{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:19:29Z","timestamp":1764785969512,"version":"3.46.0"},"reference-count":65,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,6]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:p>\n                    This is a case of squamous cell cancer (SCC) of the lung masquerading as a haematologic malignancy with marked neutrophilia ultimately found to have a\n                    <jats:italic>ROS1<\/jats:italic>\n                    rearrangement in a non-smoker patient. The patient achieved a near complete response to therapy and prompt resolution of neutrophilia after being started on a c-ros oncogene 1 (ROS1)-targeted tyrosine kinase inhibitor. Profound neutrophilia can be a presenting sign of granulocyte colony-stimulating factor (G-CSF) secreting SCC of the lung. This is significant because G-CSF can potentially masquerade as alternative diagnoses, delaying appropriate treatment. Neutrophilia may also be a potential tool for disease monitoring in such cases. Furthermore, this case describes a rare presentation of a ROS1 alteration in SCC of the lung. This illustrates the importance of routine comprehensive genomic profiling in lung cancer patients regardless of histology and smoking status.\n                  <\/jats:p>","DOI":"10.1136\/bcr-2025-267778","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:15:20Z","timestamp":1764785720000},"page":"e267778","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Profound neutrophilia as the presenting sign of GCSF-secreting, ROS1-mutant squamous cell lung cancer"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-9598-9012","authenticated-orcid":false,"given":"Sahil","family":"Garg","sequence":"first","affiliation":[{"name":"Internal Medicine, Luminis Health Anne Arundel Medical Center, Annapolis, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amol","family":"Dua","sequence":"additional","affiliation":[{"name":"Internal Medicine, Luminis Health Anne Arundel Medical Center, Annapolis, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5859-6965","authenticated-orcid":false,"given":"Adam","family":"Rock","sequence":"additional","affiliation":[{"name":"Medical Oncology, City of Hope, Duarte, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"2025120310150996000_18.12.e267778.1","unstructured":"American Cancer Society . Facts & figures 2019. Available: https:\/\/www.cancer.org\/content\/dam\/cancer-org\/research\/cancer-facts-and-statistics\/annual-cancer-facts-and-figures\/2019\/cancer-facts-and-figures-2019.pdf [Accessed 13 Jun 2020]."},{"key":"2025120310150996000_18.12.e267778.2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21492"},{"key":"2025120310150996000_18.12.e267778.3","doi-asserted-by":"publisher","DOI":"10.2147\/clep.s17191"},{"key":"2025120310150996000_18.12.e267778.4","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01626"},{"key":"2025120310150996000_18.12.e267778.5","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.35.6345"},{"key":"2025120310150996000_18.12.e267778.6","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz131"},{"key":"2025120310150996000_18.12.e267778.7","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1182\/blood.V49.5.845.845","article-title":"Demonstration of granulopoietic factor(s) in the plasma of nude mice transplanted with a human lung cancer and in the tumor tissue","volume":"49","author":"Asano","year":"1977","journal-title":"Blood"},{"key":"2025120310150996000_18.12.e267778.8","doi-asserted-by":"crossref","first-page":"576","DOI":"10.5795\/jjscc.35.576","article-title":"A case of pleomorphic renal cell carcinoma producing G-CSF","volume":"35","author":"Takahashi","year":"1996","journal-title":"J Jpn Soc Clin Cytol"},{"key":"2025120310150996000_18.12.e267778.9","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2004.024646"},{"key":"2025120310150996000_18.12.e267778.10","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s13691-018-0330-5","article-title":"Granulocyte-colony-stimulating factor-producing metaplastic carcinoma of the breast with significant elevation of serum interleukin-17 and vascular endothelial growth factor levels","volume":"7","author":"Fukui","year":"2018","journal-title":"Int Canc Conf J"},{"key":"2025120310150996000_18.12.e267778.11","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s00595-005-3100-x","article-title":"Anaplastic Thyroid Carcinoma Associated with Granulocyte Colony-Stimulating Factor: Report