Misdiagnosis of an α‑fetoprotein‑producing esophageal carcinoma: A case report and literature review

Sun,Ningbo; Yin,Xunlu; Zhong,Yuren; Zhang,Xiaotian; Xie,Yan; Meng,Xiangfang; Zang,Qi

doi:10.3892/ol.2016.4664

Misdiagnosis of an α‑fetoprotein‑producing esophageal carcinoma: A case report and literature review

Authors:
- Ningbo Sun
- Xunlu Yin
- Yuren Zhong
- Xiaotian Zhang
- Yan Xie
- Xiangfang Meng
- Qi Zang
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Affiliations: Department of Thoracic Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong 257034, P.R. China, Division of Surgery, Graduate Department, Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250014, P.R. China, Department of Burns and Orthopedics, The First Hospital of Lianyungang, Lianyungang, Jiangsu 222002, P.R. China, Department of Thoracic Surgery, Dezhou People's Hospital, Dezhou, Shandong 253014, P.R. China, Department of Thoracic Surgery, Qianfoshan Hospital Affiliated to Shandong University, Jinan, Shandong 250014, P.R. China
Published online on: June 1, 2016 https://doi.org/10.3892/ol.2016.4664
Pages: 597-600

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Abstract

α-fetoprotein (AFP)‑producing esophageal carcinoma is a rare type of esophageal cancer, with its characteristics not yet fully clarified. In the present study, a case of esophageal carcinoma was misdiagnosed as an AFP‑producing esophageal carcinoma. The patient was a 50‑year‑old woman who was referred to Qianfoshan Hospital Affiliated to Shandong University in November 2014 with a 3‑month history of progressive dysphagia. A chest computed tomography (CT) scan showed thickening of the wall of the esophagus, corresponding regions of luminal stenosis and massive lymph node swelling around the lesser curvature of the esophagus. A laboratory investigation showed that the serum AFP levels of the patient were elevated to 18.97 ng/ml (normal range <12 ng/ml). These laboratory investigation findings combined with the aforementioned pathological diagnosis supported a diagnosis of AFP‑producing esophageal carcinoma. An abdominal ultrasound was performed and a cystic low‑density measuring 5x4 mm was identified. No metastases were revealed in the liver. The boundary of the focal low density was clear, which indicated a clinical diagnosis of liver cyst. A radical esophagectomy was performed on December 5, 2014. Microscopically, the tumor was a moderately differentiated squamous cell carcinoma invading the serous layer, with no hepatoid features. Immunohistochemistry showed that the cells were diffusely negative for AFP expression. Histopathological examination revealed the absence of hepatoid features. According to these findings, the tumor was diagnosed as a moderately differentiated squamous cell carcinoma. In the present study, the case of a patient with squamous cell carcinoma that was misdiagnosed as an α‑fetoprotein‑producing esophageal carcinoma was reported, with a review of the literature.

