title: Characteristics of three cases of hepatocellular carcinoma showing enhanced technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin accumulation by single photon emission computed tomography analysis.
abstract: BACKGROUND
  The asialoglycoprotein receptor (ASGP-R) is abundantly expressed on the sinusoidal surfaces of hepatocytes. However, the majority of hepatocellular carcinomas (HCC) lack ASGP-R on their cell surface membranes. We describe three cases of HCC showing increased expression of ASGP-R in comparison with the surrounding liver tissue.
  
  
  METHODS
  We performed technetium-99m-diethylenetriaminepentaacetic acid-galactosyl human serum albumin ((99m)Tc-GSA) single photon emission computed tomography (SPECT) analysis on patients with HCC. Three cases of HCC showing enhanced accumulation of (99m)Tc-GSA were included in the present study. Histopathological and radiological examinations of the HCC were conducted. The three affected patients were all female and over 60 years old.
  
  
  RESULTS
  Computed tomography (CT) angiography or dynamic CT showed hypo-enhancement of the tumors during the hepatic arterial to portal phases. Patient 1 received percutaneous ethanol injection therapy and died 5 years later because of chronic renal failure. Patient 2 underwent surgeryand is currently healthy 5 years after the operation. Patient 3 underwent percutaneous ethanol injection therapy and died 4 years later because of a newly occurred HCC to another part of the liver. Histopathological examination showed well-differentiated HCC in all three cases. Immunohistochemical examination showed that the expression of ASGP-R was higher in the HCC than in the non-tumorous liver tissue.
  
  
  CONCLUSIONS
  We have named the HCC of this type ASGP-Roma. ASGP-Roma is well-differentiated HCC, shows CT findings that are atypical of HCC, and is diagnosed by (99m)Tc-GSA SPECT analysis. We propose that ASGP-Roma be placed in a special category among well-differentiated HCC.
authors.affiliation: Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Suzuki
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Togashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Haga
authors.forename: Koji
authors.initials: K
authors.lastname: Saito
authors.forename: Takafumi
authors.initials: T
authors.lastname: Saito
authors.forename: Kazuei
authors.initials: K
authors.lastname: Takahashi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sugai
authors.forename: Sumio
authors.initials: S
authors.lastname: Kawata