Persistently elevated alpha-fetoprotein associated with chronic hepatitis B during chemotherapy for malignant ovarian germ cell tumors: a case series and a review of the literature

Abstract

Background: Alpha-fetoprotein (AFP) plays a crucial role in the management of malignant ovarian germ cell tumors (MOGCTs) and is an important reference index for chemotherapy termination. However, a high level of AFP can also be caused by several benign diseases, causing confusion and impacting treatment decisions. Case presentation: We described four patients who were diagnosed with MOGCTs; the histologic subtype in two of them was mixed MOGCTs (yolk sac tumor with mature teratoma), while the rest was immature teratoma. The serum AFP level of each patient was abnormal before surgery, but it was still persistently elevated around 300 ng/ ml even after additional cycles of chemotherapy. All patients were thoroughly evaluated, but we did not find any evidence of disease progression or residual tumors. Liver function tests were normal, whereas serum assays revealed positive of hepatitis B surface antigen, and two patients had a high level of HBV-DNA. They were chronic carriers of hepatitis B virus and never received relevant treatments. Then they were managed with tumor surveillance and the antiviral treatment. Thereafter, the AFP levels presented a slowly decreasing trend. Conclusions: False elevation of AFP in MOGCTs is a rare condition and should be assessed with a comprehensive evaluation to avoid unnecessary treatments.

Targeted whole exome sequencing and Drosophila modelling to unveil the molecular basis of primary ovarian insufficiency

“…2C and Supplementary Table SIV ). AFP encodes alpha fetoprotein, a plasma protein mainly expressed during foetal life in the yolk sack and liver, and high levels of AFP are present in pregnant women to stop follicular growth ( Zong et al , 2019 ). Concerning DMRT3 , double sex and mab-3-related transcription factor 3, its involvement in sexual development is known, but there is scarce knowledge of its specific role in the ovary, whereas MOV10 gene, encoding an RNA helicase phosphorylated after DNA damage, exerts a role in RNA stability and regulation of the network of mammalian germ cells ( Fu et al , 2019 ).…”

A large yolk sac malignancy in a girl, an uncommon yet challenging ovarian tumor: A case report

“…14 Though extremely sensitive but not tumor-specific, 15 elevation of AFP is prognostically important and is an important index for stopping chemotherapy in YST. 16 It is a glycoprotein that is normally produced during gestation by the fetal liver and yolk sac. It has been reported that the lowering level of post-operative serum AFP could be a useful marker for determining if residual cancer cells still exist after surgery.…”

“…Though extremely sensitive but not tumor‐specific, 15 elevation of AFP is prognostically important and is an important index for stopping chemotherapy in YST 16 . It is a glycoprotein that is normally produced during gestation by the fetal liver and yolk sac.…”

Self‐Healing Electronics for Prognostic Monitoring of Methylated Circulating Tumor DNAs

“…[2] Particularly, wearable electronics have evolved from simple recording of heart rate and body movements to physiological monitoring of glucose, Na + , K + , Ca 2+ , and pH, [3][4][5][6] as well as other more advanced biomarkers in different body fluids, including sweat, [7] tears, [8] saliva, [9] and interstitial fluid, [10,11] and has greatly expanded the clinician's arsenal for early disease detection.Many current tumor biomarkers are proteins or metabolites that are abundant in cancer cells and are released into the circulatory system. [12,13] Clinically, some are used to identify cancers primarily originating from different organ systems, such as α-fetoprotein for liver cancer and germ cell tumors, [14] ß-2-microglobulin for chronic lymphocytic leukemia, [15] calcitonin for medullary thyroid cancer, [16] and prostate-specific antigen for prostate cancer. [17] Despite the wide use of these biomarkers for cancer diagnostics, these protein-based tumor markers are typically detectable at the late stages of cancer progression, [18] when the efficacy of many cancer treatments is substantially compromised.…”

“…Many current tumor biomarkers are proteins or metabolites that are abundant in cancer cells and are released into the circulatory system. [12,13] Clinically, some are used to identify cancers primarily originating from different organ systems, such as α-fetoprotein for liver cancer and germ cell tumors, [14] ß-2-microglobulin for chronic lymphocytic leukemia, [15] calcitonin for medullary thyroid cancer, [16] and prostate-specific antigen for prostate cancer. [17] Despite the wide use of these biomarkers for cancer diagnostics, these protein-based tumor markers are typically detectable at the late stages of cancer progression, [18] when the efficacy of many cancer treatments is substantially compromised.…”