ALKALINE PHOSPHATASE ACTIVITY IN CYTOLOGIC SMEARS. USEFULNESS IN THE DIAGNOSIS OF HEPATOCELLULAR CARCINOMA. Bruix J, Calvet X, Faus R, Bru C, Bianchi L, Bruguera M, Rodes J. Liver Unit, Pathology and Radiology Department. Hospital C l in ic . Barcelona. Spain.

Ultrasound guided f ine needle aspirat ion biopsy (FNAB) is usually employed to confirm the diagnosis of hepatocel lu lar carcinoma (HCC). However, th is technique has a sens i t i v i t y of only 60-70% (Okuda K, Hepatology 1986;6:729) since cytologic examination is frequently unable to d is t inguish between malignant and non-malignant hepatocytes. Based on the previous demonstration that hepatocytes may suffer some enzymatic changes during malignant transformation, the present study was aimed to invest igate the diagnostic usefulness of assessing the presence of a lka l ine phosphatase a c t i v i t y (APA) in the neoplastic ce l ls obtained by FNAB.

APA was ascertained by a cytochemical method using the Kaplow technique (Blood 1955;10- 1023) in cytologic specimens obtained in 13 patients with confirmed HCC and in I0 subjects with chronic l i ve r disease.

Only 1 out of the 13 HCC cases was found to exh ib i t normal APA. By contrast, normal APA was found in a l l specimens from the patients with non tumoral l i ve r disease.

These results show that the assessment of APA in cytologic smears obtained by FNAB has a sens i t i v i t y of 92% and a spec i f i c i t y of 100% in the diagnosis of HCC. These data suggest that this cytochemical procedure improves the diagnostic accuracy of FNAB.

G&U&I~S AI~D T~ L~IOI~AL SUB~TR~TN OF TM~ AGGRAVATION8 LN O~l~ONIG AGGR~.EIVN ~PATITLS (CAH) L.Buli~esca I Oama Antonesca, Dept .of Internal ~edlcine,F~u~de~i Hospital, Bucharest, Rem~nla

The authors have studied a @1~e~IP of 343 patients wit~ OAH, sapervised for lo years,of which 15o patients treated with prednlsone and/p~ azathie- pzlne end they intended to analyses the ag~avatlon causes of these pe.- tients,aloz~ the evolution of the disease.We noticed tee a~avetien of CAH in 42 patients (12~ of casea),clinlcally manifested by ast~enia,aublc- terus end one case with hepatic enoe~alopaty and bLcloglcal by hepetocyte- llsls (ASAT/ALAT= 187+66/341+io6=o,5),moderete Incraasln~ of billrublnamla in 7 of 42 cases (d/tN2./),2 ~),the zeaotlvation of Immunelogloal dlsor- ders:gsmmaglobullns 2 g°~,Incraased tltrea of" antlsmoot~ muscle and emil- nuclear antibodies. The leslcnsl substrata is heterogenous,pravellng t~ assocletlon of lobular inflammation end the ~TstoloEio siena o5 olzrhoga- nlc evolution. The factors tlmt induce the aEgrevetlon erez the reductlon or suppression of prednlsone,the infection wlt]~ delta virus,toe Interour- rent Infeotioz~e (2/24 cases)and abortion (i/42 cases).Tha aggravation r e - presents en essential reason of the therapy failure in CAH,not belm~ con= trolled by the Immunomodulente therapy. The evolution was -n~evou~eble 6b,6~ oi cases,of which one case died with l ulmJ~mnte hepetltis end 2 cases developed hepatic clrrnosls.

$105