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.
Conclusion: 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.