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Prasad A, Verghese D, Vijaya Rangan S, Sunadarajan N. Spontaneous tumour lysis secondary to gastric adenocarcinoma. BMJ Case Rep 2024; 17:e258369. [PMID: 38191220 PMCID: PMC10806900 DOI: 10.1136/bcr-2023-258369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
We present a case of a man in his 70s who presented with worsening rectal and back pain associated with weight loss, dyspnoea and brownish discolouration of urine. Physical examination noted abdominal distention and epigastric tenderness. Laboratory investigations revealed acute kidney injury, hyperkalaemia, hyperphosphataemia and hyperuricaemia. Contrast CT of the abdomen/pelvis showed multiple, low-density masses throughout the liver, suspicious for metastatic disease. Oesophagogastroduodenoscopy demonstrated a large, fungating, infiltrative and ulcerated mass in the gastric body and lesser curvature of the stomach. Surgical pathology confirmed invasive moderately differentiated gastric adenocarcinoma. He met both the laboratory and clinical criteria for spontaneous tumour lysis syndrome (STLS) as per the Cairo-Bishop criteria. He was managed with aggressive fluid hydration, rasburicase and allopurinol, resulting in improvement in his renal function and laboratory findings. STLS of solid organ tumours, especially gastric adenocarcinoma, is rare and requires early detection with timely management to ensure favourable outcomes.
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Affiliation(s)
- Apurwa Prasad
- AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Dhiran Verghese
- AMITA Health Saint Joseph Hospital Chicago, Chicago, Illinois, USA
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2
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Papapanou M, Athanasopoulos AE, Georgiadi E, Maragkos SA, Liontos M, Ziogas DC, Damaskos D, Schizas D. Spontaneous tumor lysis syndrome in patients with solid tumors: a scoping review of the literature. Med Oncol 2023; 40:233. [PMID: 37432468 PMCID: PMC10335952 DOI: 10.1007/s12032-023-02108-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
No systematic synthesis of all cases of spontaneous tumor lysis syndrome (STLS) in adult patients with solid tumors is available to date. Herein, we aim to recognize specific STLS characteristics and parameters related to a worse prognosis. We conducted a systematic search for randomized controlled trials, cohorts, case-control studies, and case reports. The primary endpoints were death and the need for renal replacement therapy (RRT) due to STLS. We estimated crude odds ratios (ORs) with 95% confidence intervals (95%CI) via univariate binary logistic regression. We included one cohort of 9 patients and 66 case reports of 71 patients [lung cancer 15(21.1%)]. Regarding the case reports, most patients [61(87.1%)] had metastatic disease [liver 46(75.4%)], developed acute kidney injury [59(83.1%)], needed RRT [25(37.3%)], and died due to STLS [36(55.4%)]. Metastatic disease, especially in the liver [p = 0.035; OR (95%CI): 9.88 (1.09, 89.29)] or lungs [p = 0.024; 14.00 (1.37, 142.89)], was significantly associated with STLS-related death compared to no metastasis. Cases resulting in death had a significantly higher probability of receiving rasburicase monotherapy than receiving no urate-lowering agents [p = 0.034; 5.33 (1.09, 26.61)], or the allopurinol-rasburicase combination [p = 0.023; 7.47 (1.40, 39.84)]. Patients receiving allopurinol were less likely to need RRT compared to those not receiving it or those receiving rasburicase. In conclusion, current anecdotal evidence demonstrated that metastatic disease, especially in the liver and lungs, may be associated with STLS-related death compared to no metastatic status. Careful surveillance of high-risk cases within larger studies is essential to identify markers predicting morbidity or mortality.
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Affiliation(s)
- Michail Papapanou
- Society of Junior Doctors, Athens, 15123, Greece.
