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

Abstract

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.

PIVKA-II: A biomarker for diagnosing and monitoring patients with pancreatic adenocarcinoma

“…However it has been showed that 10 of 23 reported cases of PIVKA-II producing tumors (43.4%) did not have hepatoid differentiation. It has been demonstrated that PIVKA-II producing tumors show a high rate of liver metastasis and poor prognosis [ 13 ]. In our pilot study we reported for the first time that PIVKA-II is significantly higher in PDAC than in benign pancreatic diseases and that it shows a rather good diagnostic performance compared to commonly used tumor markers Carbohydrate Antigen 19.9 (CA 19.9), Carcino-Embryonic Antigen (CEA) and CA242 [ 7 ].…”