Increase in LDH levels is seen in?
ANSWER: (A) Bulky diseaseREF: Harrison's 18th ed various pagesThough in the given question all options can show raised LDH. The examiner was most probably asking about the highest levels of LDH.LDH is used in assessment of tissue breakdown in general or hemolysis. It is used to follow-up cancer (especially lymphoma) patients, as cancer cells have a high rate of turnover with destroyed cells leading to an elevated LDH activityLDH in NHL patients with active disease is higher than in normal subjects. LDH is the same as in normal subjects in the How-grade" and 'Intermediate-grade" malignancies. I.e. LDH is more related to the spread of the lymphoma. (REF: style="color: rgba(20, 20, 20, 1); font-family: Times New Roman, Times, serif">)In lymphomas the term "bulky" disease signifies a nodal mass whose greatest dimension is more than 10 centimeters in size, and/or a widening of the mediastinum by more than one-thirdThe above text clearly signifies that the highest levels of LDH are seen in bulky disease. INTERNATIONAL PROGNOSTIC INDEX:The International Prognostic Index (IPI) is a clinical tool developed by oncologists to aid in predicting the prognosis of patients with aggressive non-Hodgkin's lymphoma.One point is assigned for each of the following risk factors:Age greater than 60 yearsStage III or IV diseaseElevated serum LDHECOG/Zubrod performance status of 2, 3, or 4More than 1 extranodal siteThe sum of the points allotted correlates with the following risk groups:Low risk (0-1 points): 5-year survival of 73%LowT-intermediate risk (2 points): 5-year survival of 51%High-intermediate risk (3 points): 5-year survival of 43%High risk (4-5 points): 5-year survival of 26%LDH levels are raised in:Testicular carcinomaHemolytic anemiaVisceral infarctionLymphoma, LeukemiaPleural effusions and serositisMelanomaInterstitial lung diseasesMyopathiesMeningitis and encephalitisHIVDysgerminomaIncreased tissue turnover
Bulky disease
Lymphoma
Liver metastasis
Lung metastasis
General