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Scientific letter
A challenging alpha-fetoprotein after liver transplantation
Un diagnóstico desafiante de alfafetoproteína elevada en paciente trasplantado hepático
Emanuel Diasa,
Corresponding author
diasj0310@gmail.com

Corresponding author.
, Hélder Cardosoa, Eduardo Rodrigues-Pintoa, Raquel Portugalb, Guilherme Macedoa
a Gastroenterology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
b Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The most common causes for elevation of serum alpha-fetoprotein are hepatocellular carcinoma and germ cell tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Less commonly&#44; it may be associated with alpha-fetoprotein producing gastric cancer&#44; a rare subtype of gastric adenocarcinoma &#40;2&#8211;15&#37;&#41; that is usually diagnosed in advanced stage and typically associated with poor prognosis and higher rates of lymphatic and venous invasion&#44; lymph node metastasis and liver metastasis than conventional gastric cancer&#46; Accordingly&#44; it is demonstrated that increased alpha-fetoprotein is associated with overall poorer prognosis in gastric adenocarcinoma&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 39-year-old female with previous medical history of liver transplantation for alcoholic liver cirrhosis performed 4 years earlier&#44; and abstinent since then&#44; who was referred to our hospital for investigation of a progressive rise of serum alpha-fetoprotein &#40;peak&#58; 1100<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#41;&#46; Since liver transplantation&#44; she had been under immunosuppression with tacrolimus without any signs of graft rejection&#46; She referred asthenia&#44; post-prandial fullness&#44; nausea and vomiting&#46; Abdominal computed tomography scan revealed gastric parietal thickening suggestive of malignancy &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41; associated with peri-gastric lymphadenopathy and two hypodense liver nodules with 10 and 32<span class="elsevierStyleHsp" style=""></span>mm&#44; both located in segment II and demonstrating peripheral hyperenhancement during arterial phase without evident washout during portal phase&#44; suggestive of liver metastasis&#46; Liver allograft did not display signs of cirrhotic transformation&#46; Therefore&#44; she undergone upper digestive endoscopy that showed a large ulcerated polypoid lesion involving the smaller curvature along body and antrum &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Biopsies of the lesion were performed and histopathological examination revealed adenocarcinoma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#44; with strong immunohistochemical positivity for alpha-fetoprotein &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#44; consistent with alpha-fetoprotein producing gastric cancer &#40;stage IV&#41;&#46; After multidisciplinary discussion&#44; palliative chemotherapy was started&#46; Additionally&#44; because of food intolerance and vomiting&#44; a palliative endoscopic stent was placed&#46; However&#44; the patient evolved unfavorably and died after 4 months&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Alpha-fetoprotein producing gastric cancer has been previously described in patients with chronic liver disease&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#8211;5</span></a> including cases associated with liver cirrhosis secondary to chronic hepatitis B<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> or unknown etiology<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> or with noncirrhotic chronic hepatitis C&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> However&#44; to the best of our knowledge&#44; we describe the first case in association with liver transplantation&#46; Even though this association could be coincidental&#44; it is possible that post-transplant immunosuppression may have played a role in the development of malignancy&#46; Further studies are needed to determine whether immunosuppression is effectively a risk factor for this uncommon malignancy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; this case demonstrates that alpha-fetoprotein producing gastric cancer must be considered in the differential diagnosis of elevated alpha-fetoprotein&#44; particularly in the presence of associated dyspeptic symptoms&#46; Although the incidence of this malignancy does not appear to be increased in patients with liver disease&#44; hepatologists should be aware of its existence when following these patients due to frequent use of alpha-fetoprotein in this setting&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos