Takahashi Yoshihisa, Inoue Tohru, Fukusato Toshio
Yoshihisa Takahashi, Toshio Fukusato, Department of Pathology, Teikyo University School of Medicine, Tokyo 173-8605, Japan.
World J Gastrointest Pathophysiol. 2010 Oct 15;1(4):129-36. doi: 10.4291/wjgp.v1.i4.129.
Protein induced by vitamin K absence or antagonist II (PIVKA-II) is a putative specific marker of hepatocellular carcinoma (HCC), but it may also be produced by a small number of gastric cancers. To date, 16 cases of PIVKA-II-producing gastric cancer have been reported, 2 of which were reported by us and all of which were identified in Japan. There are no symptoms specific to PIVKA-II-producing gastric cancer, and the representative clinical symptoms are general fatigue, appetite loss, and upper abdominal pain. Serum alpha-fetoprotein (AFP) levels are also increased in almost all cases. Liver metastasis is observed in approximately 80% of cases and portal vein tumor thrombus is observed in approximately 20% of cases. Differential diagnosis between metastatic liver tumor and HCC is often difficult. Grossly, almost all cases appear as advanced gastric cancer. Histologically, a hepatoid pattern is observed in many cases, in addition to a moderately to poorly differentiated adenocarcinoma component. The production of PIVKA-II and AFP is usually confirmed using immunohistochemical staining. Treatment and prognosis largely depends on the existence of liver metastasis, and the prognosis of patients with liver metastasis is very poor. PIVKA-II may be produced during the hepatocellularmetaplasia of the tumor cells.
维生素K缺乏或拮抗剂-II诱导蛋白（PIVKA-II）是肝细胞癌（HCC）的一种假定特异性标志物，但少数胃癌也可能产生该蛋白。迄今为止，已报道了16例产生PIVKA-II的胃癌病例，其中2例由我们报道，且所有病例均在日本被发现。产生PIVKA-II的胃癌没有特异性症状，典型临床症状为全身乏力、食欲减退和上腹部疼痛。几乎所有病例的血清甲胎蛋白（AFP）水平也会升高。约80%的病例会出现肝转移，约20%的病例会出现门静脉瘤栓。肝转移瘤与HCC之间的鉴别诊断通常很困难。大体上，几乎所有病例均表现为进展期胃癌。组织学上，除了中分化至低分化腺癌成分外，许多病例还可见肝样模式。通常采用免疫组化染色来确认PIVKA-II和AFP的产生。治疗和预后很大程度上取决于是否存在肝转移，有肝转移患者的预后非常差。PIVKA-II可能在肿瘤细胞的肝细胞化生过程中产生。