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1	Gitlin D, Pericelli A and Gitlin GM: Synthesis of -fetoprotein by liver, yolk, sac and gastrointestinal tract of the human conceptus. Cancer Res. 32:979–982. 1972.PubMed/NCBI
2	Babali A, Cakal E, Purnak T, Bıyıkoğlu I, Cakal B, Yüksel O and Köklü S: Serum α-fetoprotein levels in liver steatosis. Hepatol Int. 3:551–555. 2009. View Article : Google Scholar : PubMed/NCBI
3	Mizejewski GJ: Levels of alpha-fetoprotein during pregnancy and early infancy in normal and disease states. Obstet Gynecol Surv. 58:804–826. 2003. View Article : Google Scholar : PubMed/NCBI
4	Breborowicz J, Mackiewicz A and Breborowicz D: Microheterogeneity of alpha-fetoprotein in patient serum as demonstrated by lectin affino-electrophoresis. Scand J Immunol. 14:15–20. 1981. View Article : Google Scholar : PubMed/NCBI
5	Ezaki T, Yukaya H, Ogawa Y, Chang YC and Nagasue N: Evaluation of alpha-fetoprotein level without evidence of recurrence after hepatectomy for hepatocellular carcinoma. Cancer. 61:1880–1883. 1988. View Article : Google Scholar : PubMed/NCBI
6	Ganjei P, Nadji M, Albores-Saavedra J and Morales AR: Histologic markers in primary and metastatic tumors of the liver. Cancer. 62:1994–1998. 1988. View Article : Google Scholar : PubMed/NCBI
7	Yamagata T, Yamagata Y, Nakanishi M, Matsunaga K, Minakata Y and Ichinose M: A case of primary lung cancer producing alpha-fetoprotein. Can Respir J. 11:504–506. 2004. View Article : Google Scholar : PubMed/NCBI
8	Hamanaka W, Yoneda S, Shirakusa T, Shirahama H, Tashiro Y, Iwasaki A, Shiraishi T and Tsuru H: Alpha-fetoprotein (AFP)-producing adrenocortical carcinoma-long survival with various therapeutic strategies including a lung resection: Report of a case. Surg Today. 38:275–278. 2008. View Article : Google Scholar : PubMed/NCBI
9	Matsueda K, Yamamoto H, Yoshida Y and Notohara K: Hepatoid carcinoma of the pancreas producing protein induced by vitamin K absence or antagonist II (PIVKA-II) and alpha-fetoprotein (AFP). J Gastroenterol. 41:1011–1019. 2006. View Article : Google Scholar : PubMed/NCBI
10	Kinjo T, Taniguchi H, Kushima R, Sekine S, Oda I, Saka M, Gotoda T, Kinjo F, Fujita J and Shimoda T: Histologic and immunohistochemical analyses of α-fetoprotein-producing cancer of the stomach. Am J Surg Pathol. 36:56–65. 2012. View Article : Google Scholar : PubMed/NCBI
11	Cappetta A, Bergamo F, Mescoli C, Lonardi S, Rugge M and Zagonel V: Hepatoid adenocarcinoma of the colon: What should we target? Pathol Oncol Res. 18:93–96. 2012. View Article : Google Scholar : PubMed/NCBI
12	Kawamura N, Hatano K, Kakuta Y, Takada T, Hara T and Yamaguchi S: A case of hepatoid adenocarcinoma of the urinary bladder. Hinyokika Kiyo. 55:619–622. 2009.PubMed/NCBI
13	Isonishi S, Ogura A, Kiyokawa T, Suzuki M, Kunito S, Hirama M, Tachibana T, Ochiai K and Tanaka T: Alpha-fetoprotein (AFP)-producing ovarian tumor in an elderly woman. Int J Clin Oncol. 14:70–73. 2009. View Article : Google Scholar : PubMed/NCBI
14	Chen YY, Hsu WH, Hu HM, Wu DC and Lin WY: A case of alpha-fetoprotein-producing esophageal adenocarcinoma. Kaohsiung J Med Sci. 29:106–110. 2013. View Article : Google Scholar : PubMed/NCBI
15	Kripp M, Ströbel P, Dinter D, Lukan N, Hochhaus A and Hofheinz RD: Alpha-fetoprotein expressing metastastic adenocarcinoma of the esophago-gastric junction responding favorably to capecitabine and oxaliplatin. Anticancer Drugs. 20:75–78. 2009. View Article : Google Scholar : PubMed/NCBI
16	Kawai H, Sekine S, Sanada T, Andoh T, Takechi Y and Okada S: Alpha-fetoprotein-producing esophageal carcinoma: A case report. Anticancer Res. 23:3837–3840. 2003.PubMed/NCBI
