LESSON OF THE WEEK - FAILURE OF NORMALIZATION OF ALPHA-FETOPROTEIN CONCENTRATION AFTER SUCCESSFUL TREATMENT OF TERATOMA

The development of successful treatment regimens for germ cell rumours has been one of the important advances in cancer chemotherapy. The ef fects of such treatment are monitored by measurement of serum concentr ations of the tumour markers alpha fetoprotein and human chorionic gon adotrophin, as well as clinical and radiological assessment. The persi stence of raised concentrations of alpha fetoprotein during or after t reatment requires urgent investigation to delineate teratoma resistant to chemotherapy. We report on a patient with testicular teratoma who relapsed after initial chemotherapy in whom appreciably raised serum c oncentrations of alpha fetoprotein did not fall despite apparently suc cessful salvage chemotherapy and surgery. An exhaustive search for a f urther residuum of disease was not fruitful. The finding of raised liv er enzyme activities and hepatomegaly led to a liver biopsy, which sho wed alcoholic hepatitis. The patient decreased his alcohol intake, res ulting in normalisation of his alpha fetoprotein concentration and liv er enzyme activities.