Education And Debate

Lesson of the Week: Failure of normalisation of (alpha) fetoprotein concentration after successful treatment of teratoma

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7002.434 (Published 12 August 1995) Cite this as: BMJ 1995;311:434
  1. H S Pandha, senior registrar in medical oncologya,
  2. H S Wasan, senior registrar in medical oncologya,
  3. K Harrington, registrar in clinical oncologya,
  4. J Waxman, reader in oncologya
  1. Department of Clinical Oncology, Hammersmith Hospital and Royal Postgraduate Medical School, London W12 0NN
  1. Correspondence to: Dr Waxman.

    The development of successful treatment regimens for germ cell tumours has been one of the important advances in cancer chemotherapy. The effects of such treatment are monitored by measurement of serum concentrations of the tumour markers (alpha) fetoprotein and human chorionic gonadotrophin, as well as clinical and radiological assessment. The persistence of raised concentrations of (alpha) fetoprotein during or after treatment requires urgent investigation to delineate teratoma resistant to chemotherapy. We report on a patient with testicular teratoma who relapsed after initial chemotherapy in whom appreciably raised serum concentrations of (alpha) fetoprotein did not fall despite apparently successful salvage chemotherapy and surgery. An exhaustive search for a further residuum of disease was not fruitful. The finding of raised liver enzyme activities and hepatomegaly led to a liver biopsy, which showed alcoholic hepatitis. The patient decreased his alcohol intake, resulting in normalisation of his (alpha) fetoprotein concentration and liver enzyme activities.

    Case report

    A 37 year old man presented in May 1991 with testicular swelling and hepatomegaly. Orchiectomy was performed for an undifferentiated malignant teratoma that extended into the spermatic cord and blood vessels. Staging investigations showed para-aortic lymphadenopathy and a single lung metastasis. His concentration of human chorionic gonadotrophin was 1094 IU/l and of (alpha) fetoprotein 37 µg/l. Imaging studies showed no signs of liver metastases. His hepatomegaly was attributed to his alcohol consumption of 28 units a week and was accompanied by raised liver enzyme activities and a raised erythrocyte mean cell volume. He received four cycles of combination …

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