Alpha-fetoprotein-producing rectal cancer successfully responded to preoperative chemoradiotherapy: case report

Nakamura, Yuki; Matsuda, Kenji; Yokoyama, Shozo; Tamura, Koichi; Mitani, Yasuyuki; Iwamoto, Hisao; Mizumoto, Yuki; Murakami, Daisuke; Fujimoto, Masakazu; Yamaue, Hiroki

doi:10.1186/s40792-018-0520-6

Cited by 15 publications

(11 citation statements)

References 22 publications

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“…Li et al presented three cases of AFP-producing CRC resistance to multiple drugs, including epidermal growth factor receptor inhibitors 17. It was promising that partial patients could benefit from preoperative chemoradiotherapy 16. Adjuvant chemotherapy might also help patients 14,41.…”

Section: Discussionmentioning

confidence: 99%

<p>Clinicopathological features and prognosis of AFP-producing colorectal cancer: a single-center analysis of 20 cases</p>

Ren

Weng

Zhang

et al. 2019

CMAR

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Background: High serum levels of alpha-fetoprotein (AFP) are observed in some gastrointestinal cancers. However, primary AFP-producing colorectal cancer (CRC) is extremely rare and causes confusion among clinicians. In this study, we analyzed the clinicopathological features and clinical outcomes of AFP-producing CRC and provide a brief view of this rare carcinoma. Patients and methods: Twenty patients with AFP-producing CRC were enrolled at the Fudan University Shanghai Cancer Center from 2012 to 2015. Clinical information, including serum AFP and CEA levels, and outcomes were collected. Tumors were divided into three histologic types: the common adenocarcinoma (COM) type, mucinous adenocarcinoma type and hepatoid type (HPT). Immunohistochemical (IHC) staining of GPC3, Hepa-1, SALL4 and Arg-1 was performed. Additionally, mutations of the KRAS, NRAS and BRAF genes were examined. Finally, another 40 stage-matched patients with traditional CRC were enrolled as controls for survival analysis. Results: AFP-producing CRC was more likely to occur in males (60%) and arose mainly from the ascending (40%) and sigmoid (35%) colon. In addition, the majority of patients with AFP-producing CRC had poor differentiation (50%), advanced local invasion (80%) and lymph node (LN) metastasis (60%). Synchronous distant metastasis was commonly observed (35%). Interestingly, serum AFP levels were closely associated with LN metastasis. Histopathologically, the COM type was the most common pattern. In IHC staining, the HPT pattern was the most distinct due to high positivity rates of GPC3, Hepa-1 and Arg-1. One patient had mismatch repair deficiency, and another had a KRAS mutation. Patients with AFP-producing CRC had worse progression-free and overall survival than patients with traditional CRC. Conclusion: AFP-producing CRC has unique clinical and histopathological characteristics, showing an aggressive biological behavior and worse prognosis than traditional CRC.

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Section: Discussionmentioning

confidence: 99%

<p>Clinicopathological features and prognosis of AFP-producing colorectal cancer: a single-center analysis of 20 cases</p>

Ren

Weng

Zhang

et al. 2019

CMAR

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“…Therefore, treatment regimens are employed according to multiple guidelines and personal experience. Most will undergo the conventional treatments for colorectal cancers which include surgery and chemotherapy with many dying within a year of initiating therapy [ 21 ]. Our patient is being evaluated for autologous stem cell transplant following disease progression on standard chemotherapy for conventional CRC and germ cell tumor.…”

Section: Discussionmentioning

confidence: 99%

Colorectal adenocarcinoma with enteroblastic differentiation: diagnostic challenges of a rare case encountered in clinical practice

Abada

Anaya

Abada³

et al. 2022

J Pathol Transl Med

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Colorectal adenocarcinoma with enteroblastic differentiation (CAED) is a rare subtype of colonic adenocarcinoma characterized by increased α-fetoprotein (AFP) production and the expression of at least one enteroblastic marker including AFP, glypican 3 (GPC3), or Spalt like transcription factor 4 (SALL4). We report a case of a 26-year-old female who presented with low back pain and constipation which persisted despite supportive measures. Imaging revealed multiple liver lesions and enlarged retroperitoneal nodes. Tumor markers including AFP were markedly elevated. On biopsy, samples from the liver revealed infiltrating glands lined by columnar-type epithelium with mostly eosinophilic granular to focally clear cytoplasm. By immunohistochemistry, the tumor showed immunoreactivity with AFP, hepatocyte antigen, GPC3, SALL4, CDX2, SATB2, and cytokeratin 20. A colonoscopy performed subsequently revealed a mass in the sigmoid colon and biopsy of this mass revealed a similar histology as that seen in the liver. A diagnosis of CAED was made, following the results of gene expression profiling by the tumor with next-generation sequencing which identified pathogenic variants in MU-TYH, TP53, and KDM6A genes and therefore supported its colonic origin. Cases such as this underscores the use of ancillary diagnostic techniques in arriving at the correct diagnosis in lesions with overlapping clinicopathologic characteristics.

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“…On the other hand, the amount of lymph node and liver metastases from AFP-producing colorectal cancer is as high as that from AFP-producing gastric cancer. Both AFP-producing colorectal cancer and AFP-producing gastric cancer have been reported to have poor prognoses, and chemotherapy has not been found to be effective for both cancers [9].…”

Section: A B C Discussionmentioning

confidence: 99%

Alpha-fetoprotein-producing Colon Carcinoma with Rapidly Increasing Liver Metastases That Resulted in Death: A Case Report

Karakuchi

Toyota

Kajikawa

et al. 2021

J Anus Rectum Colon

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Alpha-fetoprotein (AFP) has been widely used as a tumor marker for detecting hepatocellular carcinoma and yolk sac tumors. Recently, cases of gastrointestinal cancer with elevated serum AFP levels have been reported. However, AFP-producing colon cancer is considered rarer than other AFP-producing gastrointestinal cancers. In this study, we report on a case of a 47-year-old woman who was diagnosed with sigmoid colon cancer and underwent sigmoidectomy and lymph node dissection. Postoperative adjuvant chemotherapy (AC) was performed after the curative surgery. After the seventh course of AC, multiple liver masses and enlarged systemic lymph nodes were detected; these were later diagnosed as liver metastases from sigmoid colon cancer. Laboratory examination revealed high AFP levels (14,657.8 ng/mL). After confirming the recurrence, her condition worsened rapidly, and she eventually died 8 months after the operation. Autopsy and histopathological findings showed that the liver mass was positive for AFP staining, but the sigmoid colon cancer tissue was not. We then determined that liver metastases of the colon cancer were more likely than germ cell carcinoma according to the clinical course and pathological findings. We assumed that colon cancer cells can rapidly expand by dedifferentiation, and we diagnosed AFP-producing colon cancer with liver metastases. Despite curative surgery and AC for AFP-producing colon cancer, the patient died of liver and systemic lymph node metastases.

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Alpha-fetoprotein-producing rectal cancer successfully responded to preoperative chemoradiotherapy: case report

Cited by 15 publications

References 22 publications

<p>Clinicopathological features and prognosis of AFP-producing colorectal cancer: a single-center analysis of 20 cases</p>

<p>Clinicopathological features and prognosis of AFP-producing colorectal cancer: a single-center analysis of 20 cases</p>

Colorectal adenocarcinoma with enteroblastic differentiation: diagnostic challenges of a rare case encountered in clinical practice

Alpha-fetoprotein-producing Colon Carcinoma with Rapidly Increasing Liver Metastases That Resulted in Death: A Case Report

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