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Hepatoid carcinoma of the pancreas producing protein induced by vitamin K absence or antagonist II (PIVKA-II) and α-fetoprotein (AFP)

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Abstract

We describe a rare case of hepatoid carcinoma of the pancreas with production of protein induced by vitamin K absence or antagonist II (PIVKA-II) and α-fetoprotein (AFP). The patient was a 49-year-old woman admitted because of high serum levels of PIVKA-II (1.63 AU/ml) and AFP (623 ng/ml) and abnormal ultrasonographic findings of the pancreas, found incidentally at medical checkup. Both ultrasonography and computed tomography showed swelling of the pancreas with small areas of low density, but no hepatic lesions. The serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were not increased. A PIVKA-II and AFP-producing pancreatic cancer was strongly suspected, and total pancreatectomy was performed. Pathological examination showed that the tumor cells were arranged in trabecular and solid patterns with bile production, and were immunohistochemically positive for PIVKA-II and AFP, resembling hepatocellular carcinoma cells. The tumor was diagnosed as hepatoid carcinoma of the pancreas, and the patient has survived 48 months after initial diagnosis. It is important that hepatoid carcinoma be considered as a possible malignant tumor of the pancreas, and simultaneous measurement of the serum levels of AFP and PIVKA-II will enable earlier diagnosis. This is the first report describing hepatoid carcinoma of the pancreas producing PIVKA-II.

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References

  1. H Ishikura Y Fukasawa K Ogasawara T Natori Y Tsukada M Aizawa (1985) ArticleTitleAFP-producing gastric carcinoma with features of hepatic differentiation. A case report Cancer 56 840–8 Occurrence Handle2410093 Occurrence Handle10.1002/1097-0142(19850815)56:4<840::AID-CNCR2820560423>3.0.CO;2-E Occurrence Handle1:STN:280:DyaL2M3lsVarsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  2. H Tanigawa Y Kida S Kuwano H Uesugi T Ojima N Kobayashi et al. (2002) ArticleTitleHepatoid adenocarcinoma in Barrett's esophagus associated with achalasia: first case report Pathol Int 52 141–6 Occurrence Handle11940219 Occurrence Handle10.1046/j.1440-1827.2002.01328.x

    Article  PubMed  Google Scholar 

  3. M Nasu T Soma H Fukushima K Kudo O Matsubara (1997) ArticleTitleHepatoid carcinoma of the lung with production of α-fetoprotein and abnormal prothrombin: an autopsy case report Mod Pathol 10 1054–8 Occurrence Handle9346187 Occurrence Handle1:STN:280:DyaK1c%2FgsVWksQ%3D%3D

    PubMed  CAS  Google Scholar 

  4. Y Oshiro Y Takada T Enomoto K Fukao S Ishikawa T Iijima (2004) ArticleTitleA resected case of metachronous liver metastasis from lung cancer producing alpha-fetoprotein (AFP) and protein induced by Vitamin K absence or antagonist II (PIVKA-II) Hepatogastroenterology 51 1144–7 Occurrence Handle15239263

    PubMed  Google Scholar 

  5. C Vardaman J Albores-Saavedra (1995) ArticleTitleClear cell carcinoma of the gallbladder and extrahepatic bile ducts Am J Surg Pathol 19 91–8 Occurrence Handle7802141 Occurrence Handle1:STN:280:DyaK2M7gtVCjsA%3D%3D Occurrence Handle10.1097/00000478-199501000-00011

    Article  PubMed  CAS  Google Scholar 

  6. H Senzaki Y Kiyozuka H Mizuoka D Yamamoto S Ueda H Izumi et al. (1999) ArticleTitleAn autopsy case of hepatoid carcinoma of the ovary with PIVKA-II production: immunohistochemical study and literature review Pathol Int 49 164–9 Occurrence Handle10355972 Occurrence Handle10.1046/j.1440-1827.1999.00840.x Occurrence Handle1:STN:280:DyaK1M3ot1WjsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. K Miyashita A Nagasaka M Nakanishi T Kudo O Wakahama S Nishikawa et al. (2000) ArticleTitleAn alpha-fetoprotein and PIVKA-II producing carcinoma of the colon: report of a case Jpn J Gastroenterol 97 1480–6 Occurrence Handle1:STN:280:DC%2BD3M%2FpvF2qtQ%3D%3D

