Alpha-fetoprotein (AFP)- and Des-gamma-carboxy Prothrombin (DCP)-producing Adenocarcinoma of the Stomach with Liver Metastasis in a Patient with Chronic Hepatitis C

Sohda, Tetsuro; Tomioka, Yoshitaka; Inomata, Shinjiro; Morita, Isamu; Eguchi, Koichi; Aoyagi, Kazuhiko; Watanabe, Hiroshi; Nakamura, Shotaro; Sakisaka, Shotaro

doi:10.2169/internalmedicine.44.294

Cited by 13 publications

(4 citation statements)

References 14 publications

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“…Gastric carcinomas expressing both AFP and DCP are extremely rare and difficult to diagnose and treat [4][5][6][7][8][9][10][11][12]. In our patient, both the serum AFP and DCP levels were extremely high, the serum CEA level was slightly elevated, and the CA 19-9 level was normal.…”

Section: Discussionmentioning

confidence: 72%

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A Case of Alpha-fetoprotein and Des-gamma-carboxy Prothrombin-Producing Gastric Carcinoma Mimicking Hepatocellular Carcinoma

Hotta¹,

Kashiwabara²,

Arai³

et al. 2016

Int J Gastroenterol Disord Ther

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Section: Discussionmentioning

confidence: 72%

“…Although 1.3%-15% of all gastric carcinomas produce AFP [1], gastric carcinomas accompanied by elevated serum levels of both AFP and DCP are rare [4][5][6][7][8][9][10][11][12]. The diagnostic criteria for gastric carcinoma producing AFP and DCP are currently unclear.…”

Section: Introductionmentioning

confidence: 99%

A Case of Alpha-fetoprotein and Des-gamma-carboxy Prothrombin-Producing Gastric Carcinoma Mimicking Hepatocellular Carcinoma

Hotta¹,

Kashiwabara²,

Arai³

et al. 2016

Int J Gastroenterol Disord Ther

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“…Since Liebman et al reported PIVKA‐II is elevated specifically in HCC, PIVKA‐II has been broadly used as a specific tumor marker in HCC. However, 23 cases of PIVKA‐II producing tumor other than HCC have been reported mainly from Japan: 15 cases of gastric cancer, two cases of mediastinal germ cell tumors, a case of ovarian cancer, pancreatic cancer, colon cancer, adrenal cortex cancer, and two cases of lung cancer, including Japanese articles. The clinicopathological features of PIVKA‐II producing lung cancers are shown in Table .…”

Section: Discussionmentioning

confidence: 99%

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

Kurohama¹,

Mihara²,

Izumi³

et al. 2017

Pathology International

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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.

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“…Chemotherapy for gastric cancer is the main treatment option for patients with a liver metastasis, but systemic chemotherapy with a combination of anti-cancer drugs such as CDDP, 5-fluorouracil, and CPT-11 generally has poor efficacy. Although S-1, a novel oral derivative of 5-fluorouracil, has been found to be effective in several cases of AFP-producing gastric cancers, long-term survival with S-1 therapy has not been reported for PIVKA-II-producing gastric cancers [ 11 ]. The prognosis in these cases largely depends on whether liver metastases are present.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Survival in a Case of Chemotherapy-Sensitive Gastric Cancer That Produced Alpha-Fetoprotein and Protein Induced by Vitamin K Antagonist-II

Ogasawara

Takahashi

Matsumoto

et al. 2015

Case Rep Gastroenterol

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The number of reported cases of alpha-fetoprotein (AFP)-producing gastric cancer has gradually increased, with a reported prevalence of 1.3-1.5% of all gastric cancer cases. However, reports of gastric cancer accompanied by elevated serum levels of both AFP and protein induced by vitamin K antagonist-II (PIVKA-II) are rare. The prognosis of AFP- and PIVKA-II-producing gastric cancer has been reported to be very poor because the tumor cells were considered to have a high malignant potential and the cancer progressed rapidly. We described a case of gastric cancer producing AFP and PIVKA-II in which chemotherapy was effective and resulted in prolonged survival, and these two tumor markers were useful for monitoring the treatment response. Routine health screening using upper abdominal ultrasonography revealed hepatic tumors in an apparently healthy 65-year-old man. Whole-body computed tomography (CT) revealed multiple hepatic tumors, and an esophagogastroduodenoscopy (EGD) revealed a Bormann type 3 tumor in the lower stomach. A biopsy specimen confirmed that the tumor was immunohistochemically positive for AFP, PIVKA-II, and human epidermal growth factor receptor 2. After chemotherapy, the gastric tumor appeared as a small elevated lesion on EGD, and CT revealed a remarkable reduction in the size of the metastatic liver tumors. The patient is still alive, 35 months after the initial chemotherapy.

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Alpha-fetoprotein (AFP)- and Des-gamma-carboxy Prothrombin (DCP)-producing Adenocarcinoma of the Stomach with Liver Metastasis in a Patient with Chronic Hepatitis C

Abstract: A 45-year-old man was admitted to our hospital because of chronic hepatitis C and a large liver tumor accompanied by increased serum levels of alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP), the tumor markers for hepatocellular carcinoma.

Cited by 13 publications

References 14 publications

A Case of Alpha-fetoprotein and Des-gamma-carboxy Prothrombin-Producing Gastric Carcinoma Mimicking Hepatocellular Carcinoma

A Case of Alpha-fetoprotein and Des-gamma-carboxy Prothrombin-Producing Gastric Carcinoma Mimicking Hepatocellular Carcinoma

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

Prolonged Survival in a Case of Chemotherapy-Sensitive Gastric Cancer That Produced Alpha-Fetoprotein and Protein Induced by Vitamin K Antagonist-II

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