Persistently elevated alpha-fetoprotein associated with chronic hepatitis B during chemotherapy for malignant ovarian germ cell tumors: a case series and a review of the literature

Xuan Zong,Ying Zhang,Jia-Xin Yang

doi:10.1186/s13048-019-0598-x

Abstract

BackgroundAlpha-fetoprotein (AFP) plays a crucial role in the management of malignant ovarian germ cell tumors (MOGCTs) and is an important reference index for chemotherapy termination. However, a high level of AFP can also be caused by several benign diseases, causing confusion and impacting treatment decisions.Case presentationWe described four patients who were diagnosed with MOGCTs; the histologic subtype in two of them was mixed MOGCTs (yolk sac tumor with mature teratoma), while the rest was immature teratoma. The serum AFP level of each patient was abnormal before surgery, but it was still persistently elevated around 300 ng/ml even after additional cycles of chemotherapy. All patients were thoroughly evaluated, but we did not find any evidence of disease progression or residual tumors. Liver function tests were normal, whereas serum assays revealed positive of hepatitis B surface antigen, and two patients had a high level of HBV-DNA. They were chronic carriers of hepatitis B virus and never received relevant treatments. Then they were managed with tumor surveillance and the antiviral treatment. Thereafter, the AFP levels presented a slowly decreasing trend.ConclusionsFalse elevation of AFP in MOGCTs is a rare condition and should be assessed with a comprehensive evaluation to avoid unnecessary treatments.

Highlights

BackgroundMalignant ovarian germ cell tumors (MOGCTs) mostly occur in adolescent and young adults under the age of 35, and encompasses several histological subtypes, including dysgerminoma (DG), yolk sac tumor (YST), and immature teratoma (IT) [1, 2]
Alpha-fetoprotein (AFP) plays a crucial role in the management of malignant ovarian germ cell tumors (MOGCTs) and is an important reference index for chemotherapy termination
Since the 1980s, the prognosis of MOGCTs has greatly improved due to the use of cisplatin-based multi-agent chemotherapy, and the 5-year survival rate is more than 85% after standard management [4]

Summary

Background

Malignant ovarian germ cell tumors (MOGCTs) mostly occur in adolescent and young adults under the age of 35, and encompasses several histological subtypes, including dysgerminoma (DG), yolk sac tumor (YST), and immature teratoma (IT) [1, 2]. The liver function test was normal, but serum assays were positive for both hepatitis B surface antigen (HBsAg) and hepatitis Be antigen (HBeAg) and showed a high level of HBV-DNA She was diagnosed with active viral hepatitis, and antiviral therapy was initiated following the physician’s recommendation. The physician recommended that the patient initiate antiviral therapy and not continue any treatment associated with GCTs. The AFP level increased to 370.7 ng/ml 2 months after the final round of chemotherapy and started to drop slowly. We performed cytoreductive surgery, and pathological analysis confirmed that most tumors were necrosed, while YST could be found in a small part After that, she received 6 cycles of chemotherapy including 4 cycles for consolidation. The most common cause was liver injury, whereas no etiology was found in some cases, especially in seminoma [31, 33,34,35,36]

Discussion

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Conclusion