Tuberc Respir Dis.  2012 Jan;72(1):72-76.

A Case of Primary Lung Cancer Producing Alpha-fetoprotein

• Yu JH
• Ahn JH
• Chung HH
• Kim YW
• Yu JS
• Kim JS

Abstract

We observed a very rare case of primary lung cancer producing alpha-fetoprotein (AFP). A 70-year-old male with a history of smoking 50 packs per year was diagnosed with large cell carcinoma of the lung. The clinical stage was T2bN3M0 (IIIB), and serum AFP was 23,247 ng/mL. There was no evidence of metastasis to the liver, scrotum or other organs. While undergoing chemotherapy for 1 year, as the cancer progressed the AFP value steadily increased. The patient died of respiratory failure due to pneumonia 12 months after being diagnosed with lung cancer.

Keyword

alpha-Fetoproteins; Lung Neoplasms; Carcinoma, Large Cell

MeSH Terms

Aged
alpha-Fetoproteins
Carcinoma, Large Cell
Humans
Liver
Lung
Lung Neoplasms
Male
Neoplasm Metastasis
Pneumonia
Respiratory Insufficiency
Scrotum
Smoke
Smoking
Smoke
alpha-Fetoproteins

Figure

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  Figure 1 The initial chest X-ray revealed a 6×5.2 cm size mass in the left lower lobe.

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  Figure 2 The initial chest CT image indicated a lobulated 6×5.2 cm size mass in the superior segment of the left lower lobe. CT: computed tomography.

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  Figure 3 (A) Chest axial images showed a FDG-avid (SUV 12.2) round shape mass in the left lower lobe. (B) Multiple lymphadenopathies were in the right paratracheal, both hilar, subcarina, both peribronchial regions (SUV 6.6). PET-CT: positron emission tomography-computed tomography; FDG: fludeoxyglucose.

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  Figure 4 Bronchoscopy revealed a polypoid mass-like lesion at the superior segment of the left lower lobe.

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  Figure 5 Microscopic examination of the lung mass showed poorly differentiated large cell carcinoma with hepatoid pattern (H&E stain, ×100).

Reference

1. Gitlin D, Perricelli A, Gitlin GM. Synthesis of -fetoprotein by liver, yolk sac, and gastrointestinal tract of the human conceptus. Cancer Res. 1972. 32:979–982.

2. Ruoslahti E, Seppälä M. alpha-Fetoprotein in cancer and fetal development. Adv Cancer Res. 1979. 29:275–346.

3. Javadpour N. The National Cancer Institute experience with testicular cancer. J Urol. 1978. 120:651–659.

4. Adachi Y, Tsuchihashi J, Shiraishi N, Yasuda K, Etoh T, Kitano S. AFP-producing gastric carcinoma: multivariate analysis of prognostic factors in 270 patients. Oncology. 2003. 65:95–101.

5. Chang YC, Nagasue N, Kohno H, Taniura H, Uchida M, Yamanoi A, et al. Clinicopathologic features and long-term results of alpha-fetoprotein-producing gastric cancer. Am J Gastroenterol. 1990. 85:1480–1485.

6. O'Conor GT, Tatarinov YS, Abelev GI, Uriel J. A collaborative study for the evaluation of a serologic test for primary liver cancer. Cancer. 1970. 25:1091–1098.

7. Liebman HA, Furie BC, Tong MJ, Blanchard RA, Lo KJ, Lee SD, et al. Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma. N Engl J Med. 1984. 310:1427–1431.

8. No EJ, Hur JW, Lee SS, Lee YM, Lee HP, Kim JI, et al. A case of alpha-fetoprotien producing adenocarcinoma of the lung. Tuberc Respir Dis. 2006. 61:70–73.

9. Yasunami R, Hashimoto Z, Ogura T, Hirao F, Yamamura Y. Primary lung cancer producing alpha-fetoprotein: a case report. Cancer. 1981. 47:926–929.

10. Saka H, Sakai S, Kondo N, Ito M, Shimokata K. Successful resection of alpha-fetoprotein-producing lung cancer. Chest. 1988. 94:879–880.

11. Kitada M, Ozawa K, Sato K, Matsuda Y, Hayashi S, Tokusashi Y, et al. Alpha-fetoprotein-producing primary lung carcinoma: a case report. World J Surg Oncol. 2011. 9:47.

12. Hirota F, Hosaka K, Funahashi K, Oota M, Ikeda A, Oobayashi Y, et al. Effective treatment of AFP-producing lung cancer with UFT. Gan To Kagaku Ryoho. 1999. 26:381–384.

13. Takahashi Y, Inoue T, Fukusato T. Protein induced by vitamin K absence or antagonist II-producing gastric cancer. World J Gastrointest Pathophysiol. 2010. 1:129–136.

14. Arnould L, Drouot F, Fargeot P, Bernard A, Foucher P, Collin F, et al. Hepatoid adenocarcinoma of the lung: report of a case of an unusual alpha-fetoprotein-producing lung tumor. Am J Surg Pathol. 1997. 21:1113–1118.

15. Ishikura H, Kanda M, Ito M, Nosaka K, Mizuno K. Hepatoid adenocarcinoma: a distinctive histological subtype of alpha-fetoprotein-producing lung carcinoma. Virchows Arch A Pathol Anat Histopathol. 1990. 417:73–80.