Serum Lactate Dehydrogenase Levels and Degenerative Patterns in Ultrasonography for Differential Diagnosis between Uterine Leiomyomas and Leiomyosarcomas.

Abstract

Background: It is difficult to distinguish clinically between leiomyoma and leiomyosarcoma. The prognosis of the latter is poor. In patients with uterine leiomyosarcomas, high serum lactate dehydrogenase (LDH) levels have been reported to be elevated. However, little is known about serum LDH levels in patients with benign leiomyomas, or about the relationship between serum LDH levels and ultrasonographic findings. We therefore explored serum LDH levels and degenerative patterns of the tumor in ultrasonography (USG) in patients with various smooth muscle tumors of the uterus.Methods: Clinical history, serum LDH and alkaline phosphatase (ALP) levels, images produced by USG, and pathological findings were reviewed in 232 patients with uterine leiomyoma, three with uterine leiomyosarcoma, one with lipoleiomyoma, and one with metastasis of the breast cancer into uterine leiomyoma treated, at Kochi Nokyo General Hospital from September 1988 to August 1996. Relationship between serum LDH levels and the presence of degenerative pattern in USG or uterine weight was also analyzed.Results: Serum LDH levels were abnormally elevated preoperatively in one of 232 patients with uterine leiomyoma, two of three with leiomyosarcoma, one with lipoleiomyoma and one with metastasis of the breast cancer into uterine leiomyoma. A degenerative pattern in USG was found in 15/232 of leiomyomas, 2/3 leiomyosarcomas, 1/1 lipoleiomyoma and 1/1 metastasis of the breast cancer into uterine leiomyoma. All cases with abnormally elevated serum LDH levels showed a degenerative pattern in USG. There was a significant difference in serum LDH levels between leiomyoma with degenerative pattern in USG and without it (p=0.0320). No significant relationship was found between the weight of the uterus and serum LDH levels in patients with leiomyoma.Conclusion: The uterine tumor associated with both degenerative pattern in USG and elevated LDH levels in the patients' serum is strongly suspected to be leiomyosarcoma. The patients with presumed uterine leiomyoma should be examined for not only degenerative patterns in USG, but also serum LDH levels.