title: Protein induced by vitamin K absence or antagonist II (PIVKA-II) producing large cell neuroendocrine carcinoma (LCNEC) of lung with multiple liver metastases: A case report.
abstract: A 78-year-old man was admitted to our hospital for multiple lung and liver tumors. Initial clinical diagnosis was hepatocellular carcinoma (HCC) with lung metastases because of a high value of serum protein induced by vitamin K absence or antagonist II (PIVKA-II) (6,705 mAU/mL). However, a review of a prior CT showed the lung tumor had existed 6 months before liver tumors were detected. The tumors progressed rapidly and the patient died 37 days after admission. Autopsy revealed that both lung and liver tumors exhibited the histology of large cell neuroendocrine carcinoma (LCNEC). Immunohistochemistry revealed that the tumor cells expressed not only neuroendocrine markers but also PIVKA-II diffusely. Hepatoid differentiation was not detected. Background liver did not show any chronic liver disease. The final diagnosis was PIVKA-II producing LCNEC of the lung with multiple liver metastases. PIVKA-II producing tumors other than HCC are extremely rare. To our best knowledge, this is the first case report of PIVKA-II producing neuroendocrine tumors of the lung.
authors.affiliation: Department of Pathology.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kurohama
authors.affiliation: Department of Pathology.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Mihara
authors.affiliation: Department of General Medicine.
authors.forename: Yasumori
authors.initials: Y
authors.lastname: Izumi
authors.affiliation: Department of General Medicine.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Kamata
authors.affiliation: Department of Pulmonology.
authors.forename: Seiji
authors.initials: S
authors.lastname: Nagashima
authors.affiliation: Department of Hepatology, Japan.
authors.forename: Atsumasa
authors.initials: A
authors.lastname: Komori
authors.affiliation: Department of Radiology, National Hospital Organization Nagasaki Medical Center.
authors.forename: Yojiro
authors.initials: Y
authors.lastname: Matsuoka
authors.affiliation: Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Ueki
authors.affiliation: Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nakashima
authors.affiliation: Department of Pathology.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ito
mesh_terms: D000368:Aged; D015415:Biomarkers; D014408:Biomarkers, Tumor / Q000032:analysis; D018287:Carcinoma, Large Cell / Q000378:metabolism / Q000556:secondary*; D018278:Carcinoma, Neuroendocrine / Q000378:metabolism / Q000556:secondary*; D017809:Fatal Outcome; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000556:secondary*; D008175:Lung Neoplasms / Q000378:metabolism / Q000473:pathology*; D008297:Male; D011498:Protein Precursors / Q000096:biosynthesis*; D011516:Prothrombin / Q000096:biosynthesis*
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin
keywords: des-gamma-carboxy prothrombin; large cell neuroendocrine carcinoma (LCNEC); liver; lung; protein induced by vitamin K absence or antagonist II (PIVKA-II)