Raised Serum Alpha-fetoprotein Levels Research Articles

CYTODIAGNOSIS OF HEPATIC LESIONS AND THEIR ASSOCIATION WITH SERUM ALPHA FETOPROTEIN LEVELS

Background: Liver is a common organ for lodgement of various infections and metastasis from other parts of body. Fine needle aspiration cytology (FNAC) plays a major decisive diagnostic role and combined with USG diagnostic accuracy is 90-95% minimizing the need of biopsy. An increased in serum AFP concentration has been observed in Hepatocellular Carcinoma (HCC) and is an important serum tumor marker. Methods: The present study was done, with the aim of studying the cytomorphological features of hepatic lesions and their association with serum Alpha Fetoprotein (AFP) levels. Study was conducted on 56 patients who underwent USG guided FNAC for diagnosis of liver lesions. Cytomorphological pattern of liver lesions were studied and serum AFP levels of the same cases were measured. Results: Maximum number of cases was in age group of 61-70 years. Male: Female ratio was 1.4:1. 82.1% cases were malignant. Most common malignancy was Metastatic deposits of Adenocarcinoma (MDA). HCC was diagnosed in 5.4% cases. Serum AFP levels in HCC were 459.93 ± 41.69 ng/mL.15.4 % of the cases of MDA and 8.3% of the cases of Metastatic deposits of Poorly Differentiated Carcinoma (MDPDC) showed raised serum AFP levels. Association between cytodiagnosis and serum AFP range was statistically significant. Sensitivity=100%, specificity=81.4%, PPV=27.3% and NPV= 100% were obtained when serum AFP was used to differentiate metastatic lesions with HCC taking < 8.5ng/mL as cut off. Conclusion: USG guided FNAC of the liver is a rapid, reliable and economical screening test. Serum AFP has been the most widely used tumor marker for diagnosing HCC but raised levels are also seen in other hepatic lesions decreasing its specificity.
 Keywords: Liver, FNAC, Serum Alpha fetoprotein levels

Is it liver or lung cancer? An intriguing case of lung adenocarcinoma with hepatoid differentiation

We report the case of a 50-year-old man who was investigated for an incidental finding of a left lung mass following left shoulder pain over a three month period. He also had a significant raised serum alpha-fetoprotein (AFP) level of 29,000, which raised the suspicion of hepatocellular carcinoma with lung metastases. However, there was no detectable liver lesion on multiphase contrasted tomography of the liver and no significant hypermetabolic nodes or distant metastasis seen in the liver on positron emission tomography scan. A lung biopsy confirmed adenocarcinoma with hepatocellular differentiation that would explain the raised serum AFP level.

The Role of Radiopathological Evaluation in Diagnosis of Beckwith-Wiedemann Syndrome

Beckwith-Wiedemann Syndrome (BWS), an overgrowth syndrome is associated with early development of embryonal tumours usually in the first four years of life. Hepatoblastoma is observed in 1% to 3% of persons with Beckwith-Wiedemann Syndrome or isolated hemihypertrophy(HH). We report a case of hepatoblastoma associated with both BWS and HH with raised serum alpha-feto protein levels and hypoglycaemia. Nepalese Journal of Radiology; Vol. 2; Issue 2; July-Dec. 2012; 86-91 DOI: http://dx.doi.org/10.3126/njr.v2i2.7693

A Teratoid Wilms' Tumor with Raised Serum Alpha-Fetoprotein Level

A Teratoid Wilms' Tumor with Raised Serum Alpha-Fetoprotein Level

Isoelectric focusing of alphafetoprotein in patients with hepatocellular carcinoma--frequency of specific banding patterns at non-diagnostic serum levels.

