A case of alpha-fetoprotein-producing adenocarcinoma of the endometrium with hepatoid component detected by elevated serum alpha-fetoprotein in chronic hepatitis C patient

Abstract

We describe a case of α-fetoprotein (AFP)-producing adenocarcinoma arising from the uterine endometrium in a 64-year-old woman with chronic hepatitis C. The patient started peginterferon α-2b and ribavirin therapy in August 2008 when the serum AFP level was 4.58 ng/mL. HCV RNA negativity was attained after 12 weeks. Thereafter, the serum AFP level rose continuously, however: AFP 69.7 ng/mL and lens culinaris agglutinin-reactive fraction of AFP (AFP-L3) 88.8% at 24 weeks after the start of treatment. Hepatocellular carcinoma was not detected, however, and imaging studies revealed an 11×8×7 cm cystic tumor in the pelvic cavity. Radical hysterectomy and partial ovariectomy were carried out. Histological studies showed AFP-positive hepatoid adenocarcinoma cells with eosinophilic cytoplasm and hyaline globules in some portion of the endometrium. After the surgery and six subsequent courses of weekly administration of carboplatin and paclitaxel, serum levels of AFP and AFP-L3 dropped within normal ranges.