title: Simultaneous resection of liver cell adenomas and an intrahepatic portosystemic venous shunt with elevation of serum PIVKA-II level.
abstract: A 27-year-old woman with no history of liver disease or oral contraceptive use presented with sudden abdominal pain. Laboratory data showed mild liver dysfunction with jaundice. Computed tomography and angiography revealed centrally located large liver cell adenomas (LCAs) and an intrahepatic portosystemic venous shunt (IHPSS) in the left lobe. The serum des-gamma-carboxy prothrombin (known as "protein induced by a lack of vitamin K or antagonist II," PIVKA-II) level was extremely high (6,647 mAU/ml), indicating malignant transformation of the tumors. Under the diagnosis of LCAs and IHPSS, the patient underwent simultaneous resection of the four liver tumors and portovenous shunt, and the hepatic vascular abnormality was resolved. The pathological diagnosis was LCAs without hepatocellular carcinoma. Immunohistochemical analysis with an anti-PIVKA-II monoclonal antibody showed positive staining of the adenoma cells. This case shows that LCA without malignant transformation can produce PIVKA-II, leading to high serum levels of PIVKA-II. Simultaneous resection of multiple tumors and closure of the portosystemic shunt are strongly recommended in a patient with LCA associated with IHPSS.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Seyama
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.forename: Wei
authors.initials: W
authors.lastname: Tang
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D018248:Adenoma, Liver Cell / Q000097:blood / Q000150:complications / Q000601:surgery; D000328:Adult; D001164:Arteriovenous Fistula / Q000097:blood / Q000150:complications / Q000601:surgery; D015415:Biomarkers / Q000097:blood*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000002:abnormalities*; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000601:surgery; D011169:Portal Vein / Q000002:abnormalities*; D011498:Protein Precursors / Q000097:blood*; D011516:Prothrombin
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin