Granulocyte colony-stimulating factor-producing esophageal squamous cell carcinoma following chemoradiotherapy and bone marrow transplantation for acute lymphoblastic leukemia

A 30-year-old man, who had been treated with craniospinal irradiation, total-body irradiation, and bone marrow transplantation for acute lymphoblastic leukemia at 20 years of age, complained of dysphagia. The patient had spike fever with leukocytosis (19,020/μl). Serum granulocyte colony-stimulating factor (G-CSF) level was also increased (53.7 pg/ml). Immunohistochemistry revealed positive staining for anti-G-CSF antibody in carcinoma cells obtained by endoscopic biopsy. The patient was diagnosed with G-CSF-producing locally advanced esophageal squamous cell carcinoma. The clinical diagnosis was T4; tumor invaded aorta, with regional lymph node metastases (N1). The patient underwent transthoracic esophagectomy with three-field lymph node dissection and gastric tube reconstruction following a radiation dose of 41.4 Gy with 5-fluorouracil continuous infusion as neoadjuvant therapy. There were no viable cancer cells in the resected esophageal specimen and lymph nodes. The patient had no evidence for typical risk factors for developing esophageal cancer. After the operation, neutrophils and G-CSF decreased to normal levels. The patient had recurrence of regional and distant multiple lymph node metastases at 3 months after operation.