Supplementary Material for: Alpha-Fetoprotein Producing Esophageal Adenocarcinoma: A Case Report

Introduction: Esophageal adenocarcinoma (EAC) is a highly aggressive cancer often linked to Barrett’s esophagus and carries a poor prognosis, especially when metastatic. Alpha-fetoprotein (AFP), commonly associated with liver cancer, is rarely found in EAC. Its presence in such cases suggests a more aggressive disease with early liver metastasis. Case Presentation: We present the case of a 40-year-old man from Pakistan who came to the hospital with difficulty swallowing, vomiting, and significant weight loss. Initial tests, including imaging and endoscopy, revealed a large tumor in the lower esophagus extending into the stomach, along with liver lesions consistent with metastases. Blood tests showed a strikingly high AFP level (>60,500 ng/mL). A biopsy confirmed esophageal adenocarcinoma, and further tests showed the tumor cells were positive for AFP and Cytokeratin 7 (CK7). These findings confirmed the rare diagnosis of an AFP-producing esophageal adenocarcinoma with liver metastases. Conclusion: This case highlights the importance of considering AFP-producing EAC in patients with liver metastases and no apparent liver disease. Differentiating this condition from liver cancer is crucial, as the treatments and outcomes differ significantly. This case is the first of its kind reported in Pakistan, underscoring the rarity of the condition and its challenging nature. Further studies are needed to better understand its prognosis and guide treatment.