A case of minimal deviation hepatoma in man with elevated liver-type pyruvate kinase isozyme

A surgical specimen of solitary, encapsulated tumor tissue obtained from a 52-year-old male, diagnosed histologically as well-differentiated hepatocellular carcinoma (Grade II, Edmondson and Steiner) with liver cirrhosis, Type A' (and B is some parts), was found to have a supernormal level of pyruvate kinase Type L and subnormal level of Type M2; the activities (units/mg protein) being 1.21 and 0.12 respectively. The resulting isozyme pattern was apparently "superdifferentiated" as compared with those of not only the tumor-bearing, cirrhotic liver (Type L, 0.19; Type M2, 0.67) but also the normal liver (Type L, 0.47+/-0.05; Type M2, 0.18+/-0.02). The electrophoretic and kinetic properties of the type L isozyme were identical with those of the cirrhotic host liver and a non-cirrhotic control liver. Other enzyme levels in the hepatoma tissue were as follows: Glucose-6-phosphatase, norma; fructose-1,6-bisphosphatase, reduced; glucokinase, absent; and hexokinase Types I and III, and glucose-6-phosphate dehydrogenase, slightly increased. The serum alpha-fetoprotein level was 95 ng/ml. The whole enzyme profile is consistent with the minimal deviation hepatomas in rats. The results were compared with those of other human hepatomas, and the mechanisms of disordered regulation in hepatoma gene expression were discussed.