Alpha-Fetoprotein-producing Neuroendocrine Carcinoma of the Pancreas with Multiple Liver Metastasis: A Case Report

Abstract Alpha-fetoprotein (AFP) is a well-known tumor marker for hepatocellular carcinoma (HCC). However, Grade 3 AFP-producing neuroendocrine tumor (NET) is a rare and aggressive cancer. We report the case of a 68-year-old female admitted for multiple liver tumors and an elevated AFP level discovered during a routine health examination. A computed tomography (CT) scan showed a pancreatic body–tail tumor with multiple liver tumors. Microscopy revealed that the tumor tissue was composed of trabecular growth of tumor cells containing abundant cytoplasm. The tumor cells were positive for chromogranin A, INSM1, synaptophysin, and CK19. These histopathological findings supported the diagnosis of an AFP-producing G3 pancreatic NET (pNET). Her serum AFP level decreased by approximately 70% after three courses of chemotherapy, including etoposide and cisplatin. After 3 months of treatment, a CT scan showed progression of bone metastasis, and the patient died 13 months after diagnosis. This case highlights that serum AFP may be a useful tumor marker for monitoring the treatment response in patients with metastatic pNETs.