α fetoprotein is elevated at the time of diagnosis in up to 90%
of patients with hepatoblastoma, but levels are usually normal
in IHE. Therefore, a solitary hepatic mass and elevated serum
AFP level suggest the possibility of a hepatoblastoma.
Both cases in this study presented with unusually high
serum AFP levels when adjusted for age. The AFP level in
case 1 continued to be high 4 days after surgery because its
half-life in serum is 2 weeks in patients of such an age .
α fetoprotein normalized 33 days after surgery.
Morphologically normal hepatic cells are suspected of
contributing to the elevated serum AFP seen in the setting of
IHE; this occurs as a response to the tumor [10,11]. Our
immunohistochemical study revealed positive AFP staining
only in hepatocytes at the advancing edge or near the margin
of the tumor; however, hepatocytes distant from the tumor
had negative AFP staining. Furthermore, AFP-positive
hepatocytes were seen more frequently in case 1 than in
case 2, which correlated with the elevated AFP levels in both
cases: more than 8 times the normal AFP level in case 1 and
more than 3 times the normal AFP level in case 2. Previous
investigators have searched for the cause of the elevated AFP
levels in IHE by immunohistochemical studies. Chan et al
 and Seo et al  tried unsuccessfully to demonstrate
AFP expression in tumor cells. These findings suggest that
tumor cells are not responsible for the elevated AFP and
reinforces our results. Our study is the first immunohisto-
chemical study to demonstrate that hepatocytes near the
tumor may be responsible for the unusually elevated serum
AFP level seen in IHE.
In conclusion, infants with hepatic masses and elevated
serum AFP may have IHE. Using immunohistochemical
staining, we clearly documented that AFP is expressed by
hepatocytes near or trapped within the tumor and not by
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