A 48-year-old man with hepatitis C-related cirrhosis is found to have a 3 cm hypervascular hepatic mass on CT with arterial enhancement and portal washout. Serum AFP is 1,200 ng/mL. Which statement about this tumor marker is MOST accurate?
- A AFP is equally elevated in intrahepatic cholangiocarcinoma and hepatocellular carcinoma
- B AFP elevation is specific to adult-onset hepatocellular carcinoma and is not seen in yolk sac tumors
- C Normal AFP excludes hepatocellular carcinoma in a cirrhotic patient
- D AFP >400 ng/mL in this clinical context is diagnostic of hepatocellular carcinoma without biopsy ✓
Explanation
In a patient with cirrhosis (high-risk background) with a hypervascular hepatic mass showing characteristic arterial enhancement and venous/delayed washout on multiphasic CT, an AFP level >400 ng/mL meets established imaging + biomarker criteria that are accepted as diagnostic for hepatocellular carcinoma without tissue biopsy in many guidelines (AASLD, EASL). AFP is also elevated in yolk sac tumors (non-seminomatous GCTs) and in hepatoblastoma in children, so it is not specific to adult HCC. Cholangiocarcinoma typically does not elevate AFP. Normal AFP does not exclude HCC, as 30–40% of HCCs are AFP-negative.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
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