- Second Department of Obstetrics and Gynecology, Medical School, "Aretaieion Hospital", National and Kapodistrian University of Athens, 76 Vas. Sofias Ave, Athens, 11528, Greece.
| | | | - Eleni Georgiadi
- 2nd Department of Radiology, Medical School, University General Hospital "Attikon", National and Kapodistrian University of Athens, 1 Rimini Str, Haidari/Athens, 12462, Greece
- School of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | | | - Michalis Liontos
- Department of Clinical Therapeutics, Division of Oncology, National and Kapodistrian University of Athens, Alexandra Hospital, 80 Vas. Sofias Ave, Athens, 10679, Greece
| | - Dimitrios C Ziogas
- First Department of Internal Medicine, Unit of Medical Oncology, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, Athens, 11527, Greece
| | - Dimitrios Damaskos
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, Athens, 11527, Greece
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Causbie J, Ramirez A, Howells J. A Case of Spontaneous Tumor Lysis After Pathologic Femur Fracture in Squamous Cell Lung Cancer. J Investig Med High Impact Case Rep 2023; 11:23247096231192898. [PMID: 37592740 PMCID: PMC10439735 DOI: 10.1177/23247096231192898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023] Open
Abstract
Tumor lysis syndrome (TLS) occurs when large numbers of tumor cells lyse and release their contents, causing electrolyte derangements and renal injury. It is an uncommon complication of solid tumors and occurs most commonly after cytotoxic therapy rather than spontaneously. In this article, we describe a case of spontaneous TLS in a patient with squamous cell carcinoma of the lung. We also present a literature review of spontaneous TLS occurrence in solid tumors.
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Affiliation(s)
| | - Ariana Ramirez
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - Joseph Howells
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
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Barakat S, Abdallah B, Finianos A, Mahmasani LA. Tumor Lysis Syndrome: A Rare Complication of Metastatic Gastric Cancer and a Possible Indicator of Disease Progression. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2022; 15:11795476221129238. [PMID: 36277906 PMCID: PMC9585557 DOI: 10.1177/11795476221129238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/01/2022] [Indexed: 11/08/2022]
Abstract
Tumor lysis syndrome (TLS) is an oncologic emergency that is usually associated with hematologic malignancies either spontaneously or following early chemotherapy and is caused by massive tumor cell lysis. However, it has been rarely reported in solid tumors. We report a case of 25-year-old lady recently diagnosed with metastatic gastric adenocarcinoma who developed TLS after the fourth cycle of chemoimmunotherapy (FOLFOX plus Nivolumab). She presented with abdominal pain, decrease in oral intake and decreased urine output. Laboratory studies showed acute kidney injury with electrolyte disturbances and was diagnosed initially with autoimmune nephritis secondary to Nivolumab but was later found to have TLS and recovered after appropriate treatment. Soon after this complication, our patient was found to have disease progression on imaging which makes the incidence of TLS an indicator of disease progression.
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Affiliation(s)
- Salim Barakat
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Batoul Abdallah
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Antoine Finianos
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Layal Al Mahmasani
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon,Layal Al Mahmasani, Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut Medical Center, Cairo Street, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
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5
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Moiseff R, Felty C, Liu X. Fatal tumor lysis syndrome in a patient with metastatic gastric adenocarcinoma. Autops Case Rep 2020; 11:e2020225. [PMID: 34307209 PMCID: PMC8294839 DOI: 10.4322/acr.2020.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/29/2020] [Indexed: 11/23/2022]
Abstract
Tumor lysis syndrome is a well-characterized and potentially deadly complication of spontaneous or treatment-related tumor destruction, and it is most commonly associated with hematologic malignancies. Our case illustrates a rare example of fatal tumor lysis syndrome in the setting of metastatic gastric adenocarcinoma treated with radiation therapy. This case highlights the critical importance of identifying patients with solid organ malignancies at risk for tumor lysis syndrome and of early recognition and treatment of this syndrome.
