Alpha‐fetoprotein and focal nodular hyperplasia: An unconventional couple

Carrier, Paul; Guyot, Anne; Debette-Gratien, Marilyne; Fredon, Fabien; Teissier, M.P.; Labrousse, François; Loustaud‐Ratti, Véronique

doi:10.1002/jgh3.12669

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…In the aforementioned article, Wojtulewicz et al reported the case of a child undergoing partial ileal resection due to necrotizing enterocolitis who reached a minimum AFP value of 1,079,367 ng/mL 37 days post-surgery, and a maximum of 1,646,028 ng/mL 49 days post-surgery. AFP increases have also been reported in a patient with gynecomastia and nodular focal hyperplasia (with values up to six times above the URL) [17]; in hepatic mesenchymal hamartomas [18]; and in systemic lupus erythematosus, Hirschsprung's disease and Beckwith-Wiedemann syndrome [19]. Substantial increases were reported in a patient with peritoneal tuberculosis [20].…”

Section: S39mentioning

confidence: 88%

Factors influencing blood tumor marker concentrations in the absence of neoplasia

Trapé,

Fernández-Galán,

Auge

et al. 2024

TUB

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BACKGROUND: Tumor markers (TMs) are a heterogeneous group of molecules used in the diagnosis, prognosis and follow-up of cancer patients. During neoplastic differentiation, cells can either directly synthesize or induce the synthesis of TMs, and the release of these molecules into the bloodstream allows their quantification in biological fluids. Although very small concentrations of TMs are usually present in the serum or plasma of healthy subjects, increased concentrations may also be found in the presence of benign diseases or due to technical interference, producing false positive results. MATERIAL AND METHODS AND RESULTS: Our review analyses the causes of false positives described between January 1970 to February 2023 for the TMs most frequently used in clinical practice: α-fetoprotein (AFP), β2-microglobulin (β2-M), cancer antigen 15-3 (CA 15-3), cancer antigen CA 19-9 (CA 19-9), cancer antigen CA 72-4 (CA 72-4), cancer antigen 125 (CA 125), carcinoembryonic antigen (CEA), chromogranin A (CgA), choriogonadotropin (hCG), cytokeratin 19 fragment (CYFRA 21-1), neuron-specific enolase (NSE), human epididymis protein 4 (HE4), serum HER2 (sHER2), squamous cell carcinoma antigen (SCCA), protein induced by vitamin K absence-II (PIVKA-II), Pro-gastrin-releasing peptide (Pro-GRP), prostate-specific antigen (PSA), Protein S-100 (S-100) and thyroglobulin (Tg). A total of 247 references were included. CONCLUSIONS: A better understanding of pathophysiological processes and other conditions that affect the concentration of TMs might improve the interpretation of results and their clinical application.

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Section: S39mentioning

confidence: 88%

Factors influencing blood tumor marker concentrations in the absence of neoplasia

Trapé,

Fernández-Galán,

Auge

et al. 2024

TUB

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“…[22] AFP is typically not elevated in a FNH but some rare cases with elevated AFP in FNH have been reported in a range of 40 -60 ng/ml. [23,24] One assumes that in these cases AFP expression is caused by a regenerative process due to features of progenitor cells within the FNH or even in the non-lesional adjacent liver. [25] Measurement of AFP levels in every newly diagnosed liver lesion is highly recommended.…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia

Gröger

2024

JCSR

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Focal nodular hyperplasia (FNH) is a common benign liver lesion, mostly solitary, and with no evidence of malignant transformation over time. The diagnosis can usually be made by imaging modalities with distinct features in magnetic resonance imaging (MRI) and computed tomography (CT) scans. We present a case series of three patients with solitary liver tumors which were, based on radiological features, first diagnosed to be large FNH. The patients were sent to our center for second opinion and probable treatment. Indication for resection was given because of nonconclusive radiologic imaging in the first, substantial growth progression in the second and elevated alpha fetoprotein (AFP) in the third case. Histology revealed well to poor differentiated hepatocellular carcinoma (HCC). FNH tends to show a distinct pattern in imaging modalities, but HCC can mimic FNH. The MRI-scan using hepatotropic contrast agent is the most sensitive imaging modality to diagnose FNH. AFP is usually not elevated in FNH. Asymptomatic FNH does not require surgery but a reliable diagnosis is crucial. In case of an un-certain diagnosis surgery should be offered to patients. In cases with a progression in size, an elevated level of AFP should be suspicious. Generally, an over-therapy via surgery should be avoided and follow-ups of a newly diagnosed FNH including measurement of AFP are advisable to detect alterations.

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“…AFP can be increased slightly (up to 100 ng/ml) in liver cirrhosis and in chronic hepatitis as well [19], but also in pregnancy or teratoma [20]. AFP is typically not elevated in a FNH but some rare cases with elevated AFP in FNH have been reported in a range of 40-60 ng/ml [21,22]. One assumes that in these cases AFP expression is caused by a regenerative process due to features of progenitor cells within the FNH or even in the non-lesional adjacent liver [23].…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia

Gröger,

Hahn,

Straub

et al. 2023

Preprint

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Backround: FNH is a common benign liver lesion, mostly solitary, and with no evidence of malignant transformation over time. The diagnosis can usually be made by imaging modalities with distinct features in MRI- and CT-scans. Case series: We present a case series of three patients with solitary liver tumors which were highly suspicious to be large FNH, based on radiological features. The patients were sent to our center for second opinion and probable treatment. Indication for resection was given because of nonconclusive radiologic imaging in the first, substantial growth progression in the second and elevated AFP in the third case. Histology revealed well to poor differentiated HCCs. Discussion: FNH tends to show a distinct pattern in imaging modalities, but HCC can mimic FNH. The MRI-scan using hepatotropic contrast agent is the most sensitive imaging modality to diagnose FNH. AFP is usually not elevated in FNH. Asymptomatic FNH does not require surgery but a reliable diagnosis is crucial. In case of an uncertain diagnosis surgery should be offered to patients. Conclusion: In cases with a progression in size, an elevated level of AFP should be suspicious. A second opinion at a center for hepato-biliary surgery with HCC/FNH-experienced radiologists and surgeons is reasonable. Generally, an over-therapy via surgery should be avoided and follow-ups of a newly diagnosed FNH including measurement of AFP are advisable to detect alterations.

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Alpha‐fetoprotein and focal nodular hyperplasia: An unconventional couple

Cited by 3 publications

References 7 publications

Factors influencing blood tumor marker concentrations in the absence of neoplasia

Factors influencing blood tumor marker concentrations in the absence of neoplasia

Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia

Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia

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