title: [Gallbladder cancer with elevated serum α-fetoprotein, α-fetoprotein-L3, and human chorionic gonadotropin levels].
abstract: A 61-year-old woman presented with fever and was diagnosed with choledocholithiasis, which was removed endoscopically. Incidentally, a markedly elevated serum α-fetoprotein(AFP)level was detected(1,951 ng/mL), but computed tomography( CT)showed only diffuse gallbladder wall thickening. Subsequently, markedly elevated serum AFP-L3 and human chorionic gonadotropin(HCG)levels were detected(99.6%and 2,867mIU/mL, respectively). Fluorodeoxyglucose(FDG)- positron emission tomography/CT demonstrated high FDG uptake only in the gallbladder. Gallbladder cancer was suspected and the patient was scheduled for a cholecystectomy. However, CT just prior to surgery revealed multiple liver metastases. Percutaneous gallbladder biopsy revealed a moderately differentiated adenocarcinoma positive for AFP but not HCG. The patient underwent chemotherapy consisting of gemcitabine and cisplatin. A CT scan obtained 12 weeks later showed disease progression and AFP and HCG levels were found to have increased to 4,021 ng/mL and 66,000mIU/mL, respectively. Although immunohistochemistry of biopsy specimen did not demonstrate HCG production, increased serum HCG level on disease progression definitely suggested HCG production of gallbladder cancer. We believe the biopsy specimen was very small and therefore did not prove HCG production. Gallbladder cancer with simultaneous production of AFP and HCG is rare, and we therefore report this case together with a review of the literature.
authors.affiliation: Dept. of Gastroenterology,Otaru General Hospital.
authors.forename: Akira
authors.initials: A
authors.lastname: Goto
authors.forename: Yu
authors.initials: Y
authors.lastname: Ishimine
authors.forename: Tsubasa
authors.initials: T
authors.lastname: Hirata
authors.forename: Takafumi
authors.initials: T
authors.lastname: Naito
authors.forename: Takashi
authors.initials: T
authors.lastname: Yabana
authors.forename: Takeya
authors.initials: T
authors.lastname: Adachi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kondo
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kasai
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000188:drug therapy / Q000556:secondary; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006063:Chorionic Gonadotropin / Q000097:blood*; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D017809:Fatal Outcome; D005260:Female; D005706:Gallbladder Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary; D008875:Middle Aged; D000509:alpha-Fetoproteins / Q000032:analysis*; D000093542:Gemcitabine
chemical_list: D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins; D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine