Spontaneous Tumor Lysis Syndrome Due to Endometrial Carcinoma.

Juan Jose Chango Azanza,Meghana Singh,Vinay Mathew Thomas,Swetha Ann Alexander,Paola Michelle Calle Sarmiento

doi:10.7759/cureus.7220

Abstract

Spontaneous tumor lysis syndrome (TLS) is a rare condition in solid tumors, particularly in endometrial carcinoma. Spontaneous TLS occurs without the use of cytotoxic therapy but is observed particularly in hematologic malignancies. Given the high morbidity and mortality associated with spontaneous TLS, it is crucial to identify and treat it promptly. There have been only four cases of spontaneous TLS reported to date in the literature from a uterine source. We present a 59-year-old female with a recently diagnosed endometrial carcinoma with neuroendocrine features by dilation and curettage who presented to the hospital with somnolence, decreased oral intake, and lower abdominal pain of three days duration. She was found to have sepsis secondary to endometritis and spontaneous tumor lysis syndrome by clinical and laboratory definitions (hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia). Signs of disease progression were found such as worsening retroperitoneal lymphadenopathy that corresponded with the suspected increased tumoral activity. We report the case of a solid tumor (endometrial) presenting with spontaneous TLS, which highlights the importance of the early identification and initiation of treatment.

Highlights

Tumor lysis syndrome is a life-threatening condition where the extensive destruction of tumor cells leads to the release of potassium, uric acid, and phosphate into the blood, leading to life-threatening complications such as renal failure, metabolic derangements, seizures, and death [1]
It is crucial to suspect spontaneous tumor lysis syndrome in patients with a history of malignancy who present with hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, kidney dysfunction, muscle cramps, tetany, nausea, vomiting, change in mental status, cardiac arrhythmias, syncope, or sudden death
We present a case of spontaneous tumor lysis syndrome due to endometrial carcinoma

Summary

Introduction

Tumor lysis syndrome is a life-threatening condition where the extensive destruction of tumor cells leads to the release of potassium, uric acid, and phosphate into the blood, leading to life-threatening complications such as renal failure, metabolic derangements, seizures, and death [1]. A computed tomography (CT) scan of the abdomen and pelvis showed a distended uterus, an irregular hypodensity, 3.5 cm in diameter; an increased endometrial thickness of 4.3 cm, and retroperitoneal lymphadenopathy She underwent a dilation and curettage, which yielded abundant blood and fragments of malignant, poorly differentiated carcinoma with neuroendocrine features and necrosis. The patient met laboratory and clinical criteria for tumor lysis syndrome by the Cairo-Bishop definition Given her severe renal dysfunction, nephrology was consulted and recommended rasburicase for the treatment of tumor lysis syndrome, which improved her uric acid levels. She became oliguric and had worsening kidney function, requiring renal replacement therapy. The patient and her family decided to transition to comfort care and the patient expired four days after admission

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Disclosures