initiation of mitotane chemotherapy 3 months later.

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Figure 1: MRI of the abdomen at presentation.
Figure 2: Biopsy findings.
Figure 3: Changes in the patient's white blood cell count.

References

  1. Mizutani, Y., Okada, Y., Terachi, T., Kakehi, Y. & Yoshida, O. Serum granulocyte colony-stimulating factor levels in patients with urinary bladder tumour and various urological malignancies. Br. J. Urol. 76, 580–586 (1995).

    Article  CAS  PubMed  Google Scholar 

  2. Sato, T. et al. Granulocyte colony stimulating factor (G-CSF) producing renal cell carcinoma [Japanese]. Rinsho Ketsueki 38, 1189–1193 (1997).

    CAS  PubMed  Google Scholar 

  3. Kobashi, Y., Okimoto, N. & Sakamoto, K. Squamous cell carcinoma of the lung producing granulocyte colony-stimulating factor and resembling a malignant pleural mesothelioma. Intern. Med. 43, 111–116 (2004).

    Article  PubMed  Google Scholar 

  4. Endo, K. et al. Gastric adenosquamous carcinoma producing granulocyte-colony stimulating factor. Gastric Cancer 8, 173–177 (2005).

    Article  CAS  PubMed  Google Scholar 

  5. Iwasa, K. et al. Anaplastic thyroid carcinoma producing the granulocyte colony stimulating factor (G-CSF): report of a case. Surg. Today 25, 158–160 (1995).

    Article  CAS  PubMed  Google Scholar 

  6. Jardin, F. et al. Intense paraneoplastic neutrophilic leukemoid reaction related to a G-CSF-secreting lung sarcoma. Am. J. Hematol. 80, 243–245 (2005).

    Article  PubMed  Google Scholar 

  7. Nishimura, M. et al. Autocrine growth by granulocyte colony-stimulating factor in malignant mesothelioma. Ann. Thorac. Surg. 82, 1904–1906 (2006).

    Article  PubMed  Google Scholar 

  8. Omura, N., Abe, S., Hirai, K. & Aoki, T. A case of granulocyte-colony stimulating factor producing gallbladder cancer. Am. J. Gastroenterol. 94, 273–275 (1999).

    Article  CAS  PubMed  Google Scholar 

  9. Usami, N. et al. Granulocyte colony-stimulating factor-producing malignant pleural mesothelioma. J. Thorac. Oncol. 2, 257–258 (2007).

    Article  PubMed  Google Scholar 

  10. Yoshimoto, A., Kasahara, K., Saito, K., Fujimura, M. & Nakao, S. Granulocyte colony-stimulating factor-producing malignant pleural mesothelioma with the expression of other cytokines. Int. J. Clin. Oncol. 10, 58–62 (2005).

    Article  PubMed  Google Scholar 

  11. Tachibana, M. et al. Autocrine growth of transitional cell carcinoma of the bladder induced by granulocyte-colony stimulating factor. Cancer Res. 55, 3438–3443 (1995).

    CAS  PubMed  Google Scholar 

  12. Peng, H. Q., Stanek, A. E., Teichberg, S., Shepard, B. & Kahn, E. Malignant rhabdoid tumor of the kidney in an adult: a case report and review of the literature. Arch. Pathol. Lab. Med. 127, e371–e373 (2003).

    PubMed  Google Scholar 

  13. Lowe, W., Weiss, R. M., Todd, M. B. & True, L. D. Malignant rhabdoid tumor of the kidney in an adult. J. Urol. 143, 110–111 (1990).

    Article  CAS  PubMed  Google Scholar 

  14. Clausen, H. V., Horn, T., Anagnostaki, L. & Larsen, S. Malignant rhabdoid tumour of the kidney in an adult: a case report with immunohistochemical and ultrastructural investigation. Scand. J. Urol. Nephrol. Suppl. 157, 123–128 (1994).

    CAS  PubMed  Google Scholar 

  15. Ebbinghaus, S. W., Herrera, G. & Marshall, M. E. Rhabdoid tumor of the kidney in an adult: review of the literature and report of a case responding to interleukin-2. Cancer Biother. 10, 237–241 (1995).

    Article  CAS  PubMed  Google Scholar 

  16. Yaris, N. et al. Malignant rhabdoid tumor of adrenal gland. Med. Pediatr. Oncol. 39, 128–131 (2002).

    Article  PubMed  Google Scholar 

  17. Dundr, P. et al. Adrenocortical adenoma with rhabdoid features. Pathol. Res. Pract. 202, 177–181 (2006).

    Article  PubMed  Google Scholar 

  18. Morozov, A. et al. INI1 induces interferon signaling and spindle checkpoint in rhabdoid tumors. Clin. Cancer Res. 13, 4721–4730 (2007).