Serum levels of alphafetoprotein are raised in 60-80% of patients with hepatocellular carcinoma. Although widely used as a serum marker, frequent false-positive results in patients with benign liver disease, result in poor specificity. This occurs particularly when levels of alphafetoprotein fall between 50-500 ng ml-1, the so-called 'grey area'. Recent reports suggest that isoelectric focusing of alphafetoprotein demonstrates certain bands that are more specific for hepatocellular carcinoma. Our aim was to determine whether the apparent specificity of this new approach is gained at the expense of decreased sensitivity. Sera from 110 patients with a 'non-diagnostic' serum alphafetoprotein level (50-500 ng ml-1) were examined by isoelectric focusing and quantified by densitometric scanning. Ten patients with chronic liver disease and a raised serum alphafetoprotein level (50-500 ng ml-1), but with no evidence of hepatocellular carcinoma, were also studied. Isoelectric focusing revealed characteristic hepatocellular carcinoma bands (bands +II and +III) in 96% patients overall, and 100% of those with levels of total alphafetoprotein greater than 100 ng ml-1. No such bands were seen among ten subjects with cirrhosis but without hepatocellular carcinoma. Bands that are characteristic of hepatocellular carcinoma (bands +II or +III) are seen in the great majority of hepatocellular carcinoma patients; their absence makes a diagnosis of hepatocellular carcinoma extremely unlikely.

Pathologic features and patient survival in hepatocellular carcinoma in relation to age

For hepatocellular carcinoma, the peak age of patients is at the sixth decade. However, the influence of age on the tumor biologic behavior and long-term patient survival is controversial. We retrospectively studied 278 patients whose hepatocellular carcinomas were surgically resected to analyze the pathologic and clinical features of the tumors and patient survival in relation to age. The patients were divided into two groups, younger than 50 years of age and older than 50 years. Ninety-seven patients were 50 years of age or under, and 181 were older than 50 years. The younger patients had: (1) more frequent hepatitis B surface antigen positivity (P = 0.022), (2) less cirrhosis (P = 0.050), (3) less tumor encapsulation, (4) a more advanced tumor stage in terms of more venous permeation (P = 0.012), more liver invasion (P = 0.010) and larger tumor (P = 0.002), and (5) a more frequently raised serum alpha-fetoprotein level (P = 0.035). In spite of the more advanced stage of the tumors, both the actuarial and disease-free survival rates did not differ significantly from those of the older group. The operative mortality rates also were similar in both groups. To conclude, there were distinct differences in the clinical and pathologic features of the tumors of patients < 50 years and those older. Although the tumors were more advanced in the younger group, the less frequently associated cirrhosis in this group might have partly compensated to result in survival rates similar to those of the older group. Because of the comparable survival rates, the treatment policy in the older group should not differ greatly from that in the younger group.

A Teratoid Wilms’ Tumor with Raised Serum Alpha-Fetoprotein Level

Tumor markers are used to diagnose certain cancers and can be useful in monitoring the response to treatment. We describe a renal tumor with the features of a teratoid nephroblastoma associated with a raised serum level of alpha-fetoprotein (AFP). The serum AFP remained high during chemotherapy but returned to normal after nephrectomy. AFP was demonstrated by immunohistochemistry in cysts lined by enteric-type epithelium within the tumor. Cytogenetic examination of the tumor showed a clone of cells with trisomy 8. Raised serum AFP has not previously been described in teratoid Wilms' tumor.

Amniotic fluid acetylcholinesterase measurement in the prenatal diagnosis of open neural tube defects. Second report of the collaborative acetylcholinesterase study