    CAS  Google Scholar 

  8. N Hirashima K Kumada K Sakakibara T Hirai H Matsuura I Itazu et al. (1995) ArticleTitleA case of hepatocellular carcinoma, gastric cancer and adrenocortical cancer showing positive immunohistochemical staining of PIVKA-II on adrenocortical tissue Jpn J Gastroenterol 92 799–803 Occurrence Handle1:STN:280:DyaK2M3lslCrtQ%3D%3D

    CAS  Google Scholar 

  9. H Ishikura K Kirimoto M Shamoto Y Miyamoto H Yamagiwa T Itho et al. (1986) ArticleTitleHepatoid adenocarcinomas of the stomach. An analysis of seven cases Cancer 56 119–26 Occurrence Handle10.1002/1097-0142(19860701)58:1<119::AID-CNCR2820580121>3.0.CO;2-U

    Article  Google Scholar 

  10. S Inoue A Nakao A Harada T Nonami H Takagi (1994) ArticleTitleClinical significance of abnormal prothrombin (DCP) in relation to postoperative survival and prognosis in patients with hepatocellular carcinoma Am J Gastroenterol 89 2222–6 Occurrence Handle7526679 Occurrence Handle1:STN:280:DyaK2M%2Fmslynsw%3D%3D

    PubMed  CAS  Google Scholar 

  11. T Nakagawa T Seki T Shiro M Wakabayashi M Imamura T Itho et al. (1999) ArticleTitleClinicopathologic significance of protein induced vitamin K absence or antagonist II and α-fetoprotein in hepatocellular carcinoma Int J Oncol 14 281–6 Occurrence Handle9917503 Occurrence Handle1:CAS:528:DyaK1MXhtFKjtbw%3D

    PubMed  CAS  Google Scholar 

  12. H Ishikura T Kishimoto H Andachi Y Kakuta T Yoshiki (1997) ArticleTitleGastrointestinal hepatoid adenocarcinoma: venous permeation and mimicry of hepatocellular carcinoma, a report of four cases Histopathology 31 47–54 Occurrence Handle9253624 Occurrence Handle10.1046/j.1365-2559.1997.5740812.x Occurrence Handle1:STN:280:DyaK2szpslGrtw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  13. GP Paner KS Thompson CV Reyes (2000) ArticleTitleHepatoid carcinoma of the pancreas Cancer 88 1582–9 Occurrence Handle10738216 Occurrence Handle10.1002/(SICI)1097-0142(20000401)88:7<1582::AID-CNCR12>3.0.CO;2-A Occurrence Handle1:STN:280:DC%2BD3c3gsVajsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  14. M Kudo Y Takamine K Nakamura H Shirane H Uchida S Kasakura et al. (1992) ArticleTitleDes-γ-carboxy prothrombin (PIVKA-II) and α-fetoprotein-producing IIc-type early gastric cancer Am J Gastroenterol 87 1859–62 Occurrence Handle1280406 Occurrence Handle1:STN:280:DyaK3s%2FotVWqug%3D%3D

    PubMed  CAS  Google Scholar 

  15. E Ando T Oriishi A Toyonaga T Tobaru M Tanaka R Shimamura et al. (2002) ArticleTitleAlpha-fetoprotein-and des-gamma-carboxy prothrombin-producing advanced gastric cancer Eur J Gastroenterol Hepatol 14 687–91 Occurrence Handle12072604 Occurrence Handle10.1097/00042737-200206000-00015 Occurrence Handle1:CAS:528:DC%2BD38XlsF2js7c%3D

