Takano Shigetsugu, Honda Ichiro, Watanabe Satoshi, Soda Hiroaki, Nagata Matsuo, Hoshino Isamu, Takenouchi Toshinao, Miyazaki Masaru
Department of Gastroenterological Surgery, Chiba Cancer Center, Japan.
Int J Clin Oncol. 2004 Aug;9(4):330-3. doi: 10.1007/s10147-004-0398-0.
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.
我们描述了一例68岁原发性晚期胃腺癌男性患者，其血浆中维生素K拮抗剂诱导蛋白（PIVKA）-II水平极高（15600 mAU/ml），而甲胎蛋白（AFP）水平正常（4 ng/ml）。超声检查和动态计算机断层扫描排除了肝细胞癌（HCC）或肝转移。术前化疗后，实施了D2淋巴结清扫的胰脾全胃切除术。术后，PIVKA-II血浆水平恢复至正常范围（29 mAU/ml）。显微镜检查显示胃腺癌呈现多种组织学类型，如中分化至低分化黏液腺癌，但未检测到胃腺癌的肝样分化。使用单克隆抗体的免疫组织化学染色证实了肿瘤细胞内PIVKA-II和AFP的定位。这些结果表明，胃癌肿瘤细胞可能产生PIVKA-II。此前已有一些关于伴有肝转移的PIVKA-II和AFP产生型晚期胃癌的报道，但这是首例单独产生PIVKA-II的无肝转移胃癌报道。
