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
alpha-fetoprotein (AFP; 490 200 ng/mL) and
protein induced by
vitamin K absence or antagonist-II (
PIVKA-II, 2284 mAU/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.