Increase in serum alpha-fetoprotein without recurrent disease after hepatectomy for hepatocellular carcinoma.

The case of a 58-year-old man with clinically-stable and compensated HBsAg-positive liver cirrhosis is reported. In April 1991, the patient underwent partial hepatectomy to treat a solitary 3.5 cm hepatocellular carcinoma (HCC), (Edmonson scale I), in the 5th liver segment. His serum alpha-fetoprotein (AFP) level was 24 ng/ml. After hepatectomy, the AFP level dropped to 8 ng/ml, but between the 4th and 12th month it rose gradually from 72 ng/ml to 4,520 ng/ml. Hepatic recurrence of HCC was excluded, but a 6 cm solitary metastasis (Edmonson scale III-IV) was detected on the right adrenal. Adrenalectomy was performed and two months later the patient is doing well and his AFP level is 51 ng/ml. The methodological approach to diagnosis, treatment and follow-up of HCC, and the relationship between AFP and liver and metastatic HCC, are discussed.