Elevated alpha-fetoprotein in benign/borderline liver masses in children

In childhood hepatic tumors, the elevated AFP level rates of hepatoblastoma, hepatocellular carcinoma and fibrolamellar variant are 60-70%, 50% and 10% respectively.[]

The undulant AFP course in patients with germ cell tumors during follow-up was assessed by Aydin et al.[] They concluded that without a demonstrable tumor, the small amplitude undulations may only require a careful follow-up. However, it should be kept in mind that despite the decrease in AFP levels, there still might be a risk of recurrence, especially in patients who have greater amplitude undulations.[]

In addition, elevated AFP levels may be seen in some benign conditions including hepatic disorders (extrahepatic biliary atresia, neonatal hepatitis, acute and chronic viral hepatitis, fulminant acute hepatitis, liver cirrhosis, hepatic abscess), hereditary disorders (hereditary AFP persistence, ataxia telangiectasia, hereditary tyrosinemia type 1), systemic lupus erythematosis, Hirschsprung disease, pregnancy and infancy.[]

In the literature, high AFP levels in different benign liver masses have been reported.[-] Sari et al.[] reported elevated AFP levels in a 15-dayold boy with hemangioendothelioma. In this case, initial AFP level was 650 ng/mL (normal range for his age 88±87 ng/mL). After high dose methylprednisolone treatment, AFP level was 54.7 ng/ mL (normal range for age 12.5±9.8 ng/mL); and when he was 2-years-old, the serum AFP level was normal. Another case is our case, which is an 11-month-old boy. He was admitted to our hospital with complaints of irritability and painless abdominal mass. Imaging studies showed a large multicystic liver mass and serum AFP level was 3829 ng/mL. The fine-needle aspiration biopsy suggested the lesion to be hepatoblastoma; therefore, he received preoperative chemotherapy. At the end of the preoperative chemotherapy, the tumor size and AFP level decreased. A right hepatectomy was performed. The pathologic examination of the specimen revealed mesenchymal hamartoma. [] The other case was focal nodular hyperplasia of the liver and elevated AFP level in an infant with isolated hemihyperplasia which was reported by Demir et al.[]

Herein, we aimed to evaluate the elevated AFP levels in benign/borderline liver masses in this study. There were three boys and two girls with a median age of 6 months (range 1-12 months) at the time that the liver mass was diagnosed. At the time of the diagnosis, AFP levels were between 123 U/L and 4905 U/L (median 2736 U/L). The masses ranging from 11 mm to 28 cm were detected during screening studies. Two patients were diagnosed with hemangioendothelioma, 1 patient had mesenchymal hamartoma of the liver, one patient had hemangioma and another one was diagnosed with focal nodular hyperplasia through histopathological examination. One of the patients with hemangioendothelioma was referred to another center for liver transplantation, but the other one died during the early follow-up while under steroid treatment. In the patient who had hamartoma with high AFP levels, which was previously reported,[] fine needle aspiration biopsy revealed malign cells; therefore, the patient was thought to have primary liver malignancy and cisplatin-adriamicin regimen was started. After the treatment, the mass size in the liver had shrunk and totally excised surgically. With the pathologic evaluation after the operation, it is determined that the first assessment of the patient was wrong and the true diagnose was hamartoma. Thus, the treatment of the patient was stopped and the patient is currently disease-free and under follow-up. The patients with hemangioma and focal nodular hyperplasia are still under follow-up without receiving any treatment.