Three cases of extreme elevation of serum alpha fetoprotein (>10,000 ng/mL) with decompensated cirrhosis without demonstrable hepatocellular carcinoma are reported. While 2 patients died of liver failure, 1 survived after liver transplantation. Extreme elevation of alpha fetoprotein not associated with hepatocellular carcinoma in liver cirrhosis heralds an ominous prognosis necessitating urgent liver transplantation.
A 53-year-old man presented to our clinic with a 4month history of loss of appetite and marked bodyweight loss (from 74 to 55 kg), and 1-month duration of progressively worsening exertional dyspnea. Pertinent abdominal sonography disclosed pancreatic head tumor with peripancreatic lymphadenopathy and a cardiac mass lesion. He was a heavy smoker but had no history of major systemic illness, including coronary arterial diseases. Upon admission, physical examination, chest film and serum biochemistry were unremarkable, except alkaline phosphatase 419 IU/L (upper limit of normal [ULN] <237) and g-glutamyl transpeptidase 246 U/L (ULN <30). The serum CA 19.9 level was 60 IU/mL. An electrocardiogram showed old inferior wall myocardial infarction, a first-degree atrioventricular block and a left anterior bundle branch block. Echocardiography showed a mass lesion (measuring 6.3 ¥ 5.4 cm) involving the right atrium (RA), the right
REFERENCES1 Lam KY, Dickens P, Chan ACL. Tumors of the heart. a 20year experience with a review of 12,485 consecutive autopsies. Arch. Pathol. Lab. Med. 1993; 117: 1027-31. 2 Bowman AR, Siegel RJ, Blanche C et al. Metastatic pancreatic adenocarcinoma to the heart diagnosed antemortem. J. Am. Soc. Echocardiogr. 2000; 13: 415-16. 3 Labib SB, Schick EC Jr, Isner JM. Obstruction of right ventricular outflow tract caused by intracavitary metastatic disease: analysis of 14 cases. J. Am. Coll. Cardiol. 1992; 19: 1664-8. 4 Faivre S, Raymond E, Woynarowski JM et al. Supraadditive effect of 2¢,2¢-difluorodeoxycytidine (gemcitabine) in combination with oxaliplatin in human cancer cell lines. Cancer Chemother. Pharmacol. 1999; 44: 117-23. 5 Louvet C, Andre T, Hammel P et al. Phase II trial of bimonthly leucovorin, 5-fluorouracil and gemcitabine for advanced pancreatic adenocarcinoma (FOLFUGEM).
Three cases of extreme elevation of serum alpha fetoprotein (>10,000 ng/mL) with decompensated cirrhosis without demonstrable hepatocellular carcinoma are reported. While 2 patients died of liver failure, 1 survived after liver transplantation. Extreme elevation of alpha fetoprotein not associated with hepatocellular carcinoma in liver cirrhosis heralds an ominous prognosis necessitating urgent liver transplantation.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.