American Board of Pathology (ABPath) Practice Test 2026 - Free Pathology Exam Practice Questions and Study Guide

The elevation of Alpha-fetoprotein (AFP) is particularly indicative of hepatocellular carcinoma (HCC), which distinguishes it from other liver diseases. AFP is a protein that is typically produced by the fetal liver and is usually present in very low levels in adults. In adults, significantly elevated AFP levels are strongly associated with liver cancer, especially HCC, and can also be seen in germ cell tumors and some other malignancies.

In liver diseases such as cirrhosis and hepatitis, AFP levels can also be elevated, but the key point is that a markedly high level of AFP is more strongly correlated with carcinoma than with other liver conditions. Therefore, when assessing a patient with liver disease, if the AFP level is extremely elevated, it raises suspicion for the presence of a malignant process, specifically carcinoma.

In contrast, while Beta-hCG can be elevated in certain germ cell tumors and can sometimes be seen in liver disease, it is not as specific for liver carcinoma. Similarly, CA 19-9 is more commonly associated with pancreatic cancer and other gastrointestinal malignancies rather than with liver lesions specifically. Lactate dehydrogenase (LDH) is a marker that can be elevated in a variety of conditions, including hemolysis and tissue