Seventeen centres from Australia, Britain, France, and the United States collaborated in a study to compare amniotic fluid acetylcholinesterase (AChE) determination by gel electrophoresis and amniotic fluid alpha-fetoprotein (AFP) measurement as diagnostic tests for open neural tube defects. The study was based on 32,642 women with singleton pregnancies (including 428 with open spina bifida and 238 with anencephaly) who had an amniocentesis at 13-24 weeks' gestation. The AChE test yielded a detection rate for open spina bifida of 99 per cent (95 per cent confidence interval 98-100 per cent), 98 per cent for anencephaly (95 per cent confidence interval 96-100 per cent), and a false-positive rate of 0.34 per cent (95 per cent confidence interval 0.28-0.40 per cent) excluding miscarriages, intrauterine death, and serious fetal abnormalities. The false-positive rate was 0.30 per cent among the 13 centres that used a specific AChE inhibitor in the test. Comparable rates for the AFP test were less favourable. (For example, the open spina bifida detection rate was 90 per cent and the false-positive rate was 0.46 per cent using the cut-off levels specified in the U.K. Collaborative AFP Study.) The AChE false-positive rate was lower in samples that were not bloodstained (0.16 per cent) than in those that were (2.4 per cent). It was higher in women who had an amniocentesis on account of a raised maternal serum AFP level (0.56 per cent) than in those who had one for other reasons (0.29 per cent). The best results were obtained by a combination of the two tests, an effective and economical policy being to perform the AFP measurement on all amniotic fluid samples and an AChE test on samples with AFP levels greater than or equal to 2.0 multiples of the normal median (about 5 per cent of all samples). Using this policy, the open spina bifida detection rate was 96 per cent and the false-positive rate was 0.14 per cent (0.06 per cent for samples that were not bloodstained and 1.2 per cent for those that were; 0.40 per cent for women with raised serum AFP levels and 0.09 per cent for other women). This policy offers a useful improvement to the prenatal diagnosis of open spina bifida.

Antenatal screening for congenital nephrosis in Finland by maternal serum alpha-fetoprotein.

In the Kuopio and North-Karelia districts of Finland 10724 pregnancies were screened for congenital nephrosis by maternal serum alpha-fetoprotein (AFP) measurement. Outcome was known for 10504 (98%) pregnancies, of which 509 (4 X 8%) had a serum AFP level greater than or equal to 2 X 5 multiples of the normal median (MoM) at 15-18 weeks gestation. After exclusion of those women who had a normal serum AFP level (less than 2 X 5 MoM) in a second sample, 'wrong dates' or multiple pregnancy, 267 (2 X 5%) remained with a high serum AFP level. Amniocentesis was carried out in 225 (2 X 1%) and 16 women had an amniotic fluid AFP level greater than 10 SD above the normal mean. In this group there were six fetuses with congenital nephrosis (four confirmed and two suspected), six other serious malformations (including an intrauterine death) and four without obvious abnormality. In the 98% pregnancies followed up there were no infants with congenital nephrosis that had been missed. Babies with congenital nephrosis require permanent hospitalization and have a mean survival of 8 months. In Finland, within certain areas, the birth prevalence is as high as 1 in 2600 per year. In such areas maternal serum AFP measurement appears to be a useful method of screening for congenital nephrosis. The service was also well accepted since 94% of the women with raised serum AFP levels wished to be screened again in a future pregnancy.

Vitamin A concentration in amniotic fluid and maternal serum related to neural-tube defects.

The vitamin A concentration of amniotic fluid and maternal serum was measured during the second trimester of pregnancy in 106 women, 12 of whom had a baby with a neural-tube defect. In these 12 pregnancies the amniotic fluid vitamin A concentration was significantly higher than in 94 normal pregnancies. There was a highly significant correlation between amniotic fluid vitamin A and both zinc and alpha-fetoprotein (AFP) levels. The maternal serum vitamin A levels were also significantly related to serum zinc levels. Women with a raised serum AFP level, but a normal baby, had significantly higher amniotic fluid vitamin A levels and significantly lower serum vitamin A levels compared with those in women with normal serum AFP levels.

Maternal serum alpha-fetoprotein for prediction of fetal and neonatal morbidity and mortality.

Serum alphafetoprotein (AFP) was assayed in 154 pregnant women in midtrimester to evaluate its efficacy as an indicator of fetal wellbeing. Raised serum AFP level accurately predicated the presence of congenital malformations in two fetuses (anencephaly in one and duodenal atresia in another). One fetus with meningomyelocele was not detected by AFP because of estimation at an early gestation. Low AFP levels showed a significant correlation with neonatal morbidity (P< 001). The AFP levels did not correlate with neonatal death.

