False elevations of alpha-fetoprotein associated with liver dysfunction in germ cell tumors

Abstract

Background. Determination of serum concentration human chorionic gonadotropin (HCG) and alpha‐fetoprotein (AFP) is crucial in diagnosis, prognosis, treatment, and follow‐up of patients with germ cell tumors. Elevation of these markers almost indicates progression or recurrence of the germ cell tumor. However, an increase in these tumor markers can be produced by several benign causes. Methods. The authors report nine cases of gonadal germ cell tumors that had increased serum levels of AFP without tumoral progression, recurrence, or residual tumor. Results. The AFP elevations were attributed to liver damage secondary to drugs (chemotherapy, anesthetics, or antiepileptics), virus, or alcoholism. No clinical evidence (or in some cases surgical evidence) of malignant tumor activity was found in any of the patients. Conclusions. The elevation of serum levels of AFP in patients with germ cell tumors can be produced by liver dysfunction. These elevations must be interpreted with caution to avoid unnecessary treatments.

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Use of Tumor Markers in Testicular, Prostate, Colorectal, Breast, and Ovarian Cancers

“…Increased AFP values may not reflect cancer, and it is therefore important to identify positive results caused by other diseases and by nonspecific interference. Benign liver disease, in particular hepatitis, and liver damage induced by chemotherapy are often associated with moderately increased serum AFP levels, and may result in misinterpretation especially if levels are rising (85,86 ).…”

Over Tümörleri̇nde Tümör Beli̇rteçleri̇ Ve Kli̇ni̇k Önemleri̇

“…Kemoterapi sırasında αFP ve βhCG düzeylerinde yavaş düşüş (αFP yarı ömrü> 6-7 gün, βhCG yarı ömrü> 3.5-4 gün) tümör relapsına işaret eder (48). Kemoterapinin başlangıcındaki αFP düzeyinde geçici yükselme özellikle büyük hacimli germ hücreli tümörde, tedaviye bağlı karaciğer disfonksiyonuna veya nekrotik hücrelerden salınıma bağlı olabilir (49). Endodermal sinus tümörlü hastada kemoterapi sırasında αFP değerinde düşme izlenirken görün-tüleme yöntemleri ile tümör boyutunda artma saptanırsa, olgunun mikst germ hücreli tümör olasılığı (immatür teratom komponenti) düşünülmelidir (50).…”

Moyamoya Vasculopathy After Cranial Irradiation—a Case Report

“…The side-effects of brain irradiation are mediated through direct parenchymal effects or through changes of the blood vessels, leading to transient or permanent dysfunction and damage. The effect of radiotherapy on the blood vessels is documented in the literature (7). Only cerebral macrovasculopathy will be considered here.…”

“…In the other paediatric cases, the radiation doses ranged from 10 Gy (facial haemangioma) to 60 Gy (craniopharyngioma), and the time interval ranged between one year (hypothalmic tumour) and 24 years (medulloblastoma) (2,7,8,10,11). One patient reported by Nishizawa developed moyamoya after local treatment with colloidal I9'Au for cystic craniopharyngioma (10).…”

“…with other malignancies ( B cell malignancies, such as NHL and multiple myeloma, O r adult T cell leukemia) that may compromise immunologic functions (3)(4)(5)(6)(7)(8). It has also been reported during corticosteroid therapy for idiopathic thrombocytopenic pUrpurd (9).…”