Elevated serum alpha-fetoprotein in poorly differentiated adenocarcinoma with neuroendocrine differentiation of the ascending colon: a case report

Abstract

Background: Colorectal cancer (CRC) is the most common form of cancer and the third leading cause of death in Taiwan. Serum alpha-fetoprotein (AFP) has been extensively used as a biomarker for hepatocellular carcinoma (HCC) and yolk sac tumors.

Case presentation: This case report presents a 90-year-old woman with right abdominal pain and poor appetite for 1 week. The computed tomography (CT) showed wall thickening in the proximal ascending colon with ruptured appendicitis. Preoperative serum AFP was high. There was no definite liver metastasis or other abnormal findings in the hepatobiliary systems. After initial empirical antibiotic treatment, we performed laparoscopic right hemicolectomy. The pathological assessment was poorly differentiated adenocarcinoma with neuroendocrine differentiation in the ascending colon. The tumor cells did not produce AFP. Amazingly, the follow-up serum AFP level 1 month after the surgery declined to normal range. The patient had an uneventful course after the surgery and was free of recurrence or metastasis within 5 months of follow-up.

Conclusions: AFP may be a useful tumor marker in poorly differentiated colorectal cancer with neuroendocrine component patients and a prediction of early treatment response.

Keywords: Adenocarcinoma; Alpha-fetoprotein; Colon cancer; Neuroendocrine; Poorly differentiated.

Fig. 1

CT scans of the abdomen. An enhanced abdominal CT scan indicated wall thickening of the ascending colon, compatible with colon cancer (a, arrow), a swelling appendix with localized abscess, compatible with ruptured appendicitis (b, arrow), and regression of appendicular abscess after antibiotics treatment (c)

Fig. 2

Resected ascending tumor. Gross appearance of the ascending colon tumor and ruptured appendicitis (a, b)