Esophageal adenocarcinoma with unexpectedly high AFP levels: A diagnostic challenge

Alpha-fetoprotein (AFP)-producing Esophageal Adenocarcinoma (EAC) is an extremely rare entity with only a few cases reported till date. Reporting the first case of AFP producing EAC from Pakistan. A 41-year-old male who presented with pain in epigastrium, vomiting, and dysphagia. On investigations, he was found to have an AFP-producing EAC with a surprisingly high AFP level of 60,500 ng/mL. Our case report highlights that apart from being a marker of Hepatocellular Carcinoma (HCC), AFP levels can sometimes increase in other tumors like EAC. With the diagnosis being really challenging due to its rarity. It is an aggressive tumor which usually presents late when the tumor has already metastasized to other organs and has a poor prognosis. Proper treatment regimen and regular follow ups with AFP levels should be done to keep a track of progress and recurrence of tumor.