Orlando Rodriguez-Amador, MD, Patricia Rivera-Cariño, MD, Priscilla Magno-Pagatzaurtundua, MD, MSc, Andres Rabell-Bernal, VA Caribbean Healthcare System, San Juan, Puerto Rico Introduction: As gastroenterologists, we are accustomed to seeing elevated alpha-fetoprotein (AFP) levels associated to hepatocellular carcinoma (HCC). However, it is important to remember that AFP may also be elevated in other malignancies, such as gastric, lung, pancreatic, ovarian, testicular, and esophageal cancers. AFP-producing esophageal adenocarcinoma is extremely rare, with only a few cases reported in the literature. Here, we present such a case.
Case Description/
Methods: A 68-year-old man with past medical history of hypertension, hyperlipidemia, and chronic alcohol use (non-smoker) was referred to the gastroenterology clinics due to persistent AFP elevation and worsening anemia. AFP levels had been elevated since two years ago ( >3000 ng/mL). He reported unintentional weight loss and progressive dysphagia. No prior abdominal imaging had been performed, and his last endoscopy was five years prior. Laboratory workup revealed normocytic anemia, thrombocytosis, and normal liver enzymes. Given the elevated AFP and history of alcohol use, HCC was initially suspected, and a liver protocol CT was ordered. It revealed mild hepatic congestion and severe thickening of the distal esophageal wall extending into the gastroesophageal junction, with involvement of the gastrohepatic ligament suspicious for malignancy. Upper endoscopy revealed a large, friable, ulcerated circumferential mass (8 cm) with partial luminal obstruction extending to the cardia. Biopsies confirmed esophageal adenocarcinoma. Endoscopic ultrasound staged the tumor as T3N2, and PET-CT identified multiple gastrohepatic lymph node lesions. Additional tumor markers were normal. The patient began neoadjuvant chemoradiation followed by a successful Ivor Lewis esophagectomy. Discussion: AFP-producing esophageal carcinoma is rare and often not considered in the differential diagnosis when evaluating elevated AFP levels in a patient. It usually presents at an advanced stage with nonspecific gastrointestinal symptoms and carries a poor prognosis due to its insidious presentation. Surgery and chemotherapy are usually the therapeutic methods. Early diagnosis is critical, as management greatly differs from HCC. Our case highlights the importance of considering alternate malignancies in patients with elevated AFP and the need for comprehensive imaging and endoscopic evaluation.
Disclosures: Orlando Rodriguez-Amador indicated no relevant financial relationships. Patricia Rivera-Cariño indicated no relevant financial relationships. Priscilla Magno-Pagatzaurtundua indicated no relevant financial relationships. Andres Rabell-Bernal indicated no relevant financial relationships.
Orlando Rodriguez-Amador, MD, Patricia Rivera-Cariño, MD, Priscilla Magno-Pagatzaurtundua, MD, MSc, Andres Rabell-Bernal, . P5024 - When AFP Misleads: A Rare Case of Esophageal Malignancy, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
