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World J Gastrointest Pathophysiol. Oct 15, 2010; 1(4): 129-136
Published online Oct 15, 2010. doi: 10.4291/wjgp.v1.i4.129
Protein induced by vitamin K absence or antagonist II-producing gastric cancer
Yoshihisa Takahashi, Tohru Inoue, Toshio Fukusato
Yoshihisa Takahashi, Toshio Fukusato, Department of Pathology, Teikyo University School of Medicine, Tokyo 173-8605, Japan
Tohru Inoue, Department of Pathology, Tokyo Kousei-Nenkin Hospital, Tokyo 162-8543, Japan
Author contributions: Takahashi Y wrote the manuscript; Inoue T diagnosed a case that we previously reported, and provided the computed tomography images of the case; and Fukusato T checked and revised the manuscript.
Correspondence to: Yoshihisa Takahashi, MD, Department of Pathology, Teikyo University School of Medicine, Tokyo 173-8605, Japan. ytakaha-tky@umin.ac.jp
Telephone: +81-3-39641211 Fax: +81-3-39649622
Received: July 26, 2010
Revised: September 24, 2010
Accepted: October 1, 2010
Published online: October 15, 2010
Abstract

Protein induced by vitamin K absence or antagonist II (PIVKA-II) is a putative specific marker of hepatocellular carcinoma (HCC), but it may also be produced by a small number of gastric cancers. To date, 16 cases of PIVKA-II-producing gastric cancer have been reported, 2 of which were reported by us and all of which were identified in Japan. There are no symptoms specific to PIVKA-II-producing gastric cancer, and the representative clinical symptoms are general fatigue, appetite loss, and upper abdominal pain. Serum alpha-fetoprotein (AFP) levels are also increased in almost all cases. Liver metastasis is observed in approximately 80% of cases and portal vein tumor thrombus is observed in approximately 20% of cases. Differential diagnosis between metastatic liver tumor and HCC is often difficult. Grossly, almost all cases appear as advanced gastric cancer. Histologically, a hepatoid pattern is observed in many cases, in addition to a moderately to poorly differentiated adenocarcinoma component. The production of PIVKA-II and AFP is usually confirmed using immunohistochemical staining. Treatment and prognosis largely depends on the existence of liver metastasis, and the prognosis of patients with liver metastasis is very poor. PIVKA-II may be produced during the hepatocellularmetaplasia of the tumor cells.

Keywords: Protein induced by vitamin K absence or antagonist II; Gastric cancer; Alpha-fetoprotein; Hepatocellular carcinoma; Hepatoid carcinoma