Background and Importance: Sacrococcygeal teratoma (SCT) with medular invasion is rare. Case Presentation: We report a case of an 11-months male infant, with no prenatal history of any abnormality, presenting since birth, a mass in the buttock extended to retrorectum associated with a right side hypotonic limb and monoplegia. Medullar and abdominal pelvic magnetic resonance imaging (MRI) showed a sacrococcygeal tissue mass and intradural lombosacral invasion with a high level of alpha-fetoprotein. Surgical performed was done successfully with an uneventful follow-up. Conclusion: Although the intradural invasion, those SCT are in major cases mature and present low risk of malignancy or recurrence.

Alpha-fetoprotein producing gastric cancer accounts for less than 10% of the gastric adenocarcinomas. Different histologic subtypes may exist, the least common of which is yolk sac morphology. To the best of our knowledge less than 10 cases have been reported with high alpha-fetoprotein and yolk sac components, either pure or mixed with ordinary adenocarcinoma of the stomach. During 10 years, from among more than 500 gastric adenocarcinoma cases that presented to the largest referral center in Southern Iran, two cases of gastric cancer with yolk sac components and high alphafetoprotein have been diagnosed, as presented in this case report.

A 19-year-old male presented with a chief complaint of mild scrotal pain for eight months duration. There was no positive history of weight loss and the patient was in generally good general health. Physical examination and laboratory findings were unremarkable. Laboratory examinations consisted of a complete blood count and biochemical tests, both of which were within normal limits. Laboratory evaluations that included beta-human chorionic gonadotropin (beta-HCG), lactate dehydrogenase (LDH), and alphafetoprotein (AFP) were also normal. Testicular ultrasonography revealed a circumscribed, heterogeneous, predominantly hypoechoic mass in the right testis that measured 13 mm in diamete.

Aim of this study is to determine the risk of adverse pregnancy outcome by maternal serum alphafetoprotein (MSAFP) level. We followed 295 pregnant women from MSAFP screening in the 14th to 22th week of gestation until the end of pregnancy and information on pregnancy outcome have been recorded in questionnaires. Of 295 pregnant women, 270 had term labor and 25 had preterm labor. The frequencies of pregnancy outcomes were as following: 3 (1.01%) stillbirths, 25(8.47%) preterm labor, and 10 (3.4%) preterm rupture of membranous (PROM), 15 (5.1%) pre-eclampsia, 23 (7.8%) oligohydramnious, and 1 (0.33%) miscarriage. The mean of preterm labor was significantly associated with the higher level of MSAFP (P =0.021). The mean was 55.1 ng/cc in preterm labor and 41.1 ng/cc in term labor. Also, second trimester MSAFP levels were higher in women with pre-eclampsia (P <0.001). The significant association was found between higher level of MSAFP with oligohydramnious (P <0.001) and low birth weight (P <0.001). Pregnancies with an elevated MSAFP level are associated with adverse obstetric outcomes and need more prenatal care.

Background and aims: Hyperbilirubinemia is one of the most common diseases in neonatal period and the early diagnos of that is important to prevent complications. The aim of this study was to determine the relationship between umbilical cord alpha fetoprotein and hyperbilirubinemia in the third day of birth.Methods: In this descreptive cross-sectional study 120 neonates were entered in the study through random sampling, after the birth, blood samples of umbilical cord were collected. Serum Alpha-fetoprotein levels were measured by ELISA techniques. On the third day of the birth 1.5CC were taken to determine the baby's bilirubin level. Laboratory values were recorded in the form and demographic data were completed in the questionnaire for collecting the data. The data were analyzed using software SPSS and Spearman test, t-test.Results: The results showed average weight of neonatal 3048.75 ± 356.23 gram, average amount of alpha-fetoprotein were 70.63 ± 14.20mg /l and mean bilirubin amount of were 10.21 ± 3.37 mgdl. There was no significant correlation between the weight and the amount of alpha-fetoprotein (P>0.05). But between weight and amount of bilirubin in the third day after the birth there was a significant inverse relationship (P<0.05, r=-0.28), Significant direct relationship was found between bilirubin and Alpha-fetoprotein (P<0.05, r=0.15).Conclusion: This study shows a statiscal relationship between alphafetoprotein and bilirubin, so, with further studies in this field, finding strong correlation between alpha-fetoprotein cord and neonatal hyperbilirubinemia, the samples from the umbilical cord can be used in screening for neonatal hyperbilirubinemia and jaundice.

