A case of cholangiocellular carcinoma with elevated serum AFP-L3 level

We reported a case of cholangiocellular carcinoma with elevated serum AFP-L3 level. A 70-year-old man who complained of body weight loss was pointed out a liver tumor at a near doctor and refered to our hospital. A tumor of 7 cm in diameter and other small nodules were detected by abdominal dynamic CT and ultrasonography. HBsAg and anti HCV were negative. Slight elevation of AFP 63.6 ng/ml and PIVKA-II 46 mAU/ml were pointed out. On the other hand, CEA and CA19-9 were not elevated. We thought that hepatocellular carcinoma was higly suspected because of the remarkable elevation of AFP-L3 88.2%. But the tumor did not show typical tumor staining by dynamic CT and angiograpy. Histology of the tumor biopsy was poorly differentiated adenocarcinoma, and we diagnosed the tumor as cholangiocellular carcinoma because all possible origins were excluded. Systemic chemotherapy (5-FU+CDDP) was performed but discontinued because of adverse events. The patient died about 2 months after diagnosis. The elevation of AFP-L3 was thought to be specific to hepatocellular carcinoma, but differential diagnosis shoud be done carefully.