A case of alpha-fetoprotein-producing esophageal adenocarcinoma

Abstract

Alpha-fetoprotein is a well-known tumor marker in the screening and follow-up of hepatocellular carcinoma. In Taiwanese society, a high prevalence of hepatitis and hepatoma and elevation of alpha-fetoprotein associated with liver function impairment usually suggested clinics undertake further examination for liver or genital tumor. We report the case of 45-year-old man who was found to have an alpha-fetoprotein-producing esophageal adenocarcinoma with an initial presentation of liver function impairment and rapid elevation of alpha-fetoprotein. Esophageal cancer was diagnosed via endoscope and a biopsy proved the presence of adenocarcinoma. A small endoscopic biopsy specimen failed to identify the alpha-fetoprotein positive tumor cell. Esophagectomy was performed and histopathological study of surgical specimen revealed grade II adenocarcinoma with regional metastatic lymphadenopathy. Immunohistochemical study was focal positive for alpha-fetoprotein. Serum alpha-fetoprotein declined transiently after esophagectomy and fluctuation of alpha-fetoprotein level was noted during the treatment with adjuvant chemotherapy. Finally, 19 months after the operation, the patient died due to multiple organ metastases with multiple organ failure. Thus, a small specimen for upper endoscopy may not be sufficient in the presence of alpha-fetoprotein-producing adenocarcinoma. Monitoring of serum alpha-fetoprotein may be useful in the evaluation and follow-up of esophageal alpha-fetoprotein-producing adenocarcinoma.

Figure 1

Barium esophagogram showed a polypoid filling defect in the distal esophagus and central depression was noted (arrow). Mild contour irregularity and rigidity was also identified at the esophagus–cardiac junction.

Figure 2

Upper endoscopy showed a polypoid lesion with fragility in the lower third of the esophagus. Mild lumen narrowing was also noted.

Figure 3

Abdominal computed tomography revealed annular wall thickening with a blurred adventitia margin in the lower esophagus and the soft tissue mass lesion was downward to the cardiac portion. Metastatic lymphadenopathy was noted (arrow).

Figure 4

Histological appearance of the surgical specimen from the esophageal caner showed tubular adenocarcinoma. Immunochemistry stain with alpha‐fetoprotein was focal positive with alpha‐fetoprotein in cytoplasm (arrows).

Figure 5

The alpha‐fetoprotein level dropped immediately after esophagectomy (arrow). It increased again with tumor recurrence.