17	Kobayashi N, Ohbu M, Kuroyama S, Kikuchi S, Shimao H, Mitomi H and Kakita A: Alpha-Fetoprotein-producing esophageal adenocarcinoma: Report of a case. Surg Today. 31:915–919. 2001. View Article : Google Scholar : PubMed/NCBI
18	Takeuchi M, Yamaoka S, Matsumura K, et al: An alpha-fetoprotein producing gastric carcinoma with hepatoid features. A case report of hepatoid adenocarcinoma of the stomach. Gastroenterol Endosc. 31:442–448. 1989.(In Japanese).
19	Nemoto A, Goshima H, Tanigawa K, et al: A case of AFP-producing gastric cancer with multiple liver metastasisn showing marked improvement by hepatoarterial infusion with cisplatin. Mie Igaku. 42:84–94. 1998.(In Japanese).
20	Suzuki Y, Watanabe M, Nonaka H, Kase H, Tokura N, Kikuchi M, Matsumoto H, Kobayashi K, Akima M and Yoshio T: A case of advanced gastric carcinoma producing alpha-fetoprotein with multiple liver metastasis in which intrahepatic chemotheraphy was effective postgastrectomy. Jpn J Gastroenterol Surg. 32:2365–2369. 1999.(In Japanese). View Article : Google Scholar
21	Wahren B, Harmenberg J, Edsmyr F, Jakobsson P and Ingimarsson S: Possible tumour markers in patients with oesophagus cancer. Scand J Gastroenterol. 14:361–365. 1979. View Article : Google Scholar : PubMed/NCBI
22	Chang YC, Nagasue N, Kohono H, Ohiwa K, Yamanoi A and Nakamura T: Xenotransplantation of alpha-fetoprotein-producing gastric cancers into nude mice: Characteristics and responses to chemotherapy. Cancer. 69:872–877. 1992. View Article : Google Scholar : PubMed/NCBI
23	Shimakawa T, Ogawa K, Naritaka Y, Wagatsuma Y, Katsube T, Hamaguchi K, Konno S, Aiba M and Kajiwara T: Alpha-fetoprotein producing Barrett's esophageal adenocarcinoma: A case report. Anticancer Res. 19:4369–4373. 1999.PubMed/NCBI
24	Sawada H, Watanabe A, Yamada Y, Yano T, Nakano H and Konishi Y: Alpha-fetoprotein producing esophageal adenocarcinoma: Report of a case. Surg Today. 23:1103–1107. 1993. View Article : Google Scholar : PubMed/NCBI
25	Sobin LH, Gospodarowicz M and Wittekind C: Oesophagus including oesophagogastric junction. TNM Classification of Malignant Tumours (7th). Wiley-Blackwell. (Oxford). 66–72. 2009.
26	Kataoka H, Miura Y, Joh T, Seno K, Tada T, Tamaoki T, Nakabayashi H, Kawaguchi M, Asai K, Kato T and Itoh M: Alpha-fetoprotein producing gastric cancer lacks transcriptionalfactor ATBF1. Oncogene. 20:869–873. 2001. View Article : Google Scholar : PubMed/NCBI
27	Foschini MP, Baccarini P, Dal Monte PR, Sinard J, Eusebi V and Rosai J: Albumin gene expression in adenocarcinomas with hepatoid differentiation. Virchows Arch. 433:537–541. 1998. View Article : Google Scholar : PubMed/NCBI
28	Koide N, Nishio A, Igarashi J, Kajikawa S, Adachi W and Amano J: Alpha-fetoprotein-producing gastric cancer: Histochemical analysis of cell proliferation, apoptosis, and angiogenesis. Am J Gastroenterol. 94:1658–1663. 1999. View Article : Google Scholar : PubMed/NCBI
29	Amemiya H, Kono K, Mori Y, Takahashi A, Ichihara F, Iizuka H, Sekikawa T and Matsumoto Y: High frequency of c-Met expression in gastric cancers producing alpha-fetoprotein. Oncology. 59:145–151. 2000. View Article : Google Scholar : PubMed/NCBI
30	Kamei S, Kono K, Amemiya H, Takahashi A, Sugai H, Ichihara F, Fujii H and Matsumoto Y: Evaluation of VEGF and VEGF-C expression in gastric cancer cells producing alpha-fetoprotein. J Gastroenterol. 38:540–547. 2003.PubMed/NCBI
31	Dhar DK, Nagasue N, Yoshimura H, Tachibana M, Tahara H, Matsuura H, Abe S, Chang YC and Nakamura T: Overexpression of P-glycoprotein in untreated AFP-producing gastric carcinoma. J Surg Oncol. 60:50–54. 1995. View Article : Google Scholar : PubMed/NCBI
32	Ohashi N, Goshima H, Yamazaki H, et al: A case report of so-called hepatoid adenocarcinoma of the stomach without liver metastasis. Ringe (J Clin Surg). 43:1537–1541. 1988.(In Japanese).