Malignancy alkaline phosphatase

Alkaline phosphatase (ALP) Liver kidney, bone, placenta, intestine, biliary epithelia 30-300 lU/L (higher in children due to increased bone growth) Raised levels may indicate biliary inflammation/ obstruction, malignant infiltration, cirrhosis, bone destruction, Paget s disease... 

Laboratory investigation reveals highly pathological inflammatory criteria , which probably point to a consuming or malignant process. Alkaline phosphatase and bilirubin rise in the further course of disease (in about 80% of cases). Lymphopenia and eosinophilia are often in evidence. (36, 38, 41) (s. tab. 38.2)... 

In liver metastases, the serum alkaline phosphatase level shows a better correlation with the extent of liver involvement than those of other liver tests. To differentiate the origin of elevated alkaline phosphatase levels, tests of other liver enzymes may be performed, such as that for 5 -nucleotidase or y-glutamyltransferase. Determination of alkaline phosphatase isoenzymes may provide additional specificity. The liver isoenzyme is thermally more stable than the bone isoenzyme (see Chapter 21 for a more detailed discussion). Other malignancies, such as leuicemia, sarcoma, and lymphoma complicated with hepatic infiltration, may also show elevated ailcaline phosphatase levels. 

With old W, Schulte U, Reinauer H. Method for determination of bone alkaline phosphatase activity analytical performance and clinical usefulness in patients with metabolic bone disease and malignant bone diseases. Clin Chem 1996 42 210-7. 

Elevated levels of alkaline phosphatase and GGT occur with obstructive disorders that disrupt the flow of bile from the hepatocytes to the bile ductules, or from the biliary tree to the intestines. Examples of the former include primary biliary cirrhosis and drug-induced cholestasis examples of the latter include gallstone disease and malignancies of the pancreas and bile ducts. In liver disease, the levels of GGT correlate well with elevations of the alkaline phosphatase, and their combination is a sensitive and specific marker for biliary tract disease. ... 

BA is a potent differentiation agent in a wide variety of cancer cells in-vivo and in-vitro [23, 24]. Butyrate has been shown to specifically affect genes regulation by transcriptional and post transcriptional modifications. It induces dose dependent differentiation and inhibits proliferation of various malignant cells types including erythroleukemia, embryonal carcinoma and colon carcinoma [25, 26]. BA induced the expression of specific differentiation-associated genes when used at concentration between 0.5-10 mM. Differentiated cells are characterized by appearance of regulatory enzymes such as alkaline phosphatase [27]. 

ALPPL2 NM 031313 GCAP Germ cell alkaline phosphatase, GCALP Testis, malignant trophoblasts, testicular cancer Unknown... 

Goldstein DJ, Rogers C, Harris H (1982) A search for trace expression of placental-Uke alkaline phosphatase in non-malignant human tissues demonstration of its occurrence in lung, cervix, testis and thymus. Clin Chim Acta 125 63-75... 

Lightman and Bloom (L15) reported a patient with a glucagon-secreting tumor situated outside the pancreas but with the histology of a malignant islet cell tumor. Serum alkaline phosphatase was normal,... 

Hypersecretion of cortisol may be due to ectopic ACTH production by nonendocrine malignant tumors (L13, 06), which may raise serum alkaline phosphatase values by a variety of mechanisms (see Section 10). Hyperphosphatasemia has also been reported in association with adrenal carcinomas which may metastasize to the liver (H27). 

Burke AP, Mostofi EK. Placental alkaline phosphatase immunohistochemistry of intratubular malignant germ cells and associated testicular germ cell tumors. Hum Pathol. 1988 19 663-670. 

Bailey D, Marks A, Stratis M, Baumal R. Immunohistochemical staining of germ cell tumors and intratubular malignant germ cells of the testis using antibody to placental alkaline phosphatase and a monoclonal anti-seminoma antibody. Mod Pathol. 1991 4 167-171. 

This nuclear transcription factor is involved in embryonic morphogenesis and is functionally related to c-kit and placental alkaline phosphatase (PLAP) expression. Nuclear staining is demonstrated in IGCNU and seminoma with a high degree of sensitivity. Positivity in nonseminomatous GCT is of lower sensitivity and, like podoplanin, activator protein-2G is also expressed in nontesticular neoplasms such as somatic malignant melanoma and mammary and ovarian carcinomas. ... 

Burke AP, Mostofi FK. Intratubular malignant germ cells in testicular biopsies clinical course and identification by staining for placental alkaline phosphatase. Mod Pathol. 1988 1 475. 

Though he is not clinically jaundiced the high alkaline phosphatase and tGT with modest increases in the AST and ALT would suggest cholestasis. This may be due to liver cirrhosis or malignant disease affecting the liver, both of which would be likely diagnoses in this case. 

Other examples follow of resistance achieved by increased production of a destructive enzyme. The treatment of acute leukaemia with cytosine arabino-side 4.13) fails in proportion as malignant cells with a higher concentration of cytosine deaminase appear (Steuart and Burke, 1971). Acquisition of insensitivity to 6-mercaptopurine by acute lymphocytic leukaemia cells in Man, and by murine sarcoma 180/TG, was shown to be due to an increase in alkaline phosphatase which causes degradation of the tumour-inhibiting nucleotide to which the cell converts this pro-drug (Rosman etal., 1974). 

Peck et al. (1978) studied the effects of isotretinoin in 81 patients with various dermatologic disorders and reported elevated erythrocyte sedimentation rate in 13 patients, slight increases in SGPT in three patients, increased SCOT in one patient, and increased alkaline phosphatase in two patients. In a SO-patient study conducted by Yoder and Peck (1977), the only abnormal laboratory test was elevated erythrocyte sedimentation rate noted in seven patients. Elrug-related hypercalcemia was seen in 3 of 42 patients treated with isotretinoin for various malignancies (Cassidy et al., 1981). 

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