Elevated serum alpha-fetoprotein in Wilms' tumor: A case report with review of literature

Abstract

Abstract Wilms' tumor is the second most common primary malignant intra-abdominal tumor in childhood. It is derived from primitive metanephric blastema and characterized by histopathologic diversity. Alpha-fetoprotein (AFP) is a typical oncofetal antigen of hepatic and germ cell tumors, particularly those containing yolk sac elements. Herein, the rare case of elevated AFP level and fall following chemotherapy has been described in a child with Wilms' tumor. The subject on report is a two-year old male baby detected with a palpable mass on the right side of the abdomen. His abdominal CT examinations revealed a huge mass in the right kidney, with the possibility of nephroblastoma on the right side and shadow of possible metastases in the left lung. Laboratory tests were within normal limits, but elevated serum alpha-fetoprotein (238 ng/ml). Following this, he was given three courses of preoperative chemotherapy actinomycin D, vincristine and pirarubicin (ACTD + VCR + THP). The result was that the level of AFP decreased to 82.78 ng/ml after the first two chemotherapy courses. He was then given third course of chemotherapy, the AFP level decline to 1.87 ng/ml two days prior to right radical nephrectomy. Postoperative AFP level was 1.42 ng/ml. One postoperative course of chemotherapy too was applied. Consequently he was free of disease at the age of 4 years and 5 months with unremarkable AFP blood value level.