    Article  PubMed  CAS  Google Scholar 

  16. Y Takahashi T Inoue (2003) ArticleTitleDes-γ carboxy prothrombin (PIVKA-II) and α-fetoprotein producing gastric cancer with multiple liver metastases Pathol Int 53 236–40 Occurrence Handle12675768 Occurrence Handle10.1046/j.1320-5463.2003.01461.x

    Article  PubMed  Google Scholar 

  17. S Kawamoto T Hiraoka K Kanemitsu M Kimura Y Miyauchi M Takeya (1992) ArticleTitleAlpha-fetoprotein-producing pancreatic cancer. A case report and review of 28 cases Hepatogastroenterology 39 282–6 Occurrence Handle1380476 Occurrence Handle1:STN:280:DyaK38zntF2gsA%3D%3D

    PubMed  CAS  Google Scholar 

  18. S Tanno T Obara R Shudo T Fujii K Sugawara N Nishino et al. (1997) ArticleTitleα-Fetoprotein producing mucin-producing carcinoma of the pancreas. A case report with immunohistochemical study and lectin-affinity profile Dig Dis Sci 42 2513–8 Occurrence Handle9440629 Occurrence Handle10.1023/A:1018812628541 Occurrence Handle1:STN:280:DyaK1c7gtFGkuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  19. HA Liebman BC Furie MJ Tong RA Blanchard K-J Lo S-D Lee et al. (1984) ArticleTitleDes-γ-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma N Engl J Med 310 1427–31 Occurrence Handle6201741 Occurrence Handle1:STN:280:DyaL2c7ptFersw%3D%3D Occurrence Handle10.1056/NEJM198405313102204

    Article  PubMed  CAS  Google Scholar 

  20. A Nakao K Taniguchi S Inoue S Takeda A Harada T Nonami et al. (1997) ArticleTitleClinical application of a new monoclonal antibody (19B7) against PIVKA-II in the diagnosis of hepatocellular carcinoma and pancreatobiliary malignancies Am J Gastroenterol 92 1031–4 Occurrence Handle9177525 Occurrence Handle1:CAS:528:DyaK2sXktFaqsLg%3D

    PubMed  CAS  Google Scholar 

  21. F Nomura M Ishijima K Kuwa N Tanaka T Nakai K Ohnishi (1999) ArticleTitleSerum des-gamma-carboxy prothrombin levels determined by a new generation of sensitive immunoassays in patients with small-sized hepatocellular carcinoma Am J Gastroenterol 94 650–4 Occurrence Handle10086646 Occurrence Handle10.1111/j.1572-0241.1999.00930.x Occurrence Handle1:CAS:528:DyaK1MXitV2ku70%3D

    Article  PubMed  CAS  Google Scholar 

  22. UA Miskad Y Yano M Nakaji S Kishi H Itoh SR Kim et al. (2001) ArticleTitleHistological study of PIVKA-II expression in hepatocellular carcinoma and adenomatous hyperplasia Pathol Int 51 916–22 Occurrence Handle11844063 Occurrence Handle10.1046/j.1440-1827.2001.01296.x Occurrence Handle1:STN:280:DC%2BD387ht1ynsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  23. K Oinuma M Kawano H Ogonuki K Mizoguchi T Ebihara T Suzuki et al. (1994) ArticleTitleA case of gastric cancer with liver metastasis showing positive immunohistochemical staining of PIVKA-II on stomach and liver Jpn J Gastroenterol 91 1022–6 Occurrence Handle1:STN:280:DyaK2c3lsValsg%3D%3D

    CAS  Google Scholar 

  24. T Inoue T Takada M Takada M Shoda Y Tsumura J Hari et al. (1994) ArticleTitleA case of PIVKA-II and AFP producing gastric cancer Jpn J Gastroenterol 91 84–8 Occurrence Handle1:STN:280:DyaK2c7kt1Wmtw%3D%3D

