Serum lactic dehydrogenase: a tumor marker of ovarian dysgerminoma in a female pseudohermaphrodite

Metastasis of ovarian dysgerminoma in a postmenopausal patient: a rare case report

Ovary dysgerminoma is one of the most good prognosis malignant tumor, which has a 5-year overall survival rate exceeding to 90%. Generally, the incidence of ovarian dysgerminoma (OD) is relatively low, accounting for ~0.6% of all ovarian tumors. Usually, it mainly occurs in very young women, about 85% of patients under 30 years old and is rare in middle-aged especially in elderly ones. This ovary dysgerminoma case report presents a 58-year-old menopausal postmenopausal woman which has a poor prognosis. Therefore, there may be differences between the elderly and young women in clinical characteristic that require separate management. This case reports a postmenopausal woman who was diagnosed with ovary dysgerminoma. After surgery, the patient was treated chemotherapy with bleomycin, etoposide, and cisplatin (BEP) according to the treatment guidelines. Unusually, the patient developed bone marrow suppression and lymph node metastasis in final. This report explored the clinical characteristic in postmenopausal woman dysgerminoma. Changes in lactate dehydrogenase (LDH) throughout the course of the disease are closely related to the progression. The patient had a disease progression when treated with the conventional treatment (BEP). The applicability of this treatment protocol to postmenopausal patients requires further research. Postmenopausal woman dysgerminoma is rare but rapid progress. Whether BEP is suitable for OD in middle-aged and elderly people remains to be further validated in the future. LDH may be a potential biomarker for monitoring the progression of OD in the elderly.

Serum lactic dehydrogenase as a tumor marker in dysgerminoma

Dysgerminoma is the most common malignant germ cell tumor in young women. The management of advanced-stage dysgerminoma challenges the gynecologic oncologist to achieve maximal survival, while maintaining childbearing potential. Radiation therapy has been extremely successful in curing dysgerminoma, but ovarian conservation is usually not possible. In contrast, various chemotherapeutic regimens have achieved high cure rates with continued ovarian function. Diagnosing recurrent dysgerminoma promptly so that salvage therapy can be initiated is important when conservative management has been employed. While alpha-fetoprotein and human chorionic gonadotropin have proven useful as tumor markers in some types of germ cell tumors, they have not been useful in patients with dysgerminoma. Serum lactic dehydrogenase (LDH) levels are known to be elevated in some patients with dysgerminoma. We treated a patient with Stage IIIC dysgerminoma whose initial serum LDH level was markedly elevated. After unilateral salpingo-oophorectomy with pelvic and paraaortic lymphadenectomy, followed by four cycles of VAC chemotherapy, her LDH level returned to normal. Her LDH level rose with disease recurrence and returned to normal again with salvage BEP chemotherapy. This is the first report to document the utility of serial LDH measurements in detecting disease recurrence in patients with ovarian dysgerminoma.

Follicle regulatory protein: a novel marker for granulosa cell cancer patients

Follicle regulatory protein (FRP) is secreted by the granulosa cell of the ovary and plays a role in modulating follicle development. A dual epitope immunoassay using two murine monoclonal antibodies, isotype IgG1 (raised against porcine FRP), in tandem was developed to measure FRP in serum. The levels of FRP in the serum of women with granulosa cell tumors, normal, menstruating women, and postmenopausal women were determined. The levels of FRP were elevated in the serum of 79% of the women with granulosa cell tumors compared to the normal controls. FRP levels in serial samples from women with granulosa cell tumors generally correlated with the clinical course of the disease. Thus, FRP may provide a useful marker for granulosa cell tumors.

Serum lactic dehydrogenase and its isoenzymes in patients with ovarian dysgerminoma

Lactic dehydrogenase (LDH) is a glycolytic enzyme that may be elevated in the serum of patients with gonadal and extragonadal germinomas. In this report, a case of unilateral ovarian pure dysgerminoma with remarkably elevated levels of serum LDH is presented. After complete excision of the tumor, serum LDH levels promptly returned to normal levels. Although an electrophoretic pattern of serum LDH isoenzymes was within normal limits pre-operatively, an increase in LDH-1 and 2 was found 1 week after operation. Seventeen additional examples of ovarian dysgerminomas with elevated serum LDH levels have been reported in the English literature including five cases who had high levels of two fast fractions of LDH. These data suggest that serum LDH levels and its isoenzymes pattern are useful tumor markers for diagnosis and post-therapy surveillance in patients with ovarian dysgerminomas.

The value of cancer antigen-125 as a tumor marker in malignant germ cell tumors of the ovary

The value of cancer antigen-125 (CA-125) as a tumor marker for malignant germ cell tumors (MGCT) of the ovary was investigated and compared with the other recognized tumor markers (human chorionic gonadotrophin (hCG), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) isoenzymes. In the 10 months following June 1984, 4 new cases with MGCT and 1 patient with active disease on treatment were evaluated. In all cases prior to planned surgery the levels of CA-125 were significantly elevated. The serum values ranged from 154 to 617 U/ml (normal less than 20 U/ml). In 1 case (pure dysgerminoma) CA-125 was the only tumor marker. In 3 patients (2 mixed germ cell tumors and 1 immature teratoma) serum LDH (LD 1, 2, and 3) was elevated, and AFP was elevated in 1 of these. In the fifth case (mixed germ cell tumor), on treatment, serum AFP was used to monitor the disease. Four patients underwent cytoreductive surgery followed by combination chemotherapy. The changes in the serum levels of CA-125 paralleled those of the other tumor markers while on therapy. In our experience CA-125 is an invaluable indicator of the clinical status of the patient and could be a new tumor marker in patients with MGCT.