Extreme Elevation of Serum Alpha Fetoprotein in Decompensated Cirrhosis without Hcc: an Ominous Sign

Abstract

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.

Isolated Transient Neonatal Clitoromegaly with Hyperandrogenism of Unknown Etiology

“…Alpha-fetoprotein has been shown to be a marker of hepatic compromise in patients in the absence of malignancy. 3,4 This phenomenon has been described in the literature and confirmed with resolution of the tumor marker over time in our patient. Over the next 3 months, the value returned to normal, at 169.2 mg/L (Table 1).…”

Extreme Alpha Fetoprotein Level and Parathyroid Hormone-Related Peptide Paraneoplastic Syndrome: A Unique Case Report of Hepatocellular Carcinoma

“…Typically, it is associated with cholangiocarcinoma and used to differentiate between cholangiocarcinoma and HCC (Senturk and Cumali, 2007). However, PTHrP has been found in the fetal liver, but is typically not present in adults (Senturk and Cumali, 2007). While studies have been reported of AFP levels greater than 10,000 pg/ml without any sign of carcinoma, our patient demonstrated significantly higher levels with hypercalcemia (Yang et al, 2019).…”

“…Our patient had a rare case of HCC with extremely elevated AFP levels and elevated PTHrP leading to hypercalcemia. In the setting of hypercalcemia of malignancy, it is important to differentiate if there is hypercalcemia due to bony metastasis or if it is due to PTHrP (Senturk and Cumali, 2007). PTHrP has demonstrated a significant role in hypercalcemia of malignancy (Wang and Zhang, 2020).…”

“…PTHrP has demonstrated a significant role in hypercalcemia of malignancy (Wang and Zhang, 2020). Typically, it is associated with cholangiocarcinoma and used to differentiate between cholangiocarcinoma and HCC (Senturk and Cumali, 2007). However, PTHrP has been found in the fetal liver, but is typically not present in adults (Senturk and Cumali, 2007).…”

“…The increased biological activity of neoplastic hepatocytes may play a role in the increased production of PTHrP and its association with significantly higher AFP levels (Roskams et al, 1993). Chang, et al (2013) found that hypercalcemia was the only paraneoplastic syndrome associated with more advanced TNM stage, higher disease burden, and poor prognosis compared to hypercholesterolemia and erythrocytosis (Senturk and Cumali, 2007). It could be inferred that our patient likely did not have the sclerosing subtype due to the hypointense signaling on MRI, pathology results, and lack of many overlapping biomarkers (Wang and Zhang, 2020).…”