Screening for neural-tube defects and maternal anxiety.

Anxiety levels were studied in 176 women with raised serum alpha-fetoprotein levels at 16-18 weeks gestation, at the time they attended a central assessment clinic, and again 2-3 weeks later in those not found to have a fetus with a neural-tube defect. Methods of imparting information about the serum screening tests and the manner in which a normal amniotic fluid result was conveyed to the patient were also studied. Overall, women attending the clinic for further assessment were extremely anxious, irrespective of the source of their information. Anxiety scores 2-3 weeks after testing were greatly influenced by whether the patient had been given a definite normal result or whether she was told to assume that the result was normal if she did not hear from the clinic. Patients who, after reassessment, did not require amniocentesis had some residual anxiety in spite of verbal reassurance.

The relation between maternal serum alpha-fetoprotein levels and fetomaternal haemorrhage.

Spontaneous fetomaternal haemorrhage at 14 to 20 weeks gestation resulted in raised serum alpha-fetoprotein (AFP) levels in 13 of 150 patients attending a genetic counselling clinic. In all 13 patients, the placenta was anterior or fundal in position. By allowing for a rise in serum AFP levels of 4 microgram/l for each fetal cell seen in 30 high power fields (Kleihauer test), a 62.5 per cent reduction in the number of patients selected for amniocentesis because of raised serum AFP levels would have been achieved. The occurrence of fetomaternal haemorrhages at the time of amniocentesis can be detected by either the Kleihauer technique or the measurement of maternal serum AFP levels.

Maternal serum alpha-fetoprotein screening in a provincial Health District.

Maternal serum alpha-fetoprotein (AFP) estimation as a routine screening test for neural tube defect (NTD) was introduced into the West Berkshire Health District, where 17 per cent of all deliveries and most of the antenatal care is undertaken by the general practitioners. In the first year, 4458 patients were screened and 43 of those (0.96 per cent) had raised serum AFP levels. Amniocentesis was performed on 31 patients (0.69 per cent). Ten fetuses with severe NTDs and one with exomphalos were detected and the pregnancies terminated. In six patients, raised serum AFP levels were due to fetal death. No normal pregnancy was terminated. Acceptability by patients was high. Provided that a good diagnostic ultrasound facility is available locally, maternal serum AFP estimation seemed to be a valuable screening test.

The significance of raised maternal serum alpha-fetoprotein levels.

A radioimmunoassay for alpha-fetoprotein (AFP) is described and normal ranges for both maternal serum and in amniotic fluid throughout pregnancy are defined. Maternal serum AFP levels in at risk pregnancies were found to be no different from those in normal pregnancies. AFP levels in pregnancies complicated by neural tube and other congenital defects, fetal death or maternal hypertension are documented. Eight patients with a fetus deformed by anencephaly or an open spina bifida were tested before 22 weeks; seven of them had raised serum AFP levels. Other causes of raised serum AFP levels are described and the significance of a raised serum AFP level is discussed with particular reference to screening programmes.

Serum alpha-fetoprotein: diagnostic significance in liver disease.

Raised serum alpha-fetoprotein levels measured by radioimmunoassay were found in 19 out of 24 (79%) patients with primary liver cancer and in 32 out of 311 (10%) patients with other liver diseases. The rise was transient in cases of hepatitis and a transient rise was also seen after alcohol intake ceased in two patients with cirrhosis. alpha-Fetoprotein levels exceeding 500 ng/ml were 30-50 times more common in primary liver cancer than in other liver diseases. A rise in level seems to reflect the extent of liver regeneration in liver diseases other than primary cancer.

Primary Hepatoma Presenting with Central Abdominal Pain and Diagnosed from a Raised Serum Alpha-Fetoprotein Level

Primary Hepatoma Presenting with Central Abdominal Pain and Diagnosed from a Raised Serum Alpha-Fetoprotein Level