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

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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.

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106, USA

    Jeremy Wang, Wendy Liu & Anthony Benjamin Post

  2. Department of Pathology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA

    Wendy Liu

  3. Department of Gastroenterology and Hepatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA

    Keyur Parikh & Anthony Benjamin Post

Authors
  1. Jeremy Wang
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  2. Wendy Liu
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  3. Keyur Parikh
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  4. Anthony Benjamin Post
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Corresponding author

Correspondence to Jeremy Wang.

Ethics declarations

Conflict of Interest:

Jeremy Wang, Wendy Liu, and Keyur Parikh declare that they have no conflict of interest. Anthony B. Post serves on the speakers’ bureau and advisory panels for Gilead Pharmaceuticals.

Human/Animal Rights:

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

Informed Consent:

Multiple attempts were made to contact the patient’s family for informed consent. However, they could not be reached with the phone numbers listed in the medical chart. The information in this case report has been sufficiently anonymized to protect patient confidentiality.

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Wang, J., Liu, W., Parikh, K. et al. Alpha-fetoprotein-producing esophageal adenocarcinoma: a mimicker of hepatocellular carcinoma . Clin J Gastroenterol 10, 7–12 (2017). https://doi.org/10.1007/s12328-016-0704-1

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  • DOI: https://doi.org/10.1007/s12328-016-0704-1

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