Question

AFP is increased in which tumor?

• A. Hepatoblastoma
• B. Wilms tumor
• C. Retinoblastoma
• D. Neuroblastoma

Hint:

Pediatric Tumor Markers Summary:
- Hepatoblastoma & Yolk Sac Tumor (Endodermal Sinus Tumor): $\uparrow$ Alpha-Fetoprotein (AFP).
- Neuroblastoma: $\uparrow$ Urinary VMA and HVA, $\uparrow$ Ferritin, $\uparrow$ Neuron-specific enolase (NSE).
- Choriocarcinoma: $\uparrow \beta$-hCG.
- Wilms tumor: No specific serum tumor marker (Hypertension $\pm \uparrow$ Renin).

Answer 1

The Correct Option is A

Concept:
Alpha-fetoprotein (AFP) is an oncofetal glycoprotein synthesized during embryonic development by the fetal yolk sac and liver.
In pediatric oncology, serum AFP serves as a vital diagnostic, prognostic, and disease-monitoring tumor marker for hepatic tumors and germ cell tumors.
Explanation:
• Hepatoblastoma is the most common primary malignant liver tumor in infants and young children ($< 5\text{ years}$ of age).

• Markedly elevated serum AFP levels (often exceeding $100,000\text{ to }1,000,000\text{ ng/mL}$) are detected in over 90% of children with hepatoblastoma.

• Serial AFP monitoring is used universally to evaluate treatment response to neoadjuvant chemotherapy, verify completeness of surgical resection, and detect early disease recurrence.

• Exception: The rare small cell undifferentiated subtype of hepatoblastoma is associated with low or normal AFP and carries a very poor prognosis.

• Wilms tumor (nephroblastoma) is a renal tumor and does not produce AFP.

• Retinoblastoma is an intraocular neuroectodermal malignancy ($RB1$ gene defect) with no AFP association.

• Neuroblastoma produces catecholamine metabolites (urinary Homovanillic Acid [HVA] and Vanillylmandelic Acid [VMA]) and ferritin, but not AFP.
Final Answer:
Serum alpha-fetoprotein (AFP) is characteristically and markedly elevated in Hepatoblastoma.