Related Experiment Videos
A case of well-differentiated, fetal-type hepatoblastoma with very low serum alpha-fetoprotein
Y Tsuchida1, H Ikeda, N Suzuki
1Department of Surgery, Gunma Children's Medical Center, Japan.
Insights
Serum alpha-fetoprotein (AFP) is typically high in pediatric liver cancer. However, a case of hepatoblastoma with low AFP highlights the need for advanced diagnostic methods.
Area of Science:
- Pediatric Oncology
- Hepatobiliary Medicine
- Biomarker Research
Background:
- Serum alpha-fetoprotein (AFP) is a well-established tumor marker for hepatoblastoma and hepatocellular carcinoma in children.
- Elevated AFP levels are observed in over 96% of pediatric liver cancer cases, aiding in diagnosis and monitoring.
- However, rare instances of hepatoblastoma with normal or low AFP levels present diagnostic challenges.
Observation:
- A 55-month-old girl presented with a large liver mass and a serum AFP level of 322 ng/mL.
- AFP subfractionation revealed a pattern typically associated with benign liver disease.
- Magnetic resonance imaging (MRI) confirmed a space-occupying lesion in the left lobe of the liver.
Findings:
- Histological examination of the resected tumor confirmed it as well-differentiated, fetal-type hepatoblastoma.
- Immunohistochemistry for AFP within the tumor tissue was negative.
- This case underscores that low or atypical AFP profiles can occur in pediatric hepatoblastoma.
Implications:
- Low serum AFP levels in pediatric hepatic masses may indicate well-differentiated or immature hepatoblastoma, or fibrolamellar hepatocellular carcinoma.
- AFP subfractionation, using techniques like lectin binding, may assist in differentiating these challenging subtypes.
- Further research into AFP heterogeneity and its clinical significance is warranted for improved pediatric liver cancer diagnostics.
Abstract:
Serum alpha-fetoprotein (AFP) is elevated in 96.6% of infants and children with hepatoblastoma and hepatocarcinoma. Serum AFP was of normal level in only one case of immature-type hepatoblastoma, and very low in only one case of fetal-type hepatoblastoma among 43 cases reviewed in 1986. Recently, a case of hepatoblastoma with very low serum AFP was encountered in the authors' surgical department. In October 1998, a 55-month-old girl was admitted. Her birth weight was 717 g. A large space-occupying lesion (SOL) located in the left lobe of the liver was seen by magnetic resonance imaging (MRI), and her serum AFP level was 322 ng/mL with a subfractionation pattern of the "benign liver disease" type based on reactivity with lens culnaris hemagglutinin and concanavalin A. The patient underwent successful left lobectomy, and histological examination showed that the tumor, weighing 268 g, was hepatoblastoma of the well-differentiated, fetal type. Immunohistochemistry findings for AFP were negative. A hepatic mass in infants and children with low serum AFP level indicates the presence of either well-differentiated or immature hepatoblastoma, or fibrolamellar hepatocellular carcinoma. Subfractionation of AFP may contribute to the differential diagnosis of these subtypes.