Kobayashi N, Ohbu M, Kuroyama S, Kikuchi S, Shimao H, Mitomi H, Kakita A
Department of Surgery, School of Medicine, Kitasato University, Sagamihara, Kanagawa, Japan.
Surg Today. 2001;31(10):915-9. doi: 10.1007/s005950170035.
Alpha-fetoprotein (AFP)-producing esophageal tumors are extremely rare. We report herein the case of a 51-year-old man found to have an AFP-producing adenocarcinoma arising from esophageal proper mucosa. The patient presented for investigation of dysphagia, and esophagogram and endoscopy revealed a lesion about 2 cm in size with a depressed center surrounded by low nodular protrusions in the lower esophagus. The preoperative serum AFP concentration was elevated to 52.4 ng/ml. A subtotal esophagectomy was performed, and macroscopic examination of the resected specimen revealed a superficial protruding lesion. Histopathological studies showed a poorly differentiated adenocarcinoma with a single lymph node metastasis. The tumor had infiltrated the submucosal layer, but there was no evidence of lymphatic or venous invasion. Immunohistochemical study revealed tumor cells positive for AFP. There were no findings of Barrett's epithelium or any mucosal changes due to reflux esophagitis. An elevated AFP level 2 years after the operation led us to suspect tumor recurrence; however, diagnostic imaging studies showed no evidence of a recurrence or metastases. The serum AFP levels responded well to chemotherapy with transient decreased levels, but continued to rise until finally, 5 years after the operation, adenocarcinoma cells were detected in the pleural effusion. Thus, careful monitoring of the serum AFP levels at regular intervals could be a useful marker to indicate recurrence of esophageal carcinoma.
产生甲胎蛋白(AFP)的食管肿瘤极为罕见。我们在此报告一例51岁男性患者,其被发现患有源自食管固有黏膜的产生AFP的腺癌。患者因吞咽困难前来检查,食管造影和内镜检查显示在食管下段有一个大小约2厘米的病变,中央凹陷,周围有低结节状隆起。术前血清AFP浓度升高至52.4 ng/ml。进行了食管次全切除术,对切除标本的宏观检查显示为浅表突出性病变。组织病理学研究显示为低分化腺癌,伴有单个淋巴结转移。肿瘤已浸润至黏膜下层,但无淋巴或静脉侵犯的证据。免疫组织化学研究显示肿瘤细胞AFP呈阳性。未发现巴雷特上皮或反流性食管炎引起的任何黏膜改变。术后2年AFP水平升高使我们怀疑肿瘤复发;然而,诊断性影像学检查未发现复发或转移的证据。血清AFP水平对化疗反应良好,水平短暂下降,但持续上升,直到术后5年,最终在胸腔积液中检测到腺癌细胞。因此,定期仔细监测血清AFP水平可能是提示食管癌复发的有用标志物。