Serum alpha-fetoprotein-positive gastric carcinoid with liver metastasis

Adult granulosa cell tumor of the ovary with foci of hepatic cell differentiation: a report of four cases and comparison with two cases of granulosa cell tumor with Leydig cells

We report four ovarian granulosa cell tumors of the adult type containing small foci of hepatic cell differentiation. The patients ranged in age from 35 to 54 years and had unilateral adnexal masses. The smallest tumor was 4.0 cm in diameter and the largest, 11.0 cm in diameter. Three tumors were solid and cystic, and one was cystic. Microscopic examination showed typical patterns of adult granulosa cell tumor, with the additional finding of scattered islands of large cells with abundant eosinophilic, slightly granular cytoplasm and central round nuclei containing single prominent nucleoli. Bile pigment was detected in canaliculi between some of the large cells in three tumors. The hepatic cells were positive immunohistochemically for cytokeratin (CAM 5.2) and epithelial membrane antigen in two cases and alpha-fetoprotein in one of two cases. Carcinoembryonic antigen was stained in a canalicular pattern in two cases. Staining for vimentin and alpha-inhibin was negative. Liver cells in granulosa cell tumors must be differentiated from Leydig cells, which are found very rarely in granulosa cell tumors, and luteinized stromal and granulosa cells, which are present more commonly in these tumors; all three of the latter cell types are positive for alpha-inhibin.

A case of gallbladder carcinoma producing both alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA)

A 73-year-old woman with gallbladder carcinoma infiltrating to the liver presenting high serum values of AFP and CEA was reported. Serum values of AFP and CEA were remarkably high (165,000 ng/ml and 1,070 ng/ml). Immunohistochemically the tumor cells were stained for AFP and CEA by the PAP method. Serum AFP subfraction was analyzed by crossed immunoaffinoelectrophoresis with lentil lectin and concanavalin A, which showed most of the serum AFP bound to both lentil lectin and concanavalin A. As a case of gallbladder carcinoma presenting a high serum value of AFP is rare, it may imply a diagnostic challenge.

Pulmonary atypical carcinoid tumor with marked alphafetoprotein production and features of an adenocarcinoma differentiation

A 67-year-old man presented with a pulmonary atypical carcinoid tumor with marked elevation of the serum alpha-fetoprotein (AFP) level to 181,000 ng/ml and no hepatic metastases. Immunohistochemistry revealed AFP-positive fine granules, sparsely distributed in some cells. The proportion of the concanavalin A nonbinding subfraction was 33.7%. Light microscopy revealed hyaline globules within or outside the clear and reticular cytoplasm of a few cells. These were ultrastructurally electron-dense materials similar to the hyaline bodies observed in yolk sac tumors. The Grimelius silver method stained only a few cells and very few cells showed a positive Masson-Fontana reaction. Electron microscopy revealed secretory granules measuring 220 nm on the average in scattered cells. Immunohistochemical studies showed 5-hydroxytryptophan in many cells and 5-hydroxytriptamine or serotonin in only a few cells. As for polypeptide hormones, gastrin was detected and in autopsy specimens carcinoembryonic antigen (CEA) immunoreactive cells were observed. Past case reports on the coexistence of carcinoid tumors and adenocarcinomas in the digestive tract suggest that the tumor cells in our case are also derived from primitive or stem cells of endodermal origin and expressed unusual differentiation in the course of treatment.

Heterotransplantation of an alpha-fetoprotein-producing human gallbladder carcinoma into nude mice

An alpha-fetoprotein (AFP)-producing human gallbladder carcinoma showing direct invasion into the liver was transplanted into BALB/c-nu/nu nude mice. Although patient serum levels of AFP and carcinoembryonic antigen (CEA) were within normal limits, they were elevated to 1,040 ng/ml and 22.1 ng/ml, respectively, after cholecystectomy. Prominent liver metastasis was demonstrated by diagnostic imaging techniques shortly after the operation. Pathologically, the resected tumor consisted of papillotubular adenocarcinoma and the part which had invaded the liver showed a solid growth pattern with no papillo-tubular structure. The transplanted tumor showed both papillo-tubular and solid growth patterns, in which positive reactions for AFP, CEA, ferritin (FER), carbohydrate antigen 19-9 (CA 19-9), albumin (ALB) and fibrinogen (FIB) were confirmed by the avidin-biotin-peroxidase complex method. Serum levels of AFP, CEA, CA 19-9, beta 2-microglobulin (BMG) and FER were elevated in the nude mice bearing tumor transplants. Twenty-five percent of the serum AFP from nude mice with tumor transplants bound with concanavalin A (Con A), suggesting that the tumor was of gastrointestinal rather than hepatic origin.

Ovarian Sertoli-Leydig cell tumour with raised serum alpha fetoprotein. A case report

A case of ovarian Sertoli-Leydig cell tumour with a raised serum alpha fetoprotein is reported. The patient first presented at the age of 27 years with a history of 6 years' amenorrhoea followed by 3 months irregular vaginal bleeding. A ovarian tumour was found and excised and shown microscopically to be a spindle cell malignant tumour. The patient was treated with chemotherapy and had a complete response. Thirty months after first presentation there was a recurrence in the pelvis which microscopically showed the typical features of a Sertoli-Leydig cell tumour. Six months later a second recurrence had the microscopic appearance of a lipid cell tumour. A raised serum alpha fetoprotein was found at the time of the second recurrence and immunohistochemistry showed this protein in the Leydig and luteinized cells of the recurrent tumours but not in the spindle cells of the original ovarian neoplasm.

Endodermal sinus tumor of the stomach

This is a case report of an endodermal sinus tumor arising in the stomach of a 72-year-old Japanese woman. The tumor showed Borrmann 2 type at the mucosal surface, and the main mass occupied the subserosal layer with outgoing extension. Microscopically, the tumor showed typical characteristics of the endodermal sinus tumor, associated with embryonal carcinoma, poorly differentiated adenocarcinoma and well differentiated tubular adenocarcinoma. Alpha-fetoprotein was detected in the serum of the patient by radioimmunoassay and within tumor tissue by immunohistochemical techniques. Ultrastructurally, a characteristic basement membrane-like material has been identified in intercellular spaces.