Alpha-fetoprotein Producing Adenocarcinoma of Esophagogastric Junction: A Case Report

Junya Fukuzawa, Hideo Terashima, Yoritaka Nakano, Chigusa Nakahashi, Tatsuya Oda, Kenji Yuzawa, Takeshi Todoroki and Nobuhiro Ohkouchi

Department of Gastrointestinal Surgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba

A 55-year-old man admitted for hematemesis and dysphagia had severe anemia, Hb 3.9 g/dl. Serum alpha-fetoprotein (AFP) was extremely high at 47,800 ng/ml. Gastrointestinal endoscopy showed an elevated lesion in the lower esophagus extending to the esophagogastric junction. Computed tomography showed multiple lung metastases. Emergency surgery for uncontrollable bleeding from the tumor in laparotomy and a transhiatus approach, involved distal esophagectomy and reconstruction using a subtotal gastric tube. In histological examination, the tumor was diagnosed as esophageal adenocarcinoma similar to hepatic cell carcinoma. Immunohistochemical study indicated positive AFP. The tumor was AFP-producing adenocarcinoma of the esophagus. After surgery, serum AFP decreased to 1,900 ng/ml. The patient was discharged on postoperative day 10. Despite adjunctive chemotherapy, he developed lung and bone metastases with increasing serum AFP, eventually dying 9 months after surgery. Only 6 such cases have been reported previously in Japan. In addition, we discussed problems on the classification of adeocarcinoma at the esophagogastiric junction.

Key words
AFP producing esophageal carcinoma, carcinoma of esophagogastric junction

Reprint requests
Junya Fukuzawa Department of Gastrointestinal Surgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
1-1-1 Tennodai, Tsukuba, 305-8575 JAPAN

Accepted
November 30, 2004

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