Excessive alpha-fetoprotein concentrations in hepatocellular carcinoma.

Excessive alpha-fetoprotein concentrations in hepatocellular carcinoma We describe a patient with hepatocellular carcinoma, whose serum concentration of ac-fetoprotein exceeded 4 800 000 ,ug/l and produced an extra band on protein electrophoresis. complaining of severe right shoulder pain and abdominal distension of about two weeks' duration. He had a massively enlarged liver with considerable abdominal distension. Laboratory investigations gave the following results (normal ranges in parentheses): haemoglobin 12-1 g/dl y Results of protein electrophoresis on cellulose acetate (a) showing presence of extra a-fetoprotein band (arrow) between albumin and ml band in patient's and neonate's serum, and absence of extra band in normal adult serum. Immunochemical confirmation of result (b) showing precipitation arc obtained with anti-a-fetoprotein (anti-AFP) serum using transfer technique (TR); electrophoretic pattern of patient's serum (EP); and precipitation band corresponding to additional fraction (X) obtained by immunofixation using anti-AFP serum (IF). On 24 February laparoscopy showed bloodstained ascites and a grossly enlarged liver with multiple deposits in both lobes. Histological examination of a small biopsy specimen taken from a deposit confirmed the diagnosis of primary hepatocellular carcinoma. The serum concentration of a-fetoprotein (AFP) measured by radioimmunoassay was so abnormally high-4 800 000 iLg/l (the normal range for healthy adults being < 25 ,Lg/l (< 25 ng/ ml))-that on serum protein electrophoresis on cellulose acetate it formed an extra band between albumin and ocl-globulin (see fig). The identification of the additional band was performed by the following techniques. A transfer technique1 2 in which the relevant band is cut out, placed on the surface of an agar plate, and left to diffuse against a specific antiserum applied to a strip of filter paper. The resulting precipitation arc may be visualised, stained, and localised. A modification of an immunofixation technique using cellulose acetate for separation3-after electrophoresis a specific antiserum (in this case anti-AFP) is applied to the separation pattern on agar gel and left to diffuse. Then the agar gel is washed, the "unfixed proteins" removed, and the gel stained. Both techniques confirmed that the additional band seen between the albumin and the xl fraction was oc-fetoprotein. Treatment with intravenous Aminosol and Intralipid was started on 27 February and continued until 6 March. The AFP concentration increased substantially during intravenous feeding, reaching a maximum value of 7 400 000 tsgll on 28 April. Despite treatment with x-irradiation to the liver area (300 rads), and subsequently a course of doxorubicin, he died on …