of a Case","volume":"36","author":"Fujita","year":"2005","journal-title":"Surg Today"},{"key":"2025120310150996000_18.12.e267778.12","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.35.815"},{"key":"2025120310150996000_18.12.e267778.13","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.34.584"},{"key":"2025120310150996000_18.12.e267778.14","doi-asserted-by":"crossref","unstructured":"Kitade H , Yanagida H , Yamada M , et al . Granulocyte-colony stimulating factor producing anaplastic carcinoma of the pancreas treated by distal pancreatectomy and chemotherapy: report of a case. surg case rep 2015;1. doi:10.1186\/s40792-015-0048-y","DOI":"10.1186\/s40792-015-0048-y"},{"key":"2025120310150996000_18.12.e267778.15","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/BF02805227","article-title":"Granulocyte-colony stimulating factor produced by pancreatic carcinoma","volume":"19","author":"Uematsu","year":"1996","journal-title":"Int J Pancreatol"},{"key":"2025120310150996000_18.12.e267778.16","doi-asserted-by":"publisher","DOI":"10.21873\/anticanres.11310"},{"key":"2025120310150996000_18.12.e267778.17","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1016\/S0022-5347(17)36229-8","article-title":"Bladder carcinoma producing granulocyte colony-stimulating factor: a case report","volume":"149","author":"Satoh","year":"1993","journal-title":"J Urol"},{"key":"2025120310150996000_18.12.e267778.18","doi-asserted-by":"crossref","unstructured":"Sato N , Asano S , Ueyama Y , et al . Granulocytosis and colony-stimulating activity (CSA) produced by a human squamous cell carcinoma. Cancer 1979;605\u201310. doi:10.1002\/1097-0142(197902)43:23.0.CO;2-P","DOI":"10.1002\/1097-0142(197902)43:2<605::AID-CNCR2820430230>3.0.CO;2-P"},{"key":"2025120310150996000_18.12.e267778.19","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-012-0202-0"},{"key":"2025120310150996000_18.12.e267778.20","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2013.822"},{"key":"2025120310150996000_18.12.e267778.21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2007.01468.x"},{"key":"2025120310150996000_18.12.e267778.22","doi-asserted-by":"crossref","unstructured":"Mouchemore KA , Anderson RL , Hamilton JA . Neutrophils, G-CSF and their contribution to breast cancer metastasis. FEBS J 2018;285. doi:10.1111\/febs.14206","DOI":"10.1111\/febs.14206"},{"key":"2025120310150996000_18.12.e267778.23","doi-asserted-by":"crossref","DOI":"10.1080\/2162402X.2015.1115177","article-title":"G-CSF regulates macrophage phenotype and associates with poor overall survival in human triple-negative breast cancer","volume":"5","author":"Hollm\u00e9n","year":"2016","journal-title":"Oncoimmunology"},{"key":"2025120310150996000_18.12.e267778.24","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1159\/000502174","article-title":"Granulocyte Colony-Stimulating Factor-Producing Bladder Cancer","volume":"12","author":"Morinaga","year":"2019","journal-title":"Case Rep Oncol"},{"key":"2025120310150996000_18.12.e267778.25","first-page":"57","article-title":"Two cases of bladder tumor producing granulocyte colony stimulating factor","volume":"45","author":"Ito","year":"1999","journal-title":"Hinyokika Kiyo"},{"key":"2025120310150996000_18.12.e267778.26","first-page":"113","article-title":"G-CSF production in human bladder cancer and its ability to promote autocrine growth: a review","volume":"4","author":"Tachibana","year":"1998","journal-title":"Cytokines Cell Mol Ther"},{"key":"2025120310150996000_18.12.e267778.27","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1046\/j.1525-1438.2000.99076.x","article-title":"G-CSF receptor expression in ovarian cancer","volume":"10","author":"Ninci","year":"2000","journal-title":"Int J Gynecol Cancer"},{"key":"2025120310150996000_18.12.e267778.28","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1827.2008.02285.x"},{"key":"2025120310150996000_18.12.e267778.29","doi-asserted-by":"crossref","unstructured":"Kasuga I , Makino S , Kiyokawa H , et al . Tumor-related leukocytosis is linked with poor prognosis in patients with lung carcinoma. Cancer 2001;2399\u2013405. doi:10.1002\/1097-0142(20011101)92:93.0.CO;2-W","DOI":"10.1002\/1097-0142(20011101)92:9<2399::AID-CNCR1588>3.0.CO;2-W"},{"key":"2025120310150996000_18.12.e267778.30","first-page":"34","article-title":"Simultaneous production of parathyroid hormone-related protein (PTHrP) and granulocyte colony-stimulating factor (G-CSF) in lung cancer patients with hypercalcemia and leukocytosis","volume":"33","author":"Sakamoto","year":"1995","journal-title":"Nihon Kyobu Shikkan Gakkai Zasshi"},{"key":"2025120310150996000_18.12.e267778.31","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-011-0043-2"},{"key":"2025120310150996000_18.12.e267778.32","first-page":"1541","article-title":"Granulocyte colony-stimulating factor expression as a prognostic biomarker in non-small cell lung cancer","volume":"25","author":"Stathopoulos","year":"2011","journal-title":"Oncol Rep"},{"key":"2025120310150996000_18.12.e267778.33","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-12-2940"},{"key":"2025120310150996000_18.12.e267778.