Which condition is NOT associated with increased AFP?

• A. Neural tube defects
• B. Spina bifida
• C. Hepatoma
• D. Choriocarcinoma

Answer: (D)

Alpha-fetoprotein is produced by fetal liver and yolk sac and can be found in maternal blood or amniotic fluid. Elevated AFP reflects abnormal fetal development or tumor production. Neural tube defects like spina bifida raise maternal AFP because the defective neural tube lets more AFP cross into the maternal circulation. AFP is also produced by certain tumors, especially hepatocellular carcinoma and yolk sac (germ cell) tumors, leading to higher levels. Choriocarcinoma, however, mainly secretes human chorionic gonadotropin (hCG) and not AFP, so AFP levels typically remain normal. So the condition not associated with increased AFP is choriocarcinoma.