Hepatoid Esophageal Cancer

Abstract

Purpose: To recognize esophageal cancer as a possible explanation for high Alfa fetoprotein (AFP). Methods: Case review and review of literature. Results: Alpha-fetoprotein (AFP)-producing esophageal tumors are extremely rare. AFP producing tumors with liver metastasis pose significant diagnostic dilemma with regards to delineating the primary. A 56 years old gentleman with no significant past history presented for evaluation of fatigue and weight loss. He did not complain of dysphagia, hematemesis or melena. Initial evaluation reveled iron deficiency anemia. A CT scan showed multiple liver lesions. Alfa-fetoprotein was elevated at >3000 ng/ml. Fine Needle Aspiration of liver was positive for malignant cells. Gastroscopy revealed a large fungating mass in lower esophagus, with yellowish colored debris. The biopsy material showed a malignant tumor with extensive necrosis. The tumor cells were large, had large nuclei and occasional prominent nucleoli. They were arranged in clumps, columns and vague acinar configuration intercepted by thin vascular channels. Many mitotic figures were present. By immunohistochemical stains, tumor was suggestive to be of hepatoid origin. Conclusion: Primary tumors of the upper gastrointestinal tract showing hepatoid differentiation are very infrequent. Most have been reported as arising in the stomach. To our knowledge, this is the first case of hepatoid esophageal cancer to be reported from the United States.