Tumor Lysis Syndrome Following Thoracotomy Under Cardiopulmonary Bypass in a Case of Hepatocellular Carcinoma With Right Atrial and Inferior Vena Cava Tumor Thrombus

Juey-Ming Shih

doi:10.7759/cureus.20311

Abstract

Tumor lysis syndrome (TLS) occurring after surgical resection of right atrium (RA) and inferior vena cava (IVC) tumor thrombus is a very rare but insidious condition. We report a case of hepatocellular carcinoma who developed TLS after uneventful excision of RA+IVC tumor thrombus under median sternotomy and cardiopulmonary bypass (CPB). Although the procedure was not expected to arouse massive tumor cell necrosis, post-operative course was complicated by metabolic acidosis, hypocalcemia, and progressive hyperkalemia indicative of TLS. Unfortunately, laboratory diagnosis of TLS was delayed under conditions of continuous renal replacement therapy (CRRT) for peri-operative acute renal failure. Despite all efforts, the patient died 36 hours after surgery due to lethal arrhythmia and disseminated infarction of the kidneys, spleen, and liver.

Highlights

Hepatocellular carcinoma (HCC) represents the majority of all primary liver cancers, the second leading cause of cancer-related deaths in the world [1]
We report a case of HCC with inferior vena cava (IVC)+right atrium (RA) tumor thrombus who received successful tumor thrombus excision via median thoracotomy and under cardiopulmonary bypass
Tumor lysis syndrome (TLS) occurring after surgical management for HCC with IVC+RA tumor thrombus is a rare and insidious condition that can go unnoticed

Summary

Introduction

Hepatocellular carcinoma (HCC) represents the majority of all primary liver cancers, the second leading cause of cancer-related deaths in the world [1]. The literature has increasingly reported cases among cancers of the lung, breast, gastrointestinal tract, liver, urogenital and gynecological organs, and even the skin [6] This progressive increase may be primarily attributed to recent advancements in the treatment of these solid tumors. A 79-year-old female patient with underlying conditions of hypertension, coronary artery disease, and hepatitis C presented with progressive bilateral legs edema up to the lower abdomen over several weeks She initially visited our cardiology outpatient department where echocardiography was performed. Subsequent contrast-enhanced computed tomography (CECT) revealed a large hypervascular tumor in segment 8 of the liver with tumor extension into the hepatic vein, IVC, RA, and right ventricle (RV) She disclosed that she had been diagnosed with solitary HCC eight months earlier but had refused treatment.

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Disclosures