Evaluation of Lactate Dehydrogenase Tumor Marker in Children With Gonadal Germ Cell Tumor, Epithelial Tumor, Sex Stromal Tumor, par gonadal Tumor, and Cyst

To the Editor: Ovarian and testicular tumors, especially germ cell tumors (GCT), rarely occur in children [1]. Gonadal tumors present with broad symptoms, causing delayed diag- nosis in≥70% of patients and poorer outcomes [2]. Discov- ering the appropriate tumor marker for detecting and manag- ing cancer patients is essential. Our 5-y (2015–2020) study analyzed the effectiveness of lactate dehydrogenase (LDH), an enzyme [3], in 96 children with cysts, and nonmalignant and malignant (para)gonadal tumors at our hospital, using normal LDH level of 0–300 u/L.

Most patients presented at ages>12–15, stage 2, and patient-to-tumor size peaked at>5–10 cm. Seventy-five out of 96 patients had elevated LDH, 52 being GCT. Sixty- eight out of 96 patients had malignant tumors; of which, 67 patients had LDH ->300 u/L. The sensitivity, specificity, and area-under-curve values were 98.5%, 71.4%, and 0.850, respectively. The p value was 0.001.

Ten out of 12 patients with recurrence and 32/32 patients with metastasis had LDH ->300 u/L. LDH normalized in 59/75 patients between after-the-operation and 6-mo period, and in 12/75 patients after 6 mo. However, LDH remained elevated in 4/75 patients with rhabdomyosarcoma – 767 u/L; dysgerminoma – 2185 u/L (highest LDH value in our study); mixed GCT – 704 u/L and 1210 u/L, till they died. The value of LDH for the largest tumor size of 28 cm was 394 u/L. Eight patients without malignancy, who had 5–26 cm tumor sizes, compressed organs, both gonads affected, torsion or chronic diseases, had LDH ->300 u/L.

The LDH median values were as follows: 251.5 u/L – patients without malignancy; 327.0 u/L – stage 1; 432 u/L – stage 2; 771.5 u/L – stage 3; and 1210.0 u/L – stage 4. The p value was 0.031 showing a positive correlation with tumor stage. Considering that stage 3, the onset of late-stage cancer critical for prognosis [4], fell in the 700 u/L range, we re-analyzed all patients using LDH – 700 u/L; 24/24 patients with LDH ->700 u/L had malignancy. Nineteen out of 21 patients admitted with metastasis; 15/16 patients with elevated LDH level after 6 mo, 23/27 patients at stages 3–4; 18/28 patients with poor prognosis; and 4/4 patients who died, all had LDH ->700 u/L.

References

1. Cecchetto G. Gonadal germ cell tumors in children and adoles- cents. J Indian Assoc Pediatr Surg. 2014;19:189–94.

2. Doubeni CA, Doubeni AR, Myers AE. Diagnosis and manage- ment of ovarian cancer. Am Fam Physician. 2016;93:937–44.

3. Jurisic V, Radenkovic S, Konjevic G. The actual role of LDH as tumor marker, biochemical and clinical aspects. Adv Exp Med Biol. 2015;867:115–24.

4. Dinkelspiel HE, Champer M, Hou J, et al. Long-term mortality among women with epithelial ovarian cancer. Gynecol Oncol. 2015;138:421–8.

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