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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.

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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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