    CAS  Google Scholar 

  25. T Hyodo R Kawamoto (1996) ArticleTitleDouble cancer of the stomach, one AFP-producing tumor J Gastroenterol 31 851–4 Occurrence Handle9027651 Occurrence Handle10.1007/BF02358614 Occurrence Handle1:STN:280:DyaK2s7nvFeltw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  26. N Yamada Y Yanagisawa H Murayama Y Aoyagi (1997) ArticleTitleA case report of AFP and PIVKA-II producing gastric cancer Endosc Forum 13 16–20

    Google Scholar 

  27. H Cho T Imada M Tokunaga K Hasuo T Oshima C Doi et al. (1998) ArticleTitleAlpha-fetoprotein carcinoma of the stomach: report of two cases Yokohama Igaku 49 865–9

    Google Scholar 

  28. H Ohta K Kuroda Y Mafune T Yoshida T Kamimura T Aiba et al. (1999) ArticleTitleClinical study on liver metastasis of AFP-producing gastric cancer—characteristic findings of angiography Jpn J Gastroenterol 96 941–6 Occurrence Handle1:STN:280:DyaK1MvhtFSqtA%3D%3D

    CAS  Google Scholar 

  29. T Ishii R Ozawa N Miyajima N Bann Y Hirata T Ishidata et al. (2002) ArticleTitleA case of AFP and PIVKA-II producing gastric carcinoma forming a massive tumor embolus in the portal vein Jpn J Gastroenterol 99 275–81

    Google Scholar 

  30. C Okuse H Yotsuyanagi Y Takahashi T Hayashi M Suzuki S Iino et al. (2003) ArticleTitleGastric cancer with liver metastasis producing α-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist II (PIVKA-II): a case report Jpn J Gastroenterol 100 28–34

    Google Scholar 

  31. S Takano I Honda S Watanabe H Soda M Nagata I Hoshino et al. (2004) ArticleTitlePIVKA-II-producing advanced gastric cancer Int J Clin Oncol 9 330–3 Occurrence Handle15375711 Occurrence Handle10.1007/s10147-004-0398-0

    Article  PubMed  Google Scholar 

  32. S Yokohama Y Iimuro A Iwai H Haga H Terajima N Yamamoto et al. (2004) ArticleTitleA case of early hepatoid adenocarcinoma of the stomach accompanied by liver metastasis with biliary tumor thrombus Jpn J Gastroenterol Surg 37 1633–8

    Google Scholar 

  33. T Sohda Y Tomioka S Inomata I Morita K Eguchi K Aoyagi et al. (2005) ArticleTitleAlpha-fetoprotein (AFP)- and des-gamma-carboxy prothrombin (DCP)-producing adenocarcinoma of the stomach with liver metastasis in a patient with chronic hepatitis C Intern Med 44 294–8 Occurrence Handle15897638 Occurrence Handle10.2169/internalmedicine.44.294

    Article  PubMed  Google Scholar 

  34. M Tamano H Sugaya M Oguma T Murohisa Y Tomita Y Matsumura et al. (1999) ArticleTitleImmunolocalisation of PIVKA-II in paraffin-embedded specimens of hepatocellular carcinoma Liver 19 406–10 Occurrence Handle10533798 Occurrence Handle1:STN:280:DC%2BD3c%2FgtFeltw%3D%3D

    PubMed  CAS  Google Scholar 

  35. M-G Huisse M Leclercq J Belghiti J-F Flejou JW Suttie A Bezeaud et al. (1994) ArticleTitleMechanism of the abnormal vitamin K-dependent γ-carboxylation process in human hepatocellular carcinomas Cancer 74 1533–41 Occurrence Handle7520347 Occurrence Handle10.1002/1097-0142(19940901)74:5<1533::AID-CNCR2820740507>3.0.CO;2-V Occurrence Handle1:STN:280:DyaK2czktVGjsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  36. J Ikoma M Kaito T Ishihara N Nakagawa A Kamei N Fujita et al. (2002) ArticleTitleEarly diagnosis of hepatocellular carcinoma using a sensitive assay for serum des-gamma-carboxy prothrombin: a prospective study Hepatogastroenterology 49 235–8 Occurrence Handle11941963 Occurrence Handle1:CAS:528:DC%2BD38XjtFSns7g%3D

