巨大肝転移を伴ったＰＩＶＫＡ‐ＩＩ，ＡＦＰ産生進行胃癌の１例

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  • PIVKA-II AND AFP PRODUCING ADVANCED GASTRIC CANCER WITH LIVER METASTASIS

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Since the first report of protein induced by Vitamin K antagonist (PIVKA-II) and AFP producing gastric cancer in 1992, some cases of PIVKA-II producing gastric cancer have been described. We encountered a case of primary advanced gastric cancer with liver metastasis and discussed PIVKA-II producing gastric cancer including previous cases. We describe the case of a 57-year-old woman with primary advanced gastric cancer with liver metastasis, who displayed high plasma levels of PIVKA-II (1534mAU/ml) and AFP (39160ng/ml). After total gastrectomy and hepatic right trisegmentectomy were performed, plasma levels of PIVKA-II returned to within the normal range, and 19 months after the operation she is alive with lung metastasis. Macroscopic findings of resected specimens revealed Borrmann type 2 advanced gastric cancer from cardia to esophago-cardiac junction. Localizations of PIVKA-II and AFP were determined from resected specimens of gastric cancer by using immunohisto-chemistry (IHC). Positive staining of both PIVKA-II and AFP within tumor cells in the stomach was demonstrated by IHC. These results indicate that tumor cells from gastric cancer may produce PIVKA-II and AFP. An aggressive tumor resection might be necessary to improve the prognosis of patients with PIVKA-II and AFP producing gastric cancer with liver metastasis.

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