Case ReportsSpontaneous Tumor Lysis Syndrome in Solid Tumors: Really a Rare Condition?
Section snippets
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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Cited by (62)
Spontaneous tumour lysis syndrome in hepatocellular carcinoma presenting with hypocalcemic tetany: An unusual case and systematic literature review
2017, Clinics and Research in Hepatology and GastroenterologyCitation Excerpt :We did an extensive search of literature and searched Pubmed and Embase for all available articles using keywords (“Hepatocellular carcinoma” OR “hepatoma”) AND (“tumour lysis” OR “tumour lysis syndrome”) and found only three case reports of STLS in HCC (Table 1). The first case was reported by Vaisban et al. in 2003 in a 72 year old male who presented with weakness abdominal pain and dyspnoea [7]. In this case HCC was detected from liver mass found during cholecystectomy.
Spontaneous tumor lysis syndrome in renal cell carcinoma: A case report
2014, Clinical Genitourinary CancerCitation Excerpt :Spontaneous TLS is not as common in solid tumors, but we believe that it might be underdiagnosed, because many milder cases could be missed easily without a high index of suspicion. STLS has been reported in gastric cancer,7 lung,8 pheochromocytoma,9 breast,10 hepatocellular,11 melanoma,12 sarcoma,13 and adenocarcinoma of unknown primary.14 There were 5 case reports of STLS in genitourinary cancers: 4 in germ cell tumors,15-17 and 1 in prostate carcinoma.18
Spontaneous tumor lysis syndrome in a patient with newly diagnosed metastatic colonic adenocarcinoma
2018, Canadian Journal of Emergency MedicineSpontaneous tumour lysis secondary to gastric adenocarcinoma
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