Lactate Dehydrogenase

LDH is a 134 kD cellular protein highly expressed in skeletal, cardiac, and smooth muscle as well as in liver, kidney, and brain. It functions in both aerobic and anaerobic metabolism, converting lactate to pyruvate in the former and pyruvate to lactate in the latter. LDH is elevated in a wide spectrum of dis eases, and its specificity for testicular tumors is extremely poor. In addition, LDH has not been shown to have strong predilection for specific histologies in GCTs. Therefore, LDH is not particularly useful in diagnosis. However, LDH has been found to be an extremely useful prognostic marker and has an important role in monitoring response to treatment and recurrence, especially in patients with advanced disease. Routine assessment of LDH levels has therefore been recommended by both the National Comprehensive Cancer Network (NCCN) and the Oncological Urology Working Group of the European Association of Urology (EAU).1415

Five isoenzymes of LDH have been described; each is a tetramer of two LD subunits. LDH isoenzyme 1 (LDH-1) consists of four LD-P subunits. In testicular cancer, LDH-1 is the most commonly elevated isoenzyme16 and has been shown to pre-

Immunohistochemistry Testicular Cancer

Figure 7-4. Immunohistochemistry demonstrates positive hCG staining of syncytiotrophoblastic elements in choriocarcinoma (A) and in seminoma (B).

Figure 7-4. Immunohistochemistry demonstrates positive hCG staining of syncytiotrophoblastic elements in choriocarcinoma (A) and in seminoma (B).

diet response to therapy, relapse-free survival, and overall survival.16-19

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