Background: Hepatocellular carcinoma (HCC) is common all over the world as well as Iran. The incidence of HCC is higher in hepatitis B carriers and it is highly recommended to periodically screen these patients by serum alpha-fetoprotein (AFP) and liver ultrasound (US) every 6 months. We explore the diagnostic accuracy and the performance of (AFP) in cases of hepatitis B carriers as a screening tool by using serum total AFP concentration of 20 ng/ml. Materials and Methods: The study included 2452 HBsAg carriers with no evidence of hepatocellular carcinoma or cirrhosis were followed up in a 6-year prospective surveillance program with testing by ultrasound and alphafetoprotein every 6 months referred to the Ahwaz JundiShapour university hospitals and hepatitis clinic (1999-2004). Men and nonpregnant women with an elevated AFP level were evaluated for the presence of HCC by ultrasound (US) examination. Hepatitis B surface antigen (HBsAg), anti-HBc antibody and alpha-fetoprotein (AFP) were determined in all cases by enzyme-linked immunosorbent assay (ELISA). Findings: One or more AFP elevations (higher than 20 ng/ml) were found in 32 cases, but 13 (45%) hepatocellular carcinomas were detected in these patients during follow up (9 men and 4 women). Of the 32 HBsAg carriers with AFP serum levels of more than 20 ng/ml, HCC was not detected in 19 cases (65%). The positive predictive value for AFP to detect HCC was only 31% for our AFP cut-off value, and the sensitivity and specificity was approximately 56 and 88%, respectively.The positive predictive value for ultrasound examinations to detect HCC was 64%, while the sensitivity and specificity was 90 and 92%, respectively. Conclusion: We conclude that AFP alone is not a useful marker for HCC screening because of its poor predictive value and low sensitivity, particularly in patients with underlying viral hepatitis B without cirrhosis and is not recommended except when ultrasonography is either not available or of poor quality. Ultrasonography seems more efficient and accurate as a screening tool.    

Introduction: Early recurrence of hepatocellular carcinoma (HCC) is a major risk factor affecting survival even after hepatectomy. Many clinical, biochemical parameters and pathological grading like fibrosis 1 index have been used for risk stratifying HCC. However not many studies have combined all of them. It is therefore important to risk stratify HCC especially with newer PET based metabolic parameters to see if they match with existing clinicopathological parameters to achieve better clinical outcome. The objectives of this study were twofold,firstly, to evaluate [ F]FDG PET as a prognostic biomarker to predict tumour recurrence. Secondly, if clinicopathological parameters combined with PET indices increase the risk correlate in predicting HCC disease recurrence. 18 Methods: Records of 200 adult HCC patients were analysed, (6: 1, Male: Female,mean age ±,SD, 52 ±,2 year). All underwent [ 18 F]FDG PET (PET MR: PET CT = 168: 32) and subsequent therapy. Patients had a follow up for at least 15 months or onset of first recurrence, whichever was earlier. Clinicopathological data, alpha-fetoprotein (AFP) titres, SUVmax and few other PET indices were documented along with details of first recurrence. Statistical analysis was also performed. Results: In a multivariate analysis of various prognostic factors including T (SUVmax)/ L (SUVmax), serum alphafetoprotein, T stage, size of tumour, and vascular invasion of tumour, T (SUVmax)/ L (SUVmax) was the most significant with a cut off value of 1. 9. Only vascular invasion of tumour and AFP titres had additional significance. 16% ( 32/200 patients) developed recurrence (OR 1. 673). Comparing the low and high AFP titres by Kaplan Meir curve, P was found to be 0. 039 that predicted a worse prognosis in patients with higher AFP titres. Similarly patients with higher SUV T/L: ratio of tumour SUVmax to liver (> 1. 9) also revealed higher recurrence rate. Cut-off SUVmax was 3. 03 g/ml in our series (range 2. 5-23. 8 g/ml) and found to be strongly associated with AFP, tumour size, number, and histological grade of tumour. Conclusion: Our study shows that PET based metabolic indices are effective robust tools to predict tumour recurrence in aggressive HCC. Secondly, when clinicopathological parameters are combined with PET based indices there is better prediction of HCC recurrence and one can reclassify HCC patients into mild, moderate, and high-risk groups. We found it very useful in predicting poor clinical outcome especially in high-risk HCC patients,so that stricter surveillance measures can be recommended to identify early recurrence and offer appropriate therapy. The strength of this study lies in the fact that the observed associations between the combined parameters were found to be stronger than those reported in the past.