Serum Alkaline Phosphatase Is Useful to Diagnose and Predict the Prognosis of Osteosarcoma Arising from Uterus: A Case Report

Abstract

Background:

Pure osteosarcoma arising from the uterus is extremely rare. It is difficult to diagnose and predict disease progression with blood markers, because of the rarity. In this study, we describe a case of pure osteosarcoma arising from the uterus, which showed that alkaline phosphatase (ALP) was more sensitive than lactate dehydrogenase (LDH) for the diagnosis and observation of disease development.

Case:

A 78-year-old woman was referred to our hospital due to calcification of the uterine mass. Pelvic magnetic resonance imaging revealed a mass lesion (10 cm in diameter) showing a low-intensity area on both T1- and T2-weighted images. Positron emission tomography/computed tomography revealed 18-fluoro-2-deoxy-d-glucose (FDG) uptake in the pelvic mass and multiple dissemination in the abdominal cavity. Blood test results showed elevated levels of both ALP (3520 IU/L) and LDH (247 IU/L). From these data, we considered the possibility of a uterine malignant tumor and performed primary debulking surgery. By laparotomy, a uterine mass and disseminated lesions at the sigmoid colon and omentum were noted. We performed a total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and resection of the sigmoid colon with dissemination. The pathological diagnosis was pure osteosarcoma arising from uterine corpus.

Results:

Two weeks postsurgery, some metastatic regions arose. Along with metastatic progression, ALP levels were continually elevated, whereas LDH did not show a constant tendency.

Conclusion:

The novel finding of this report is that ALP might be more sensitive and useful than LDH in diagnosing osteosarcoma arising from the uterus and aid in evaluating the recurrence and disease progression. (J GYNECOL SURG 36:205)