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Affiliation(s)
- Robin Moiseff
- Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, Lebanon, NH, USA
| | - Cameron Felty
- Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, Lebanon, NH, USA
| | - Xiaoying Liu
- Dartmouth-Hitchcock Medical Center, Department of Pathology and Laboratory Medicine, Lebanon, NH, USA
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Fan FS, Yang CF. Chemotherapy-induced necrotising tumour lysis and perforation of a huge gastric cancer simulating emphysematous pancreatitis. Ecancermedicalscience 2020; 14:1054. [PMID: 32582369 PMCID: PMC7302892 DOI: 10.3332/ecancer.2020.1054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Indexed: 12/24/2022] Open
Abstract
A 56-year-old man was diagnosed to have a huge gastric cancer extending from the lesser curvature of the stomach to the pancreas with multiple hepatic and peritoneal metastases. Two days after completing chemotherapy with cisplatin plus high dose leucovorin and fluorouracil, drastic necrotising tumour lysis led to gastric perforation and septic shock most likely due to bacterial peritonitis. The image of tumour lysis looked like an emphysematous pancreatitis. Afterwards, immunohistochemical study of the tumour specimen confirmed moderate positivity of dihydropyrimidine dehydrogenase and absence of Bcl-2 expression. The incomplete expression of dihydropyrimidine dehydrogenase and total deficiency of Bcl-2 are considered to be the main underlying causes of such extraordinary chemosensitivity and so severe a tumour lysis phenomenon. Pre-emptive intensive survey of possible biomarkers of chemosensitivity is thus highly recommended upon treating a massive gastric cancer.
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Affiliation(s)
- Frank S Fan
- Section of Haematology and Oncology, Department of Medicine, Ministry of Health and Welfare Changhua Hospital, Chang-Hua County, Taiwan.,https://orcid.org/0000-0002-8123-6941
| | - Chung-Fan Yang
- Department of Pathology, Ministry of Health and Welfare Changhua Hospital, Chang-Hua County, Taiwan.,https://orcid.org/0000-0002-7366-4380
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Lingamaneni P, Desai P, Vennikandam MM, Moturi K, Baranwal A, Gupta S. Tumor Lysis Syndrome in a Patient With Gastric Adenocarcinoma. J Investig Med High Impact Case Rep 2020; 8:2324709620933427. [PMID: 32536280 PMCID: PMC7294369 DOI: 10.1177/2324709620933427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tumor lysis syndrome (TLS) is a severe metabolic complication that usually occurs in patients with aggressive tumors who undergo treatment with chemotherapy. Traditionally, it was mainly associated with hematologic malignancies. However, over the past 4 decades, there have been increasing reports of TLS in solid tumors. We report a case of TLS in a patient with gastric cancer, as a complication of FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) chemotherapy. Our patient was a 48-year-old man with metastatic gastric adenocarcinoma who presented with altered mental status and slurred speech. On examination, he was confused and disoriented, but the rest of his examination, including vitals, was unremarkable. Laboratory findings on admission were significant for an elevated uric acid of 14.5 mg/dL, creatinine of 4.1 mg/dL, and phosphorus of 6.9 mg/dL. He had received his first cycle of FOLFOX chemotherapy 4 days prior to admission. The constellation of electrolyte abnormalities and the temporal relationship to chemotherapy led to the diagnosis of chemotherapy-induced TLS. He was treated with aggressive fluid repletion and rasburicase, following which the electrolyte derangements resolved, and he improved clinically. This case highlights the importance of early recognition of TLS in patients with gastric cancer. Initiation of early treatment can reduce the high morbidity and mortality associated with this oncologic emergency.
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Affiliation(s)
| | - Parth Desai
- John H Stroger Hospital of Cook County, Chicago, IL, USA
| | | | - Krishna Moturi
- John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Anmol Baranwal
- John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Shweta Gupta
- John H Stroger Hospital of Cook County, Chicago, IL, USA
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Sommerhalder D, Takalkar AM, Shackelford R, Peddi P. Spontaneous tumor lysis syndrome in colon cancer: a case report and literature review. Clin Case Rep 2017; 5:2121-2126. [PMID: 29225869 PMCID: PMC5715407 DOI: 10.1002/ccr3.1269] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/30/2017] [Accepted: 10/18/2017] [Indexed: 12/20/2022] Open
Abstract
Although tumor lysis syndrome is well described, it is rarely seen or suspected in solid malignancies. Early recognition of this entity is paramount in reducing morbidity and mortality. Treating physicians should be aware of this possibility in solid tumor patients with either bulky disease or extensive liver involvement.
