Primary colon cancer with a high serum PIVKA-II level

Kazuya Kato, Yoshiaki Iwasaki, Masahiko Taniguchi, Kazuhiko Onodera, Minoru Matsuda, Takako Kawakami, Mineko Higuchi, Kimitaka Kato, Yurina Kato, Hiroyuki Furukawa

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Abstract

Introduction: Protein induced by vitamin K absence/antagonist-II (PIVKA-II) is an abnormal protein, and several reports have demonstrated the efficacy of PIVKA-II in the diagnosis of hepatocellular carcinoma (HCC). We report an extremely rare case of adenocarcinoma of the colon with a high serum PIVKA-II level. Presentation of Case: A 95-year-old woman presented with right lower quadrant pain and appetite loss. An abdominal computed tomography scan and ultrasonography showed an ascending colon tumor and multiple metastatic tumors in the liver. The serum level of PIVKA-II was extremely high, 11,900 ng/mL. Colonoscopic examination revealed a tumor accompanied by an ulcer in the ascending colon, which was highly suspicious for malignancy. Multiple biopsies showed well-differentiated adenocarcinoma of the colon, which was evaluated as colon cancer, stage IV. PIVKA-II-productive colon cancer was confirmed. Chemotherapy with TS-1 was administered. The patient died 3 months after initial admission. Discussion: The expression of PIVKA-II was detected in non-cancer areas, with non-specific expression observed in plasma cells in our case. There might be some possibility that hepatoid differentiation exists in other regions of the colon tumor or in the liver tumor, parenchymal cells or lung metastases, which were composed of PIVKA-II-positive and AFP-negative cells. Conclusion: To the best of our knowledge, high serum levels of PIVKA-II resulting from colon adenocarcinoma have not been reported previously. We report this rare case together with a review of the literature.

Original languageEnglish
Pages (from-to)95-99
Number of pages5
JournalInternational Journal of Surgery Case Reports
Volume6
DOIs
Publication statusPublished - 2015

Keywords

  • Adenocarcinoma
  • Carbohydrate antigen 19-9 (CA 19-9)
  • Carcinoembryonic antigen (CEA)
  • Colon cancer
  • Protein induced by vitamin K absence/antagonist-II (PIVKA-II)

ASJC Scopus subject areas

  • Surgery

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  • Cite this

    Kato, K., Iwasaki, Y., Taniguchi, M., Onodera, K., Matsuda, M., Kawakami, T., Higuchi, M., Kato, K., Kato, Y., & Furukawa, H. (2015). Primary colon cancer with a high serum PIVKA-II level. International Journal of Surgery Case Reports, 6, 95-99. https://doi.org/10.1016/j.ijscr.2014.11.072