Alpha-fetoprotein-producing esophageal adenocarcinoma: a mimicker of hepatocellular carcinoma

Abstract

Alpha-fetoprotein (AFP)-producing esophageal adenocarcinoma (EAC) is a rare occurrence. Elevation of serum AFP is commonly associated with hepatocellular carcinoma and yolk sac tumors, but rarely with esophageal carcinoma. Here, we report a rare case of AFP-producing EAC. A 51-year-old man presented with two weeks of acid reflux and a 35-lb weight loss. Laboratory data were notable for transaminitis and AFP was 2524 ng/mL. Computed tomography of the abdomen revealed abnormal thickening of the esophagus and multiple metastatic masses throughout the liver. Biopsy of one of the masses revealed adenocarcinoma of gastrointestinal origin. Subsequent upper endoscopy revealed an esophageal mass with biopsy notable for ulcerated dysplastic glandular mucosa with likely underlying malignancy. The patient underwent palliative esophageal stent placement but died two months later. Elevated AFP levels are an unusual occurrence in EAC. Prognosis is poor given its advanced presenting stage and high metastatic potential. Most cases are unsuccessfully treated with surgery and chemotherapy. Serial measurement of serum AFP may be useful for monitoring clinical status and treatment response. Clinicians should consider AFP-producing EAC in their differential diagnosis in the work-up of a liver mass in the setting of elevated AFP or liver function impairment, especially in the absence of chronic liver disease.

Multimodality Therapy Including Proton Beam Therapy for AFP Producing Esophageal Cancer with Multiple Liver Metastases

“…4 ). Some other reports have reported a relationship to exist between the serum AFP level and tumor progression or the treatment effect ( 5 , 13 , 19 ).…”

“…AFP producing gastric cancer has been reported to have a poor prognosis and high liver metastatic potential in many studies. To our knowledge, there have only been 17 reports about AFP producing esophageal cancer ( 5 , 12 - 28 ). Most cases described in these reports were advanced cases with liver metastasis.…”

“…Tissues may regain the ability to produce AFP if they undergo malignant transformation AFP-producing gastric cancer represents 1-6 per cent of all gastric cancers ( 3 ), and it is associated with a poor prognosis because of high rates of liver and lymph node metastasis ( 4 ). AFP-producing esophageal adenocarcinoma is a rare occurrence ( 5 ). To our knowledge, our case is only the 17th case of AFP-producing esophageal adenocarcinoma to be reported in the literature.…”

An Extremely Rare Presentation of an Alpha-Fetoprotein-Producing Esophageal Adenocarcinoma

“…AFP is a glycoprotein that is normally produced by the fetal liver and yolk sac and production begins at the sixth week of gestation. AFP levels normalize to 10–15 ng/mL (normal <12 ng/mL) within the first year of infancy [1]. Elevated AFP level is a tumor marker that signals malignant transformations; however, elevated AFP levels are rarely associated with EACs.…”

“…Serial measurement of serum AFP has been shown to be useful for monitoring clinical status and treatment response. Clinicians should consider AFP-producing EAC in their differential diagnosis when working up a liver mass in the setting of liver dysfunction or an elevated AFP level, especially in the absence of chronic liver disease [1].…”