THE ROLE OF SUBFRACTIONATION OF ALPHA-FETOPROTEIN IN THE TREATMENT OFPEDIATRIC SURGICAL PATIENTS

Subfractionation of serum alpha-fetoprotein (AFP) is a useful method t o discriminate between yolk sac tumors, hepatic malignancies, and beni gn liver diseases in adults but has not been validated in infants and children. AFP subfractionation was performed on AFP-positive sera from 73 infants and children. AFP subfraction profiles were classified int o three common types: (1) yolk sac type, (2) hepatoblastoma type, and (3) benign hepatic type, according to the reactivity of individual AFP samples to lectins. In 68 of 73 samples (93.2%), AFP subfraction prof iles were accurately classified into these three types, and an atypica l AFP subfraction profile resembling the hepatoblastoma type was found in sera from five infants (6.8%). Differentiation between hepatoblast oma and hepatitis when patients are very young can be difficult, Subfr actionation is more accurate when patients are older. This technique w as found to be useful in the diagnosis of neonatal ovarian tumors, in recurrent hepatoblastoma/yolk sac tumor with low serum AFP, and in the differential diagnosis of hepatic mass (malignancy versus hyperplasti c nodule) in the liver with long-standing cholestasis. Estimation of s erum AFP subfraction profiles facilitates the differential diagnosis o f various AFP-positive pediatric diseases, such as hepatoblastoma, hep atoma, hepatitis or germ cell tumors, This test is inexpensive, can be carried out within 48 hours, and should be performed for the differen tial diagnosis of pediatric liver disease. Copyright (C) 1997 by W.B. Saunders Company.