Alpha-fetoprotein

Last revised by Joshua Yap ◉ ◈ on 4 May 2023

Citation, DOI, disclosures and article data

Citation:

Bell D, Yap J, Weerakkody Y, et al. Alpha-fetoprotein. Reference article, Radiopaedia.org (Accessed on 06 Mar 2025) https://doi.org/10.53347/rID-64153

DOI:

https://doi.org/10.53347/rID-64153

Permalink:

https://radiopaedia.org/articles/64153

rID:

64153

Article created:

7 Nov 2018, Daniel J Bell ◉

Disclosures:

At the time the article was created Daniel J Bell had no recorded disclosures.

View Daniel J Bell's current disclosures

Last revised:

4 May 2023, Joshua Yap ◉ ◈

Disclosures:

At the time the article was last revised Joshua Yap had no financial relationships to ineligible companies to disclose.

View Joshua Yap's current disclosures

Revisions:

12 times, by 9 contributors - see full revision history and disclosures

Systems:

Vascular, Gastrointestinal, Hepatobiliary, Paediatrics, Obstetrics

Sections:

Pathology

Synonyms:

Raised AFP
Conditions associated with altered alpha fetoprotein levels
Serum AFP reduction
Reduced serum AFP
Alpha-fetoprotein (AFP)
Altered alpha-fetoprotein
Alpha fetoprotein (AFP) elevation
Raised serum alpha fetoprotein levels
Serum AFP elevation
Alpha fetoprotein reduction
Elevated serum alpha-fetoprotein (AFP)
Raised alpha-fetoprotein
Raised serum alpha-fetoprotein

Alpha-fetoprotein (AFP) is an important plasma protein synthesized by the yolk sac and fetal liver. In adults, its main utility is as a tumor marker, primarily for hepatocellular carcinoma or teratoma. Functionally it is the fetal homologue of albumin, i.e. it acts as a major carrier protein in the antenatal circulation. It is encoded by the AFP gene ¹.

Interpretation

Elevation

This may occur in a broad spectrum of conditions:

liver tumors (hepatocellular carcinoma, hepatoblastoma)
- <10 ng/mL is within normal limits
- >20 ng/mL is above normal limits but has low specificity for tumor since it may occur in a setting of diffuse liver injury
- increasing AFP over time, especially with stable AST and ALT is suspicious
- AFP has a low sensitivity and specificity for hepatic malignancy
- in the presence of hepatocellular carcinoma, an elevated AFP level is indicative of an aggressive tumor ⁵
pancreatic tumors
- pancreatoblastoma
antenatal conditions (maternal serum AFP (MSAFP))
- normal pregnancy
  - rises from 12 weeks and peaks during the early 3^rdtrimester
  - increased in multifetal pregnancy
- neural tube defects
- omphalocele
- OEIS complex
- cloacal exstrophy
- gastroschisis
- limb-body wall complex
- placental chorioangioma
- placental lakes
germ cell tumors
ovarian Sertoli-Leydig cell tumor (rarely) ⁴
other tumors
- fetal adenocarcinoma of the lung ⁶
non-malignant conditions

Reduction

This may be seen in pregnancy.

AFP reduction may be associated with:

certain chromosomal anomalies
Cornelia de-Lange syndrome ²

Quiz questions

References

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Alpha-fetoprotein