Hiraoka Atsushi, Kurose Kiyotaka, Kumagi Teru, Hirooka Masashi, Yokota Tomoyuki, Fujiwara Toshiteru, Utsunomiya Sachiko, Hirata Mami, Ohtani Hiromi, Michitaka Kojiro, Horiike Norio, Kobayashi Nobuaki, Onji Morikazu
Third Department of Internal Medicine, Ehime University School of Medicine, Ehime, Japan.
Department of Internal Medicine, Matsuyama Johto Hospital, Ehime, Japan.
Curr Ther Res Clin Exp. 2005 Nov;66(6):589-97. doi: 10.1016/j.curtheres.2005.12.004.
α-Fetoprotein (AFP) is a useful marker of hepatocellular carcinoma (HCC), and protein induced by vitamin K absence or antagonist II (PIVKA-II) and fucosylated AFP (AFP-L3) are specific tumor markers.
The aim of this article was to report a case of intrahepatic cholangiocarcinoma (CC) with high levels of expression of AFP, AFP-L3, and PIVKA-II.
A 70-year-old man weighing 66 kg with a diagnosis of intrahepatic CC presented with a liver tumor 4.0 cm in diameter and elevated concentrations of carbohydrate antigen 19-9 (575 U/mL), PIVKA-II (379 mAU/mL), and AFP (497 ng/mL; AFP-L3, 88.1%). On extended medial hepatic segmentectomy, microscopy showed that the tumor was a CC without HCC. The patient subsequently underwent immunohistochemical assessments using cytokeratin-19, epithelial membrane antigen (EMA), hepatocyte paraffin-1 (HP-1), PIVKA-II, and AFP.
In all specimens, desmoplasia was observed. However, results of immunohistochemistry showed positive results for cytokeratin-19 and EMA; HP-1 results were negative. Results of PIVKA-II and AFP testing in the tumor were positive.
The case presented here showed characteristics of CC and HCC, whereas the histologic expression of the tumor suggested CC. Based on the literature search, this is the first known report of a case of a CC expressing AFP and PIVKA-II confirmed on immunohistochemical staining. This case is interesting with regard to the ability of the progenitor cells to differentiate HCC and CC.
甲胎蛋白（AFP）是肝细胞癌（HCC）的一种有用标志物，维生素K缺乏或拮抗剂II诱导蛋白（PIVKA-II）和岩藻糖基化甲胎蛋白（AFP-L3）是特异性肿瘤标志物。
本文旨在报告1例甲胎蛋白、AFP-L3和PIVKA-II表达水平高的肝内胆管癌（CC）病例。
一名70岁男性，体重66 kg，诊断为肝内CC，出现直径4.0 cm的肝肿瘤，碳水化合物抗原19-9（575 U/mL）、PIVKA-II（379 mAU/mL）和甲胎蛋白（497 ng/mL；AFP-L3，88.1%）浓度升高。在扩大的肝内侧段切除术中，显微镜检查显示肿瘤为CC而非HCC。患者随后接受了细胞角蛋白-19、上皮膜抗原（EMA）、肝细胞石蜡-1（HP-1）、PIVKA-II和甲胎蛋白的免疫组织化学评估。
在所有标本中均观察到纤维组织增生。然而，免疫组织化学结果显示细胞角蛋白-19和EMA呈阳性；HP-1结果为阴性。肿瘤中PIVKA-II和甲胎蛋白检测结果为阳性。
本文报告的病例具有CC和HCC的特征，而肿瘤的组织学表现提示为CC。基于文献检索，这是首例经免疫组织化学染色证实的表达甲胎蛋白和PIVKA-II的CC病例报告。就祖细胞分化为HCC和CC的能力而言，该病例很有意思。