    PubMed  CAS  Google Scholar 

  37. Y Shimauchi M Tanaka R Kuromatsu R Ogata Y Tateishi S Itano et al. (2000) ArticleTitleA simultaneous monitoring of lens culinaris agglutinin a-reactive α-fetoprotein and des-γ-carboxy prothrombin as an early diagnosis of hepatocellular carcinoma in the follow-up of cirrhotic patients Oncol Rep 7 249–56 Occurrence Handle10671666 Occurrence Handle1:STN:280:DC%2BD3c7jvVGntw%3D%3D

    PubMed  CAS  Google Scholar 

  38. RH Hruban JM Molina MN Reddy JK Boitnott (1987) ArticleTitleA neoplasm with pancreatic and hepatocellular differentiation presenting with subcutaneous fat necrosis Am J Clin Pathol 88 639–45 Occurrence Handle3673946 Occurrence Handle1:STN:280:DyaL1c%2Fks1Kmtw%3D%3D

    PubMed  CAS  Google Scholar 

  39. S Tanno T Obara T Fujii T Izawa Y Mizukami Y Saitoh et al. (1999) ArticleTitleα-Fetoprotein-producing adenocarcinoma of the pancreas presenting focal hepatoid differentiation Int J Pancreatol 26 43–7 Occurrence Handle10566157 Occurrence Handle1:STN:280:DC%2BD3c%2Fjt1Gqsw%3D%3D

    PubMed  CAS  Google Scholar 

  40. T Yano H Ishikura T Wada T Kishimoto S Kondo H Katoh et al. (1999) ArticleTitleHepatoid adenocarcinoma of the pancreas Histopathology 35 86–95 Occurrence Handle10.1046/j.1365-2559.1999.0728f.x

    Article  Google Scholar 

  41. K Hughes S Kelty R Martin (2004) ArticleTitleHepatoid carcinoma of the pancreas Am Surg 70 1030–3 Occurrence Handle15586521

    PubMed  Google Scholar 

  42. MS Rao V Subbarao JK Reddy (1986) ArticleTitleInduction of hepatocytes in the pancreas of copper-depleted rats following copper repletion Cell Differ 18 109–17 Occurrence Handle3513967 Occurrence Handle10.1016/0045-6039(86)90005-9 Occurrence Handle1:CAS:528:DyaL28XhsVOmtLs%3D

    Article  PubMed  CAS  Google Scholar 

  43. T Makino N Usuda S Rao JK Reddy DG Scarpelli (1990) ArticleTitleTransdifferentiation of ductular cells into hepatocytes in regenerating hamster pancreas Lab Invest 62 552–61 Occurrence Handle2342330 Occurrence Handle1:STN:280:DyaK3c3lvVChtg%3D%3D

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, 710-8602, Japan

    Kazuhiro Matsueda & Hiroshi Yamamoto

  2. Department of Surgery, Kurashiki Central Hospital, Kurashiki, Japan

    Yasuo Yoshida

  3. Department of Pathology, Kurashiki Central Hospital, Kurashiki, Japan

    Kenji Notohara

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  1. Kazuhiro Matsueda
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  2. Hiroshi Yamamoto
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  3. Yasuo Yoshida
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  4. Kenji Notohara
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Matsueda, K., Yamamoto, H., Yoshida, Y. et al. Hepatoid carcinoma of the pancreas producing protein induced by vitamin K absence or antagonist II (PIVKA-II) and α-fetoprotein (AFP). J Gastroenterol 41, 1011–1019 (2006). https://doi.org/10.1007/s00535-006-1889-8

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