PMC8278444_01
Computed tomography scan of case 1 before surgery showed a left upper renal tumor (A) and gross picture of the renal tumor (B), tumor metastasis in the pelvis after primary tumor resection (C) and the computed tomography scan image of the bladder tumor in case 2 (D) were also shown.
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Sonography and computed tomography (CT) scans showed a 5-cm left upper renal mass (Figure 1A). Further CT scans showed widely disseminated tumors in the abdominal cavity, pelvis, para-aortic lymph nodes, and lungs (Figure 1B).
In case 1, the patient underwent major surgery on August 4 with PLR found 5 weeks later; peak white cell count was 191.8 x 103/microL. This patient died due to rapid tumor progression.
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Her WBC count increased to a peak of 191.8 x 103/microL within 10 days before the date of death (Figure 2).
In case 1 (A), the primary tumor was diagnosed as HGUC (Hematoxylin and Eosin stain 200x), (B) negative G-CSFR expression in the primary tumor (IHC 200x), (C and D) expression of G-CSF and G-CSFR in the metastatic tumor (IHC 200x).
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Immunohistochemistry (IHC) showed that granulocyte colony-stimulating factor (G-CSF) was weakly expressed in the primary tumor and that G-CSF receptor (G-CSFR) expression was demonstrated in the metastatic tumor (Figure 3).
PMC8278444_02
In case 2 (A), the urinary bladder tumor was diagnosed as HGUC with squamous metaplasia (Hematoxylin and Eosin stain 200x), (B) tumor seen in the first surgery exhibited G-CSFR expression (IHC 200x), (C and D) tumor removed by cystoprostatectomy showed G-CSF and G-CSFR expression (IHC 200x).
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Grossly, the urinary bladder during cystoprostatectomy contained a 7.5 x 4.7 cm tumor invading the prostate, and a pathologic diagnosis of HGUC with focal squamous differentiation was made (Figure 4A). Additional IHC for G-CSF and G-CSFR was positive (Figure 4B-D).