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Affiliation(s)
- David Sommerhalder
- Department of MedicineLouisiana State University Health Science Center‐ShreveportShreveportLouisiana71130
- Division of Hematology and OncologyLouisiana State University Health Science Center‐ShreveportShreveportLouisiana71130
| | - Amol M. Takalkar
- Department of RadiologyLouisiana State University Health Science Center‐ShreveportShreveportLouisiana71130
| | - Rodney Shackelford
- Department of PathologyLouisiana State University Health Science Center‐ShreveportShreveportLouisiana71130
| | - Prakash Peddi
- Department of MedicineLouisiana State University Health Science Center‐ShreveportShreveportLouisiana71130
- Division of Hematology and OncologyLouisiana State University Health Science Center‐ShreveportShreveportLouisiana71130
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9
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Spontaneous Tumor Lysis Syndrome in a Patient with a Dedifferentiated Endometrial Adenocarcinoma. Case Rep Oncol Med 2017; 2017:5103145. [PMID: 28929002 PMCID: PMC5591980 DOI: 10.1155/2017/5103145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 06/06/2017] [Accepted: 07/30/2017] [Indexed: 12/23/2022] Open
Abstract
Tumor lysis syndrome (TLS) is an oncological emergency caused by massive cytolysis of malignant cells. This syndrome eventually induces metabolic abnormalities. TLS is observed mainly among tumors with rapid cell proliferation or high sensitivity to antineoplastic treatment. In rare cases, TLS occurs without any cytotoxic treatment. Previous reports have shown that alternative stress including proceeding infection or an operation might play a role in TLS. However, exact mechanism of spontaneous TLS remains unknown. Here, we describe a case of a 59-year-old woman who presented with dedifferentiated endometrial adenocarcinoma and developed TLS without any cytotoxic chemotherapy. Although spontaneous TLS in solid malignancies are extremely rare, clinicians should consider the possibilities of TLS especially in aggressive solid tumors.
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10
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Weerasinghe C, Zaarour M, Arnaout S, Garcia G, Dhar M. Spontaneous Tumor Lysis Syndrome in Small-Cell Lung Cancer: A Rare Complication. World J Oncol 2015; 6:464-471. [PMID: 28983349 PMCID: PMC5624673 DOI: 10.14740/wjon946w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 12/25/2022] Open
Abstract
Tumor lysis syndrome (TLS) is a life-threatening condition which consists of a constellation of electrolyte imbalances, acute renal failure, seizure, and arrhythmias. It is most commonly seen with hematologic malignancies after the initiation of chemotherapy. However, it can also occur spontaneously, prior to treatment with cytotoxic agents. TLS has been rarely described with non-hematologic solid tumors, and it is even more uncommon to have spontaneous tumor lysis syndrome (STLS) in solid tumors. To our knowledge, only two cases of STLS in small-cell lung cancer (SCLC) were reported in the literature. Herein, we present the case of a patient with metastatic SCLC who developed STLS. Our case highlights that in the setting of metastatic solid tumors, STLS must be in the differential diagnosis, to allow prompt initiation of prophylaxis and treatment.
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Affiliation(s)
- Chanudi Weerasinghe
- Department of Medicine, Staten Island University Hospital, North Shore - LIJ Health Care System, Staten Island, New York, USA
| | - Mazen Zaarour
- Department of Medicine, Staten Island University Hospital, North Shore - LIJ Health Care System, Staten Island, New York, USA
| | - Sami Arnaout
- Department of Medicine, Staten Island University Hospital, North Shore - LIJ Health Care System, Staten Island, New York, USA
| | - Gwenalyn Garcia
- Department of Medicine, Division of Hematology/Oncology, Staten Island University Hospital, North Shore - LIJ Health Care System, Staten Island, New York, USA
| | - Meekoo Dhar
- Department of Medicine, Division of Hematology/Oncology, Staten Island University Hospital, North Shore - LIJ Health Care System, Staten Island, New York, USA
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