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Des‐γ carboxy prothrombin (PIVKA‐II) and α‐fetoprotein producing gastric cancer with multiple liver metastases

We describe the case of an 87‐year‐old woman who presented to Tokyo Kousei Nenkin Hospital because of appetite loss and general fatigue. Multiple liver masses and Borrmann type 2 gastric tumor were detected. A clinical diagnosis of hepatocellular carcinoma and gastric cancer was made based on the patient's high levels of serum α‐fetoprotein (AFP; 490 200 ng/mL) and protein induced by vitamin K absence or antagonist‐II (PIVKA‐II, 2284mAU/mL). The patient's general condition worsened gradually and she died 42 days after admission. Autopsy revealed that the predominant histological structure of the gastric tumor was trabecular or sheet‐like, although a tubular structure was also found. Venous invasion was prominent. Immunohistochemically, the tumor tissue was positive for AFP and a few tumor cells were positive for PIVKA‐II. The histological appearance and immunohistochemical features of the hepatic tumors resembled that of the gastric tumor. This case was pathologically diagnosed as AFP‐ and PIVKA‐II‐producing gastric carcinoma with multiple liver metastases. When tumors are found in the stomach and liver and serum PIVKA‐II level is abnormally high, the possibility of PIVKA‐II‐producing gastric cancer with liver metastasis should be considered, especially when hepatitis virus markers are negative and liver cirrhosis is not present.