Granulocyte colony-stimulating factor-producing cutaneous squamous cell carcinoma: A case report and literature review.

RATIONALE: Granulocyte colony-stimulating factor (G-CSF) leads to an abnormal increase in the white blood cell count and is associated with a poor prognosis due to accelerated progression of the G-CSF-producing tumors. G-CSF-producing tumors arising from skin malignancies are rare.

PATIENT CONCERNS: A 72-year-old female patient presented with a 6-cm skin tumor on the genital midline. Two biopsy specimens revealed condyloma acuminatum, but a total resection and bilateral inguinal lymph node dissection were performed because the tumor was suspected of being malignant.

DIAGNOSES: Histopathological analysis revealed poorly differentiated verrucous carcinoma with a lymph node metastasis. After the white blood cell count and G-CSF rose to 111,000/μL and 543 pg/mL, respectively, the tumor was diagnosed as a G-CSF-producing tumor. The patient died 8 months after her initial visit.

INTERVENTIONS: We summarize the previously reported cases of G-CSF-producing cutaneous squamous cell carcinoma (SCC).

OUTCOMES: The present report includes a review of 11 previous cases of G-CSF-producing cutaneous SCC, all of which occurred in Japanese patients. Compared with the typical SCC patient, the patients in the studies cited were relatively young, and the lesions tended to occur on the genitals or buttocks. The mean tumor length is 9.2 ± 4.8 cm, and many instances were much larger than typical cutaneous SCCs due to the very rapid growth of G-CSF-producing tumors. The histological type of these cases included poorly differentiated SCC and a special type of SCC with high malignancy potential. Only 2 of the 11 patients survived; the median overall survival of the deceased patients was 7.8 ± 6.4 months, which was indicative of an extremely poor prognosis.

LESSONS: The present case is the first to report a case of G-CSF-producing tumors developed from verrucous carcinoma and had an extremely poor prognosis. G-CSF-producing cutaneous SCC should be considered in the differential diagnoses of malignant lesions developing on the genitals or buttocks or having a histological type or growth rate indicating high malignancy.