A unique case of an alpha-fetoprotein-producing lung cancer with testicular metastasis
DOI:
https://doi.org/10.5489/cuaj.22Abstract
Alpha-fetoprotein (AFP)-producing primary lung tumours are rare;
we present the first case of an AFP-producing lung tumour with
metastasis to testes. The patient, a 72-year-old man, presented
with a history of flu-like symptoms and abdominal pain. On examination
he had a hard, tender left scrotal mass. Imaging showed a
4.4-cm right lower lobe lung mass and the serum-AFP was raised
(1189 ng/mL). Left orchidectomy excised a necrotic tumour.
Microscopy showed complete hemorrhagic infarction and immunohistochemistry
showed a lack of staining for AFP. Serum-AFP
rose 3 days post-orchidectomy to 1466 ng/mL. The patient subsequently
developed melaena and died. Autopsy revealed a 9 ×
5-cm necrotic right lower lobe lung tumour. Immunohistochemistry
showed the tumour cells reacted with a pan-cytokeratin antibody
and less than 5% expressed AFP. Bilateral adrenal tumour deposits
were also identified in addition to those in the bowel and spleen.
The expression of AFP solely in the lung lesion and lack of expression
in both testes, together with a rise in serum-AFP post-orchidectomy
and the bilateral adrenal metastases, is overwhelming evidence
for the reversal of the usual situation: a poorly differentiated
AFP-secreting metastatic lung adenocarcinoma
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