Alpha-fetoprotein-producing esophageal adenocarcinoma: Report of a case

Alpha-fetoprotein (AFP)-producing esophageal tumors are extremely rare. We report herein the case of a 51-year-old man found to have an AFP-producing adenocarcinoma arising from esophageal proper mucosa. The patient presented for investigation of dysphagia, and esophagogram and endoscopy revealed a lesion about 2cm in size with a depressed center surrounded by low nodular protrusions in the lower esophagus. The preoperative serum AFP concentratio n was elevated to 52.4ng/ml. A subtotal esophagectomy was performed, and ma croscopic examination of the resected specimen revealed a superficial protr uding lesion. Histopathological studies showed a poorly differentiated aden ocarcinoma with a single lymph node metastasis. The tumor had infiltrated t he submucosal layer, but there was no evidence of lymphatic or venous invas ion. Immunohistochemical study revealed tumor cells positive for AFP. There were no findings of Barrett's epithelium or any mucosal changes due to ref lux esophagitis. An elevated AFP level 2 years after the operation led us t o suspect tumor recurrence; however, diagnostic imaging studies showed no e vidence of a recurrence or metastases. The serum AFP levels responded well to chemotherapy with transient decreased levels, but continued to rise unti l finally, 5 years after the operation, adenocarcinoma cells were detected in the pleural effusion. Thus, careful monitoring of the serum AFP levels a t regular intervals could be a useful marker to indicate recurrence of esop hageal carcinoma.