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

This paper describes a rare case of adenocarcinoma located in the middle portion of the esophagus with liver metastasis. An 80-year-old man was admitted to our hospital with dysphagia and vomiting, following which an upper gastrointestinal series and esophagoscopy located an elevated-type carcinoma in the middle thoracic esophagus. Computed tomography revealed an esophageal tumor invading the left atrium and aorta, and multiple intrathoracic lymph node swellings, and an ultrasonograph of the liver showed multiple liver metastases. The serum carcinoembryonic antigen, carbohydrate antigen 19-9, and squamous cell carcinoma-related antigen levels were normal, but the serum alpha-fetoprotein (AFP) level was 351.5 ng/ml. The patient died 124 days after undergoing an esophageal bypass operation. On post-mortem histological examination, the original esophageal tumor was diagnosed as a poorly differentiated adenocarcinoma without a squamous component and immunohistochemical staining for AFP showed positive granules in the cytoplasm. All the metastatic nodules, including the lymph nodes, liver, spleen, and lungs, showed the same histological type and AFP-staining pattern as the original esophageal tumor. To our knowledge, this is the first case of AFP-producing esophageal carcinoma to be reported in Japan.