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A 47-year-old man without any discomfort was found to have elevated serum α-fetoprotein (AFP) of 41.0 ng/ml (normal range <20 ng/ml) during a health check-up in January 2000. Physical examination and laboratory data were non-contributory except for positive hepatitis B surface antigen. Two years later, his AFP increased to 388.0 ng/ml in March 2002. A contrast-enhanced abdominal CT scan demonstrated nearly total fatty replacement of the pancreas and a well-defined tumour, measuring 2 cm in diameter, at the pancreatic tail (fig 1, arrow). Serum levels of carbohydrate antigen 19-9 and carcinoembryonic antigen were 7.88 U/ml (normal range <37 U/ml) and 0.82 ng/ml (normal range <5.0 ng/ml), respectively. Two months later, his AFP rose to 490.5 ng/ml. The patient underwent a positron emission tomography (PET) scan, which showed a focus of increased uptake at the pancreatic tail (fig 2).
Is the pancreatic tumour the incidental or pertinent finding for the elevated AFP?
See page 46210.1136/gut.2006.115014a for answer
Competing interests: None.
Patient consent: Informed consent was obtained for publication of the person’s details and figures in this report.
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