High serum alpha-fetoprotein concentration associated with pseudoinfarction of a cirrhotic liver: Report of a case

Abstract

We report herein the case of a 65-year-old man with cirrhosis of the liver in whom a portal vein thrombus was found to be the cause of a marked elevation in serum alpha-fetoprotein (AFP). The patient presented with fever and abdominal pain, and a diagnostic work-up revealed a liver mass and an increased serum AFP concentration of 91,000 ng/ml. The mass gradually regressed, and the AFP concentration simultaneously decreased to 163 ng/ml. However, because hepatocellular carcinoma (HCC) could not be ruled out, a partial hepatectomy was performed. Histological examination of the resected specimen revealed a thrombus of the portal vein surrounded by the fibrosis associated with liver cirrhosis, but no neoplastic lesion was found. Thus, portal thrombus associated with liver cirrhosis might induce an extremely high level of AFP production.

Remarkable alpha-fetoprotein elevation and pseudo-infarction of cirrhotic liver: case report

“…Hepatic infarction due to PVT was found in patients with liver cancer, cirrhosis, or chronic pancreatitis [12]. Zahn's infarct has been observed in the setting of various vascular processes, including occlusive phlebitis in PV radicles [13], PVT [14], PV thromboembolism [15], and tumor-induced stenosis of intrahepatic vessels [16]. Macroscopically, the lesions may turn bluish-red, leading to the term "cyanotic atrophy" [11].…”