Case Reports
Spontaneous Tumor Lysis Syndrome in Solid Tumors: Really a Rare Condition?

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ABSTRACT

Acute tumor lysis syndrome (ATLS), which occurs spontaneously, without cytotoxic therapy, is a rare condition. Spontaneous TLS (STLS) has been seen most commonly in lymphoma and leukemia. We report a series of 3 cases of STLS in patients with solid tumors who were hospitalized in our department during a 9-month period and suggest that STLS is probably more frequent than previously thought.

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Case 1

An 82-year-old woman was admitted because of a 1-week history of weakness, oliguria, and confusion. She had a right hemicolectomy 2 years earlier for colon cancer. Liver and bone metastases were found a year later. She had never received chemotherapy for this malignancy. In a previous hospitalization, 3 weeks before, her renal function was normal.

Abnormal laboratory tests included: serum urea nitrogen (BUN) of 94 mg/dL; creatinine, 3.5 mg/dL; uric acid, 20.3 mg/dL; phosphorus, 5.5 mg/dL; calcium,

Case 2

An 80-year-old man was admitted with a 6-month history of weakness, 17-kg weight loss, 1 week of right lower abdominal pain, 39°C fever, and vomiting. Laboratory results showed a BUN of 69 mg/dL; creatinine, 2.8 mg/dL; uric acid, 16.5 mg/dL; potassium, 6.6 mg/dL; phosphorus, 5.8 mg/dL; calcium, 8.4 mg/dL; and LDH, 864 U/L.

CT showed a 20-cm tumor of the right adrenal gland. CT-guided biopsy of this tumor showed pheochromocytoma. Mete-Iodobenzylguanidine radionucleotide scan revealed a right middle

Case 3

A 72-year-old man was admitted for weakness, abdominal pain, and dyspnea of past 4 days’ duration. In 2001, he had undergone cholecystectomy for stones. During the surgery, a liver mass was noted. Open biopsy showed liver fibrosis and hepatocellular carcinoma. He didn’t receive chemotherapy because of the advanced stage of the cancer. Laboratory tests done 3 weeks before admission showed normal uric acid levels and normal renal function. On admission, laboratory tests showed a hemoglobin of 12 

Discussion

The central event of ATLS is the necrosis of a large amount of neoplastic tissue with subsequent massive release of intracellular contents into the circulation, usually after chemotherapeutic treatment. The sudden rise in potassium poses the first threat—hyperkalemia. The release of phosphate causes hyperphosphatemia, with precipitation of calcium phosphate crystals, which leads to hypocalcemia and also acute renal tubular damage. A massive release of purine nucleotides leads to hyperuricemia,

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