肝転移を伴ったPIVKA II産生胃癌の1例 [in Japanese] A CASE OF PIVKA II-PRODUCING GASTRIC CANCER WITH HEPATIC METASTASIS [in Japanese]
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PIVKA II産生胃癌の報告は稀である.今回肝転移を伴ったPIVKA II産生胃癌の1例を経験したので若干の文献的考察を加え報告する.症例は77歳,男性. 2004年7月の検診で胸部大動脈瘤を指摘され9月10日に当院を受診した. CT検査で胸部大動脈瘤以外に肝S6に腫瘍も認めたため,消化器臓器も精査した.血液検査でHCV抗体陽性を認めるも,肝機能異常は認めなかった.また腫瘍マーカーはAFP, PIVKA IIのみ上昇を認めた.上部消化管内視鏡検査で胃幽門後壁に3型様腫瘍を認め,胃生検検査でAFP産生胃癌と診断された.術前診断はAFP産生胃癌と,転移性または原発性肝癌と考え11月2日に幽門側胃切除術と肝右葉切除術を行った.病理学的診断は胃,肝腫瘍ともに管状組織と胞巣状増殖から構成される腺癌であった.また免疫染色ではAFP, PIVKA II染色ともに陽性であったため, PIVKA IIおよびAFP産生胃癌と診断した.
PIVKA II-producing gastric cancer has rarely been reported. This paper presents a case of PIVKA II-producing gastric cancer with hepatic metastasis, together with a review of the literature.<br> A 77-year-old man, found to have a thoracic aortic aneurysm at a medical checkup in July, was seen at the hospital on September 10, 2004. CT scan revealed a tumor in the S6 of liver as well as a chest aortic aneurysm, and then close exploration of the gastrointestinal organs was conducted. Blood tests showed HCV antibody positive, but no abnormalities in the hepatic function were noted. As for tumor makers, elevations of AFP and PIVKA II were noted. Upper gastrointestinal endoscopy revealed a type 3 like tumor in the posterior wall of the gastric pylorus. A biopsy of the stomach yielded a diagnosis of AFP-producing gastric cancer. AFP-producing gastric cancer with metastatic or primary hepatic carcinoma was diagnosed, and a distal gastrectomy and right hepatic lobectomy were performed on November 2. The pathological diagnoses of gastric and hepatic tumors were adenocarcinoma composed of tubular tissue and acinous pattern of proliferation. Immunostaining tests were positive for both AFP and PIVKA II. Accordingly gastric cancer producing PIVKA II and AFP was diagnosed.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 67(6), 1279-1284, 2006-06-25
Japan Surgical Association