A Case of Alpha-Feto-Protein (AFP) -Producing Metastatic Carcinoma of the Sigmoid Colon

Masanori Kobayashi¹⁾, Norihiro Kokudo¹⁾, Makoto Seki¹⁾, Takashi Takahashi¹⁾, Akio Yanagisawa²⁾ and Katsujiro Maekawa³⁾

Department of Surgery¹⁾, Department of Pathology²⁾ Cancer Institute Hospital and
Department of Surgery of Saiseikai Kawaguchi General Hospital³⁾

We report a case of alpha-feto-protein (AFP) -producing metastatic carcinoma of the sigmoid colon. A 65-year-old woman underwent sigmoidectomy for sigmoid colon cancer at another hospital. Eight months later abdominal CT showed a metastatic liver tumor in the left lobe. The serum AFP level was 1,036.8 ng/ml at the time of diagnosis. Left bisegmentectomy and partial resection of the posterior segment was performed with curative intent. Twenty-six days after liver resection, a golf ball sized recurrent tumor was recognized in the subcutaneus tissue near the operation wound. Abdominal CT demonstrated tumor recurrence in the remnant liver. The patient died of hepatic failure ninety-four days after liver resection (1 year 4 month after the first operation). Histological findings of the primary lesion and liver tumor were moderatery differentiated adenocarcinoma including neoplastic cells with clear cytoplasm arranged in solid sheet or trabecular pattern (hepatoid differentiated areas). Immunohistochemical AFP staining showed AFP-positive cells. Both in the primary tumor and liver metastasis, AFP-positive cells were detected mainly in hepatoid differentiated areas. AFP-producing colorectal carcinomas tend to metastasize to the liver, and have a poor prognosis.

Key words
alpha-fetoprotein, sigmoid colon cancer, hepatoid differentiation

Reprint requests
Masanori Kobayashi Department of Surgery, Takasaki Centeal Hospital 498-1 Takazekimachi, Takasaki, 370-0043 JAPAN

Accepted
April 28, 1999

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