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A 79-year-old female was transferred to our department with suspected liver tumor. Laboratory examinations showed leukocytosis (9,530/μl) and high levels of serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and alpha-fetoprotein (AFP). Ultrasonography and computed tomography demonstrated a solitary tumor in the right lobe of the liver, and the gallbladder was not detected. A needle biopsy specimen of the liver tumor revealed moderately differentiated adenocarcinoma and we diagnosed suspected gallbladder carcinoma with liver infiltration. Fever of 37℃ to 38.5℃ persisted from 5 days after transfer and the leukocyte count in the peripheral blood increased to a maximum of 3.7 x 10^4 /μl during observation. The serum granulocyte colony-stimulating factor (G-CSF) level was high (122 pg/ml) and bone marrow aspiration showed hyperplasia of the mature neutrophils. There was no evidence of infection. Conservative therapy was given, and the patient died after 17 weeks. Immunohistochemically, the moderately differentiated adenocarcinoma cells at necropsy showed positive staining for CEA, and negative staining for AFP. These clinical findings indicated that the high level of G-CSF might have originated from the gallbladder carcinoma, though infection can not be ruled out as a possible cause.

The relationship between gallbladder stones (GBSs) and gallbladder carcinomas (GBCs) was studied in 991 patients with GBSs and 66 patients with GBCs who were operated upon in the Niigata University Hospital during a 20 years' period between 1969 and 1988. The frequency of GBCs in patients with GBSs was 3.4% in average, and become higher in accordance with patients' age. On the other hand, the incidence of GBSs in the entire GBC series was 53.0%. A higher incidence of GBCs associated with GBSs was found in patients with age over 70 than in the younger groups. Cholesterol stones were most frequent (71.1%) of all three types (bilirubinate : 18.4%, black stones : 10.5%) in the entire GBC series. A lower proportion of cholesterol stones was, however, demonstrated in patients older than 70, especially in the female. Regardless of types, GBSs themselves might play an important role in developement of GBCs in the older patients. In contrast, cholesterol stones in particular might participate in the occurence of GBCs in the younger patients.