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An autopsy case of alpha-fetoprotein-producing large duodenal adenocarcinoma

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Abstract

We report an autopsy case of a large duodenal adenocarcinoma that produced alpha-fetoprotein (AFP). The patient was a man in his 70s with diabetes mellitus. He presented with epigastralgia and was referred to our hospital. Upper gastrointestinal endoscopy and abdominal computed tomography revealed a large tumor of 11 cm in diameter in the descending limb of the duodenum. A tumor biopsy showed poorly differentiated adenocarcinoma. Although his carcinoembryonic antigen (CEA) and carbohydrate antigen 19–9 (CA19-9) levels were within the normal range, his AFP levels were significantly elevated (42,078.4 ng/mL). Due to vascular invasion, curative resection was not feasible, and chemotherapy was chosen as the treatment option. After gastrojejunostomy was performed to enable oral intake, one cycle of modified leucovorin/5-fluorouracil/oxaliplatin (mFOLFOX6) therapy was administered. However, it proved ineffective, and the patient's anorexia gradually worsened. Ultimately, he succumbed to the progression of cancer cachexia. Autopsy findings revealed a 14-cm-long duodenal carcinoma primarily located in the duodenal bulb, with direct invasion into the stomach, pancreas, and liver. A pathological examination confirmed a diagnosis of poorly differentiated adenocarcinoma with AFP production. Duodenal cancer is rare, and AFP-producing duodenal cancer is even rarer, with only 21 reported cases, including our own. We present this autopsy case of AFP-producing duodenal adenocarcinoma and review the cases reported in the relevant literature.

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Authors and Affiliations

  1. Department of Gastroenterology, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan

    Sumire Hirota, Atsushi Naganuma, Rintaro Kobayashi, Yuhei Suzuki, Takashi Hoshino, Hidetoshi Yasuoka & Satoru Kakizaki

  2. Department of Pathology, National Hospital Organization Takasaki General Medical Center, Takasaki, Gunma, 370-0829, Japan

    Yuko Tanaka

  3. Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan

    Toshio Uraoka

  4. Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-Cho, Takasaki, Gunma, 370-0829, Japan

    Satoru Kakizaki

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  1. Sumire Hirota
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Correspondence to Satoru Kakizaki.

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The authors declare no conflicts of interest in association with the present study.

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All procedures followed were performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Hirota, S., Naganuma, A., Kobayashi, R. et al. An autopsy case of alpha-fetoprotein-producing large duodenal adenocarcinoma. Clin J Gastroenterol 16, 829–835 (2023). https://doi.org/10.1007/s12328-023-01843-5

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  • DOI: https://doi.org/10.1007/s12328-023-01843-5

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