Alpha-fetoprotein- and des-gamma-carboxy prothrombin-producing advanced gastric cancer

Abstract

A case of alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) producing gastric cancer with multiple liver metastasis is reported. The simultaneous presence of Borrmann I gastric cancer and IIa aggregating type gastric cancer was noted. Borrmann I gastric cancer was a poorly differentiated adenocarcinoma, while IIa aggregating type gastric cancer was a moderately differentiated adenocarcinoma. Plasma levels of AFP and DCP were 247,000 ng/ml and 320,000 mAU/ml, respectively. Immunohistochemical staining confirmed the production of these two proteins in Borrmann I gastric cancer.

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

“…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.…”

“…In general, vitamin K deficiency and warfarin intake can induce an increase in serum DCP levels and serum prothrombin time. A histopathological feature of DCP-producing tumors is the presence of an AFP-producing hepatoid gastric adenocarcinoma [4]. Histopathologically, the AFPproducing gastric carcinoma showed areas of tubular adenocarcinoma and hepatoid cells.…”

“…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.…”

Des-gamma carboxy prothrombin (PIVKA-II)- and alpha-fetoprotein (AFP)-producing gastric cancer

“…Several investigators have reported the effectiveness of metronidazole, 2 6-mercaptopurine, 3 and intravenous cyclosporine for internal fistulas in patients with CD. 4 Tacrolimus is a calcineurin inhibitor with immunomudulatory properties. 5 In the patient described here, we used tacrolimus for the treatment of enterovesical and duodenocolic fistulas in CD, and obtained successful management.…”

“…[2][3][4][5] The result of immunohistochemical staining for PIVKA-II was poor in two patients, partially positive in two patients, and positive in one patient. Four (80%) out of the five patients were positive for hepatic metastasis, causing death within 6 months.…”