1334

Abstract

Introduction: Tumor lysis syndrome (TLS) is an oncologic emergency that is caused by massive tumor cell lysis with the release of large amount of potassium, phosphate, nucleic acids. Uric acid, a catabolic product of nucleic acid precipitation in renal tubules leads to acute kidney injury. TLS occurs mostly after initiation of cytotoxic therapy in patients with high-grade lymphomas and acute leukemia. TLS can also occur spontaneously with malignancies with a high proliferative rate and a large tumor burden. There are few reported cases of spontaneous TLS with solid organ malignancy. We present a case of spontaneous TLS associated with endometrial/ovarian carcinoma. A 45 years old female presented to Upstate University Hospital with a 5 day history of lower abdominal pain and abdominal distension. Her past medical/surgical history was uneventful but had limited preventative and gynecological care. On examination, she was noted to have ascites and 12 weeks size of uterus. Her initial work up revealed leukocytosis (white blood cell count 36000/µL with 90% polymorphonuclear cells), Hyperkalemia (5.6 mmol/L), Hyperphosphatemia (11.9 mg/dl), Hyperuricemia (22 mg/dl), Hypocalcemia (Ionized calcium 0.89 mmol/L), Uremia (Blood Urea Nitrogen 94 mg/dl and Creatinine 4.2 mg/dl) and anion gap metabolic acidosis (PH 7.26, Serum bicarbonate 16 mmol/L. A 13 cm enlarged uterus, 4x3x3 cm mass over the left side of uterine fundus, left adnexal mass, grossly thickened endometrium, thickened omentum/peritoneum, bilateral pleural effusion and ascites was noted on radiological examination. Cytopathological examination from pleural and ascitic fluid and tumor marker studies revealed poorly differentiated carcinoma of gynecologic origin. She was treated with intravenous fluids, Rasburic acid, urinary alkalinization and hemodialysis for spontaneous tumor lysis syndrome. Peripheral blood flow-cytometry was negative for hematological malignancy. She was deemed unfit for cyto-reductive surgery. Palliative chemotherapy with carboplatin and Paclitaxel was initiated but she later opted for hospice care and subsequently died in hospital. Although many cases of TLS have been described after treatment of non-hematologic solid tumors; there are very few reported cases of spontaneous TLS associated with solid tumors. The identification of patients at risk for TLS and determination of the degree of the risk are the cornerstone of management of TLS. Successful management of TLS include a high index of suspicion, aggressive hydration, allopurinol, urate oxidase, urinary alkalinization and dialysis.