A resected case of G-CSF-producing lung cancer associated with pulmonary bulla

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A 51-year-old man was referred to our hospital because of an abnormal chest shadow on a chest radiograph. Computed tomographic imaging demonstrated a mass measuring 6 cm in diameter adjacent to the bulla with fluid retention in the right upper lobe. Laboratory examination showed a WBC of 21,050/mm<SUP>3</SUP> and high serum levels of CRP. We suspected lung cancer associated with an infective pulmonary bulla. Preoperative transbronchial brushing cytology of the mass revealed non-small cell carcinoma, and a right upper lobectomy was performed. Pathological examination of the resected specimen showed that the tumor developed from the lung parenchyma and progressed into the adjacent bulla. The tumor cells resided in the bulla. General bacteria and acid-fast bacillus tests were negative in a cultivation survey, and histopathological examination demonstrated giant cell carcinoma of the lung. Although preoperative levels of serum granulocyte-colony stimulating factor (G-CSF) were high, they returned to normal after the operation. An immunohistochemical analysis demonstrated that the tumor cells were positive for G-CSF, indicating that the tumor was a G-CSF-producing lung cancer. Our patient had leukocytosis in association with paraneoplastic syndrome of G-CSF-producing lung cancer, and fluid retention in the bulla with invasion of the tumor, and we suspected this to be related to the giant cell carcinoma with extensive necrosis.