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2011.02.021"},{"key":"2025120310150996000_18.12.e267778.35","doi-asserted-by":"crossref","DOI":"10.1186\/s12885-022-10065-w","article-title":"Programmed cell death ligand 1 measurement study in granulocyte colony-stimulating factor-producing lung cancer: an observational study","volume":"22","author":"Miyazaki","year":"2022","journal-title":"BMC Cancer"},{"key":"2025120310150996000_18.12.e267778.36","doi-asserted-by":"crossref","first-page":"3305","DOI":"10.2169\/internalmedicine.2819-19","article-title":"Granulocyte Colony-stimulating Factor- and Interleukin-6-producing Large-cell Carcinoma of the Lung with Sarcomatoid Changes Suggestive of Epithelial-mesenchymal Transition: An Autopsy Case Report","volume":"58","author":"Yoshida","year":"2019","journal-title":"Intern Med"},{"key":"2025120310150996000_18.12.e267778.37","first-page":"7067","article-title":"Current state and future opportunities in granulocyte colony-stimulating factor (G-CSF)","volume":"30","author":"Link","year":"2022","journal-title":"Support Care Cancer"},{"key":"2025120310150996000_18.12.e267778.38","doi-asserted-by":"crossref","first-page":"e21","DOI":"10.1016\/j.cllc.2019.09.001","article-title":"Multiclonality and Radiosensitivity of Granulocyte-colony Stimulating Factor-Producing Lung Adenocarcinoma Positive for an Activating EGFR Mutation","volume":"21","author":"Tsutsumi","year":"2020","journal-title":"Clin Lung Cancer"},{"key":"2025120310150996000_18.12.e267778.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.cllc.2018.03.014"},{"key":"2025120310150996000_18.12.e267778.40","article-title":"A case of granulocyte colony-stimulating factor producing lung adenocarcinoma with anaplastic lymphoma kinase gene rearrangements","volume":"46","author":"Choi","year":"2023","journal-title":"Respir Med Case Rep"},{"key":"2025120310150996000_18.12.e267778.41","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1159\/000508439","article-title":"Aggressive Recurrent Pancreatic Cancer Producing Granulocyte Colony-Stimulating Factor","volume":"14","author":"Morita","year":"2020","journal-title":"Case Rep Gastroenterol"},{"key":"2025120310150996000_18.12.e267778.42","doi-asserted-by":"publisher","DOI":"10.1038\/nrc2190"},{"key":"2025120310150996000_18.12.e267778.43","first-page":"01","volume-title":"Lung cancer in never smokers. seminars in respiratory and critical care medicine","volume":"32","author":"Yang","year":"2011"},{"key":"2025120310150996000_18.12.e267778.44","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.06.8015"},{"key":"2025120310150996000_18.12.e267778.45","doi-asserted-by":"publisher","DOI":"10.1007\/s10147-010-0160-8"},{"key":"2025120310150996000_18.12.e267778.46","doi-asserted-by":"crossref","DOI":"10.1080\/2162402X.2018.1494677","article-title":"Smoker and non-smoker lung adenocarcinoma is characterized by distinct tumor immune microenvironments","volume":"7","author":"Li","year":"2018","journal-title":"Oncoimmunology"},{"key":"2025120310150996000_18.12.e267778.47","doi-asserted-by":"crossref","first-page":"450","DOI":"10.21037\/tlcr.2018.05.14","article-title":"Lung cancer in never smokers-the East Asian experience","volume":"7","author":"Zhou","year":"2018","journal-title":"Transl Lung Cancer Res"},{"key":"2025120310150996000_18.12.e267778.48","doi-asserted-by":"crossref","first-page":"3069","DOI":"10.1002\/cncr.29531","article-title":"Differences in driver genes between smoking-related and non-smoking-related lung cancer in the Chinese population","volume":"121 Suppl 17","author":"Gou","year":"2015","journal-title":"Cancer"},{"key":"2025120310150996000_18.12.e267778.49","doi-asserted-by":"publisher","DOI":"10.1080\/15384047.2017.1323580"},{"key":"2025120310150996000_18.12.e267778.50","doi-asserted-by":"crossref","first-page":"e286","DOI":"10.1016\/j.cllc.2024.04.013","article-title":"Brief