Hepatocellular carcinoma (HCC) is well known for its aggressive nature and high recurrence rates. Alpha- fetoprotein (AFP) secreting tumors are more common in HCC. However, a few proportion of HCC do not produce AFP more than the basal level. AFP secreting tumors are more aggressive in nature since the ability of AFP to promote effective progression, growth, and metastasis of tumor. AFP also intervenes the immune system to evade the immune responses against cancer cells. AFP-producing tumors contain poorly differentiated cells similar to embryonic stem cells of liver mimicking rapid replication, proliferation, and AFP secretion by fetal liver. In this review, we highlight the crucial roles of AFP in immune evasion, aggressiveness, progression, and tumor biology of HCC.

Introduction: Primary extranodal lymphomas (pENL) are a group of lymphomas arising from tissues other than lymph nodes and are a highly heterogenous group of lymphoproliferative disorders. The incidence of pENL is increasing and is probably due to improved diagnostics. This study was undertaken to ascertain the clinical and pathological characteristics of extranodal non-Hodgkin lymphoma from a tertiary care hospital. Materials and Methods: This was a retrospective study of histologically proven Non Hodgkin lymphoma patients, conducted during the period January 2015 to December 2017 in the Department of Medical Oncology, Omega Hospitals, Hyderabad, India. Detailed clinical history, laboratory reports, imaging and histopathological reports were obtained from the medical records. All cases were classified based on morphologic and immunophenotypic criteria according to World Health Organization 2008 classification. Results: Primary extranodal non Hodgkin lymphoma constituted 32.2% (38/118) of all Non Hodgkin lymphomas. The mean age of presentation was 47.2 years. Majority (68.4%) had Stage I & II disease. The most common site of extranodal lymphoma was the Gastro intestinal tract (36.8%) followed by Head and neck region (26.3%). The most common histopathological type was Diffuse large B-cell lymphoma (DLBCL) (47.4%). Conclusion: The study showed that the primary extra nodal Non hodgkin lymphomas constituted almost 1/3 rd of all NHLs & is comparable to data from other parts of India. Hence NHL must be strongly suspected in patients with extranodal disease and an appropriate pathological and immunophenotypic evidence will clinch the diagnosis.

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