Granulocyte Colony-Stimulating Factor-Producing Spindle Cell Carcinoma of Maxillary Sinus.

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Spindle cell carcinoma is a relatively rare tumor occurring usually in the upper respiratory and/or digestive tract, and less frequently in the maxillary sinus. Recently we treated a patient with spindle cell carcinoma of maxillary sinus.The patient was a 65-year-old male. The initial pathologic diagnosis was well-differentiated squamous cell carcinoma.He received immunochemotherapy (balloon-occluded arterial infusion of CDDP and recombinant interleukin-2) as a neoadjuvant, followed by radiation. The tumor was partially reduced in size, but total regression was not achieved. The residual tumor was surgically removed, and postoperative irradiation was applied to a total dose of 60 Gy.Six months later, however, the tumor reappeared and grew rapidly. Definitive surgical treatment was performed. Pathologic examination revealed that the recurrent tumor consisted of carcinoma and sarcomatous, spindle cell compartments. Differential diagnosis included carcinosarcoma, malignant fibrous histiocytoma, and spindle cell carcinoma. Immunohistochemical techniques were used to distinguish between epithelial and mesenchymal properties in a sarcomatoid area. Keratin was found in sarcomatoid parts, so the tumor was diagnosed as spindle cell carcinoma.The spindle cell carcinoma reappeared within 3 months and leukocytosis in the peripheral blood paralleled tumor growth. A tumor cell line (OKK-HK) was established from this spindle cell carcinoma. Granulocyte colony-stimulating factor (G-C SF) was detected (1255 pg/ml) in the supernatant of cultures of this cell line.This spindle cell carcinoma responded well to the local administration of WPG (biological response modifier). However, the patient died of respiratory failure.
耳鼻咽喉科臨床学会の論文

Granulocyte Colony-Stimulating Factor-Producing Spindle Cell Carcinoma of Maxillary Sinus.

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