Report on Global Clinician Practices in the First-Line Management of Metastatic Non-Small Cell Lung Cancer","volume":"25","author":"Sridhar","year":"2024","journal-title":"Clin Lung Cancer"},{"key":"2025120310150996000_18.12.e267778.51","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1177\/0141076819843654","article-title":"Lung cancer in never-smokers: a hidden disease","volume":"112","author":"Bhopal","year":"2019","journal-title":"J R Soc Med"},{"key":"2025120310150996000_18.12.e267778.52","doi-asserted-by":"crossref","first-page":"35979","DOI":"10.18632\/oncotarget.8745","article-title":"Clinical and genetic features of lung squamous cell cancer in never-smokers","volume":"7","author":"Huang","year":"2016","journal-title":"Oncotarget"},{"key":"2025120310150996000_18.12.e267778.53","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.22413"},{"key":"2025120310150996000_18.12.e267778.54","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/1759-7714.12899","article-title":"Prevalence of ROS1 fusion in Chinese patients with non\u2010small cell lung cancer","volume":"10","author":"Zhang","year":"2019","journal-title":"Thorac Cancer"},{"key":"2025120310150996000_18.12.e267778.55","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdt071"},{"key":"2025120310150996000_18.12.e267778.56","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0124354","article-title":"The Frequency and Clinical Implication of ROS1 and RET Rearrangements in Resected Stage IIIA-N2 Non-Small Cell Lung Cancer Patients","volume":"10","author":"Fu","year":"2015","journal-title":"PLoS ONE"},{"key":"2025120310150996000_18.12.e267778.57","first-page":"300","article-title":"Clinicopathologic characteristics of patients with ROS1 fusion gene in non-small cell lung cancer: a meta-analysis","volume":"4","author":"Zhu","year":"2015","journal-title":"Transl Lung Cancer Res"},{"key":"2025120310150996000_18.12.e267778.58","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-020-0408-9"},{"key":"2025120310150996000_18.12.e267778.59","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1016\/j.jtho.2018.07.001","article-title":"The Incidence of Brain Metastases in Stage IV ROS1-Rearranged Non-Small Cell Lung Cancer and Rate of Central Nervous System Progression on Crizotinib","volume":"13","author":"Patil","year":"2018","journal-title":"J Thorac Oncol"},{"key":"2025120310150996000_18.12.e267778.60","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/j.jtho.2018.05.026","article-title":"Characteristics and Outcome of ROS1-Positive Non-Small Cell Lung Cancer Patients in Routine Clinical Practice","volume":"13","author":"Park","year":"2018","journal-title":"J Thorac Oncol"},{"key":"2025120310150996000_18.12.e267778.61","doi-asserted-by":"publisher","DOI":"10.1111\/his.12379"},{"key":"2025120310150996000_18.12.e267778.62","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol29020057"},{"key":"2025120310150996000_18.12.e267778.63","doi-asserted-by":"crossref","first-page":"1238093","DOI":"10.3389\/fmolb.2023.1238093","article-title":"Progress of non-small-cell lung cancer with ROS1 rearrangement","volume":"10","author":"Yang","year":"2023","journal-title":"Front Mol Biosci"},{"key":"2025120310150996000_18.12.e267778.64","doi-asserted-by":"crossref","first-page":"365","DOI":"10.4236\/jct.2020.116031","article-title":"ROS1 in Squamous Non-Small Cell Lung Cancer\u2014Combined Immunotherapy (PD1\/CTLA4) or Targeted Therapy?","volume":"11","author":"Yakobson","year":"2020","journal-title":"JCT"},{"key":"2025120310150996000_18.12.e267778.65","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1007\/s10388-013-0387-3","article-title":"Granulocyte colony-stimulating factor-producing esophageal squamous cell carcinoma following chemoradiotherapy and bone marrow transplantation for acute lymphoblastic leukemia","volume":"10","author":"Mayanagi","year":"2013","journal-title":"Esophagus"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-267778","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T18:15:25Z","timestamp":1764785725000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-267778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":65,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,3]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bcr-2025-267778"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-267778","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}