title: Alpha-fetoprotein-producing esophageal adenocarcinoma: a mimicker of hepatocellular carcinoma.
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.
authors.affiliation: Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106, USA. jeremywang@mednet.ucla.edu.
authors.forename: Jeremy
authors.identifier: http://orcid.org/0000-0003-4783-0434
authors.initials: J
authors.lastname: Wang
authors.affiliation: Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106, USA.|Department of Pathology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
authors.forename: Keyur
authors.initials: K
authors.lastname: Parikh
authors.affiliation: Case Western Reserve University School of Medicine, 2109 Adelbert Rd, Cleveland, OH, 44106, USA.|Department of Gastroenterology and Hepatology, University Hospitals Case Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
authors.forename: Anthony Benjamin
authors.initials: AB
authors.lastname: Post
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D000509:alpha-Fetoproteins / Q000032:analysis* / Q000096:biosynthesis
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins
keywords: Alpha-fetoprotein; Esophageal adenocarcinoma; Hepatocellular carcinoma; Liver mass