Fig 5 - uploaded by Tsukasa Shimamura
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腺腔形成に乏しい組織がシート状に配列し（ａ，H.E. 染色×200倍率） ，一部に AFP 染色 陽性反応が認められた（ｂ，AFP 染色×200倍率） ． a b
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A 68-year-old woman presented to a local doctor with the chief complaint of weight loss in August 2011. She was referred to our hospital for detailed examination and treatment of a suspected liver tumor. A computed tomography scan of the abdomen revealed multiple masses in the liver, and lower gastrointestinal endoscopy revealed sigmoid colon cance...
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The objective of the current study was to look at the levels of blood micro ribonucleic acid- (miR-) 497, carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 24-2, and hepatitis B surface antigen (HBsAg) in patients with colorectal cancer (CRC), as well as the clinical importance of these markers in CRC patients. The serum levels of miR-497,...
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We encountered a patient with alpha-fetoprotein-producing sigmoid colon cancer who showed an extremely poor prognosis. The patient, an 86-year-old man, was referred to our hospital with a history of abdominal pain, bloody stools, and difficulty in defecating. Physical examination revealed a fist-sized mass in the lower abdomen. Total colonoscopy revealed a type 1 tumor in the sigmoid colon, and histological examination of a biopsy specimen revealed a moderately differentiated adenocarcinoma. Hematological examination showed normal serum levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), but elevation of the serum alpha-fetoprotein (AFP) level to 193.4 ng/ml; therefore, the patient was diagnosed as having AFP-producing colon cancer was suspected. Examination of the AFP lectin reactive fractions revealed marked elevation of the L3 fraction (L1 3.6%, L2 0.0%, L3 96.4%). Computed tomography (CT) of the abdomen revealed an irregularly-shaped tumor measuring 50 mm in diameter in the sigmoid colon, and multiple masses in the liver and peritoneum. The patient was diagnosed as having sigmoid colon cancer with multiple concurrent liver metastases and peritoneal dissemination. In order to control the anemia progression and improve the cancerous obstruction of the colon, we performed sigmoidectomy. Intraoperatively, the primary tumor and disseminated nodules were found to be very fragile and to bleed easily; massive bloody ascites was noted. Immunohistochemistry revealed mild immunostaining of the tumor for AFP, and we made a diagnosis of AFP-producing sigmoid colon cancer, pT4b (mesentery proper), NX, M1c2(H,P), pStageⅣC. Although he had had an uneventful postoperative course for 2 weeks, the anemia progressed 2 weeks after surgery. CT showed a rapid increase in peritoneal dissemination and liver metastases, and tumor hemorrhage from the peritoneal nodules. After consultation with his family, we continued conservative treatment, but the anemia progressed gradually and he died about month after the surgery. We report a rare case of AFP-producing sigmoid colon cancer, with a review of the relevant literature.
AFP-producing colorectal cancer is a rare condition that carries a poor prognosis due to the high incidence of synchronous liver metastasis. Herein, we present the case of a patient diagnosed as having an AFP-producing colon cancer with synchronous liver metastases, who was successfully treated by conversion therapy using XELOX (capecitabine and oxaliplatin) plus bevacizumab. The 65-year-old male patient was referred to us with multiple liver tumors diagnosed by abdominal ultrasonography at another hospital. The patient’s serum AFP level was elevated to 1,636 ng/mL, and colonoscopy showed a type 2 tumor with circumferential stenosis of the transverse colon. After an abdominal contrast-enhanced CT revealed multiple liver metastases, the patient was diagnosed as having AFP-producing transverse colon cancer with synchronous liver metastases. After resection of the cancer, chemotherapy with XELOX plus bevacizumab was initiated. The liver tumors showed significant reduction in size and were assessed as resectable after eight cycles of treatment. Accordingly, right hepatectomy was performed and the liver metastases were completely resected. Tumor recurrence was detected in the remnant liver of S4 19 months after the lobectomy, and partial hepatectomy was performed. The patient experienced no further recurrence as of 40 months after the first operation.
A 57-year-old woman was referred to our hospital for thorough examination of anemia and a positive fecal occult blood test. Colonoscopy revealed a type 1 tumor of the descending colon. A biopsy led to a diagnosis of poorly differentiated adenocarcinoma. There were no obvious abnormalities suggestive of metastasis in thoracoabdominal computed tomography. We performed partial resection of the descending colon with D2 lymphadenectomy with the diagnosis of carcinoma of the descending colon. Immunohistochemistry showed positive reaction for α-fetoprotein (AFP), and the final diagnosis of AFP producing carcinoma of the descending colon was made.
The serum AFP level was as high as 176.1ng/ml in one month after the operation, but thereafter it decreased to the normal range. The patient survives without recurrence as of 4 years and 4 months after the operation.
Although AFP producing colon cancer is relatively rare, it is reported that the potential for liver metastasis is high and the prognosis is very poor. We report a rare case of a patient with AFP-producing carcinoma of the descending colon who has achieved long term recurrence-free postoperative survival, together with a review of the literature.