    Article  CAS  PubMed  Google Scholar 

  19. Banzai, C. et al. Advanced malignant rhabdoid tumor of the ovary effectively responding to chemotherapy: a case report and review of the literature. Gynecol. Oncol. 105, 261–265 (2007).

    Article  PubMed  Google Scholar 

  20. Zacharieva, S. et al. Circulating vascular endothelial growth factor and active renin concentrations and prostaglandin E2 urinary excretion in patients with adrenal tumours. Eur. J. Endocrinol. 150, 345–349 (2004).

    Article  CAS  PubMed  Google Scholar 

  21. Cai, G. et al. Case report of extrarenal rhabdoid tumor of pelvic retroperitoneum molecular profile of angiogenesis and its implication in new treatment strategy. Cancer Biol. Ther. 8, 417–421 (2009).

    Article  CAS  PubMed  Google Scholar 

  22. Algar, E. M. et al. Imprinted CDKN1C is a tumor suppressor in rhabdoid tumor and activated by restoration of SMARCB1 and histone deacetylase inhibitors. PLoS ONE 4, e4482 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  23. Khan, T. S. et al. Streptozocin and o,p'DDD in the treatment of adrenocortical cancer patients: long-term survival in its adjuvant use. Ann. Oncol. 11, 1281–1287 (2000).

    Article  CAS  PubMed  Google Scholar 

  24. Abraham, J. et al. A phase II trial of combination chemotherapy and surgical resection for the treatment of metastatic adrenocortical carcinoma: continuous infusion doxorubicin, vincristine, and etoposide with daily mitotane as a P-glycoprotein antagonist. Cancer 94, 2333–2343 (2002).

    Article  CAS  PubMed  Google Scholar 

  25. Huang, H. & Fojo, T. Adjuvant mitotane for adrenocortical cancer—a recurring controversy. J. Clin. Endocrinol. Metab. 93, 3730–3732 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Terzolo, M. et al. Adjuvant mitotane treatment for adrenocortical carcinoma. N. Engl. J. Med. 356, 2372–2380 (2007).

    Article  CAS  PubMed  Google Scholar 

  27. Schteingart, D. E. Adjuvant mitotane therapy of adrenal cancer—use and controversy. N. Engl. J. Med. 356, 2415–2418 (2007).

    Article  CAS  PubMed  Google Scholar 

  28. Bertherat, J., Coste, J. & Bertagna, X. Adjuvant mitotane in adrenocortical carcinoma. N. Engl. J. Med. 357, 1256–1257 (2007).

    Article  CAS  PubMed  Google Scholar 

  29. Dickstein, G., Shechner, C. & Nativ, O. Adjuvant mitotane in adrenocortical carcinoma. N. Engl. J. Med. 357, 1257–1258 (2007).

    CAS  PubMed  Google Scholar 

  30. Kasperlik-Zaluska, A. A., Migdalska, B. M., Zgliczynski, S. & Makowska, A. M. Adrenocortical carcinoma. A clinical study and treatment results of 52 patients. Cancer 75, 2587–2591 (1995).

    Article  CAS  PubMed  Google Scholar 

  31. Lee, J. E. Adjuvant mitotane in adrenocortical carcinoma. N. Engl. J. Med. 357, 1258 (2007).

    CAS  PubMed  Google Scholar 

  32. Machens, A. & Dralle, H. Adjuvant mitotane in adrenocortical carcinoma. N. Engl. J. Med. 357, 1258–1259 (2007).

    CAS  PubMed  Google Scholar 

  33. Fassnacht, M. et al. Efficacy of adjuvant radiotherapy of the tumor bed on local recurrence of adrenocortical carcinoma. J. Clin. Endocrinol. Metab. 91, 4501–4504 (2006).

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge and thank Dr Diana McNeill, the Departments of Medicine and Pathology, and the Internal Medicine Residency Program, Duke University Medical Center, Durham, NC for their kind support in the evaluation and publication of this case.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Medical Oncology, Memorial Sloan–Kettering Cancer Center, New York, NY, USA

    Emil Lou

  2. Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA

    Jeremy Goodwin

  3. Department of Pathology, Duke University Medical Center, Durham, NC, USA

    David N. Howell

  4. Department of Infectious Disease, Duke University Medical Center, Durham, NC, USA

    L. Brett Caram

  5. Department of Pathology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA

    John Hicks

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Correspondence to Emil Lou.

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The authors declare no competing financial interests.

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Lou, E., Goodwin, J., Howell, D. et al. A G-CSF-secreting adrenal carcinoma with rhabdoid-like differentiation causing leukocytosis. Nat Rev Urol 6, 392–397 (2009). https://doi.org/10.1038/nrurol.2009.101

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