Des-gamma-carboxy prothrombin (PIVKA-II)-producing mediastinal embryonal carcinoma with features of hepatoid differentiation.

The case of a 48-year-old man with primary nonseminomatous embryonal carcinoma at the posterior mediastinum is described. The patient displayed extremely high plasma levels of Des-gamma-carboxy prothrombin (PIVKA-II) (4040 mAU/ml). Ultrasonography and dynamic computed tomography ruled out hepatocellular carcinoma (HCC) or liver metastasis. After preoperative systemic chemotherapy, total tumor resection was performed. Postoperatively, the plasma levels of PIVKA-II returned to within the normal range (24 mAU/ml). An immnohistochemical study using anti-PIVKA-II monoclonal antibody revealed the cytoplasmic expression of PIVK4-II in the carcinoma cells. These results indicate that tumor cells, which are manifested as hepatoid differentiation, may produce PIVKA-II. This case seems to be the first case reported in which PIVKA-II was produced by nonseminomatous mediastinal embryonal carcinoma without HCC or liver metastasis.

[1]  R. Kawamoto,et al.  Double cancer of the stomach, one AFP-producing tumor , 1996, Journal of Gastroenterology.

[2]  M. Kaminishi,et al.  Des-gamma carboxy prothrombin (PIVKA-II)- and alpha-fetoprotein (AFP)-producing gastric cancer , 2005, Journal of Gastroenterology.

[3]  M. Miyazaki,et al.  PIVKA-II-producing advanced gastric cancer , 2004, International Journal of Clinical Oncology.

[4]  M. Sata,et al.  Alpha-fetoprotein- and des-gamma-carboxy prothrombin-producing advanced gastric cancer , 2002, European journal of gastroenterology & hepatology.

[5]  K. Batts,et al.  Carcinoma of the stomach with hepatocyte differentiation (hepatoid adenocarcinoma). , 1997, Mayo Clinic proceedings.

[6]  J. Melamed,et al.  Hepatoid adenocarcinoma in the urinary bladder. Unusual localization of a newly recognized tumor type , 1994, Cancer.

[7]  M. Kudo,et al.  Des-gamma-carboxy prothrombin (PIVKA-II) and alpha-fetoprotein-producing IIc-type early gastric cancer. , 1992, The American journal of gastroenterology.

[8]  A. Nakao,et al.  Clinical evaluation of plasma abnormal prothrombin (des-gamma-carboxy prothrombin) in hepatobiliary malignancies and other diseases. , 1991, The American journal of gastroenterology.

[9]  H. Liebman.  Isolation and characterization of a hepatoma-associated abnormal (des-gamma-carboxy)prothrombin. , 1989, Cancer research.

[10]  H. Liebman.  Isolation and characterization of a hepatoma-associated abnormal (des-gamma-carboxy)prothrombin. , 1989, Cancer research.

[11]  T. Nagasaka,et al.  The Frequency and Histology of Hepatic Tissue in Germ Cell Tumors , 1987, The American journal of surgical pathology.

[12]  H. Ishikura,et al.  An AFP‐producing gastric carcinoma with features of hepatic differentiation. A case report , 1985, Cancer.

[13]  Shou-Dong Lee,et al.  Des-γ-Carboxy (Abnormal) Prothrombin as a Serum Marker of Primary Hepatocellular Carcinoma , 1984 .

[14]  B. Furie,et al.  Des-gamma-carboxy (abnormal) prothrombin as a serum marker of primary hepatocellular carcinoma. , 1984, The New England journal of medicine.

[15]  J. Stenflo,et al.  Vitamin K-dependent formation of gamma-carboxyglutamic acid. , 1977, Annual review of biochemistry.