A case of alkaline phosphatase producing hepatocellular carcinoma

Abstract

58 yr-old man was admitted because of mass in the liver. On admission, the serum level ofalkaline phosphatase was markedly increased to 68.2 KAU, but serum total bilirubin and γ-GTP levels were normal. The tumor was diagnosed as hepatocellular carcinoma (HCC) by angiography. After the transcatheter arterial embolization of the tumor, both the serum alkaline phosphatase and alpha-fetoprotein levels extremely decreased. But the both levels increased again later, and the patient died because of the rupture of HCC. Histologically, the tumor was well differentiated hepatocellular carcinoma (pseudoglandular type) without cirrhosis. Analysis of the serum alkaline phosphatase isoenzymes by polyacrylamide gel disc electrophoresis showed the presence of variant alkaline phosphatase (Warnock). The staining of the cancerous tissue by the indirect immunoperoxidase method using polyclonal anti-placental alkaline phosphatase antibody revealed positive staining in the cytoplasm of the tumor cells.