PIVKA-II-producing advanced gastric cancer.
We describe the case of a 68-year-old man with primary advanced adenocarcinoma of the stomach, who displayed extremely high plasma levels of protein induced by vitamin K antagonist (PIVKA)-II (15 600 mAU/ml) and normal levels of alphafetoprotein (AFP) (4 ng/ml). Ultrasonography and dynamic computed tomography ruled out hepatocellular carcinoma (HCC) or liver metastasis. After preoperative chemotherapy, pancreatico-spleno total gastrectomy with D2 lymphadenectomy was performed. Postoperatively, plasma levels of PIVKA-II returned to within the normal range (29 mAU/ml). Microscopic examination revealed stomach adenocarcinoma showing various histological types, such as moderately to poorly differentiated mucinous adenocarcinoma, but hepatoid differentiation of gastric adenocarcinoma was not detected. Localization of PIVKA-II and AFP within tumor cells was demonstrated by immunohistochemical staining using monoclonal antibodies. These results indicate that tumor cells from gastric cancer may produce PIVKA-II. Some cases of PIVKA-II- and AFP-producing advanced gastric cancer with liver metastasis have been reported, but this is the first report of gastric cancer without liver metastasis producing PIVKA-II alone.
Takano
Shigetsugu
S
Department of Gastroenterological Surgery, Chiba Cancer Center, Japan. takano@oak.dti.ne.jp
Honda
Ichiro
I
Watanabe
Satoshi
S
Soda
Hiroaki
H
Nagata
Matsuo
M
Hoshino
Isamu
I
Takenouchi
Toshinao
T
Miyazaki
Masaru
M
D000230:Adenocarcinoma / Q000097:blood / Q000378:metabolism* / Q000473:pathology; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D013505:Digestive System Surgical Procedures; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011498:Protein Precursors / Q000032:analysis / Q000096:biosynthesis*; D011516:Prothrombin / Q000032:analysis / Q000096:biosynthesis*; D013274:Stomach Neoplasms / Q000097:blood / Q000378:metabolism* / Q000473:pathology; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000032:analysis / Q000096:biosynthesis
D015415:Biomarkers; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin