Extremely elevated alpha-fetoprotein due to acute exacerbation of chronic hepatitis B without malignancy: a case report

Abstract

BackgroundAlpha-fetoprotein is produced by a variety of tumors such as hepatocellular carcinoma, hepatoblastoma, and germ cell tumors of the ovary and testes. However, we present a case of significantly elevated serum alpha-fetoprotein without evidence of malignant disease in a patient who is a carrier of chronic hepatitis B.Case presentationA 60-year-old Korean man presented with markedly increased alpha-fetoprotein (2350 ng/mL; normal <5 ng/mL). Various diagnostic evaluations, including computed tomography of the abdomen and thorax and ultrasonography of the abdomen and testes, showed liver cirrhosis and mild splenomegaly; however, no mass was detected in the liver, testes, or other organs scanned. The laboratory findings showed elevated liver function, positivity for hepatitis B e antigen, and a marked increase in hepatitis B virus deoxyribonucleic acid copy number (>7 × 105 IU/mL). Our patient was diagnosed with acute exacerbation of chronic hepatitis B, and we presumed that this condition might be related to extremely elevated alpha-fetoprotein. When our patient was treated with entecavir, the serum alpha-fetoprotein level immediately decreased, in parallel with the hepatitis B virus deoxyribonucleic acid copy number.ConclusionsWe report a rare case of extremely elevated alpha-fetoprotein due to acute exacerbation of chronic hepatitis B without any malignancy, and a decrease in this tumor marker simultaneous with a decrease in hepatitis B virus deoxyribonucleic acid copy number on entecavir treatment. This case report is important due to the rarity of the case; furthermore, it provides details of a diagnostic process for a variety of benign diseases and malignant tumors that should be considered in patients with elevated alpha-fetoprotein. Thus, we present a case report, along with a review, that will be helpful for diagnosis and treatment of patients with elevated alpha-fetoprotein.

Pure Testicular Seminoma with Non-Pathologic Elevation of Alpha Fetoprotein: A Case Series

“…The most common reason for non-malignant AFP elevation is hepatic disease, for example, various forms of hepatitis or cirrhosis and liver trauma [4,5] . Also, liver tissue damage induced by therapeutic measures, for example, radiotherapy [22] or chemotherapy was reported to cause unexpected elevations of serum AFP levels [23] .…”

Elevated a-Fetoprotein in the Absence of Carcinoma Caused by Relapse of Hepatitis C Viral Infection after Liver Transplantation

“…AFP-L3 exhibits the highest lectin affinity and is commonly seen in patients with HCCs. Some reports have described AFP elevation in the absence of HCC; however, in these cases the AFP levels were only around 2,000 ng/mL 7-10. Viral infections activate multiple proinflammatory mediators such as tumor necrosis factor α, malondialdehyde, and nitric oxide, which recruit immune cells to the liver to generate an antiviral response 11.…”

Factors influencing blood tumor marker concentrations in the absence of neoplasia

“…Although these increases are typically moderate (<100 ng/mL) [13], higher levels have also been observed in various benign conditions. Yoon et al reported a case of a patient with chronic acute hepatitis B with an AFP value of 2,350 ng/mL in whom the absence of tumor was confirmed [14]. In children and adolescents, elevated concentrations of AFP have been reported in hereditary tyrosinemia type I (values 140 times the URL) [15], in hereditary persistence of AFP (with values 10 times above the URL and reaching 1,000 ng/mL), in ataxia telangiectasia (with values between 20 or 30 times the URL and occasionally reaching 1,000 ng/mL, and rising slightly with age), in ataxia with oculomotor apraxia type II (with values not exceeding 60 ng/mL and not rising with age, in contrast to ataxia telangiectasia) and also modest increases in some cases of ataxia with oculomotor apraxia type I where marker values are usually within the normal range.…”