Tumor Lysis Syndrome in a Retroperitoneal Sarcoma.

Yousef Zakharia,Joshua Mansour,Christopher Koch,Eduard Fatakhov,Borys Hrinczenko,Srinivasa Vasireddi,Kais Zakharia

doi:10.1177/2324709614542340

Abstract

In the present case, a 49-year-old white female presented to the clinic with a 2-month history of nausea, vomiting, and right upper quadrant pain. On examination a 3-cm mass on the right anterior scalene muscle was noted. A computed tomography scan was performed revealing a 8.7 × 7.7 × 6.1 cm retroperitoneal mass with possible invasion of the inferior vena cava and right renal and left common iliac veins. An excisional biopsy was performed with pathology compatible with spindle cell sarcoma. The patient was then sent for follow-up at the sarcoma clinic as an outpatient. However, before chemotherapy was to be started the patient would be admitted to the hospital with progressively worse nausea and vomiting. At that time the patient’s lab work showed lactic acidosis, acute renal failure, hyperuricemia, hyperphosphatemia, and hypocalcemia, which met the Cairo–Bishop criteria for tumor lysis syndrome (TLS). The patient was admitted to the intensive care unit and kidney dialysis initiated. The patient would become progressively obtunded at which time the family opted for hospice care. The patient eventually succumbed peacefully 3 days after her last admission. In this case report, we briefly review the literature on TLS in solid tumors, and we present a rare case of spontaneous TLS in a retroperitoneal sarcoma.

Highlights

Tumor lysis syndrome (TLS) is a medical emergency caused by massive lysis of malignant cells and release of intracellular components into the blood stream
Spontaneous TLS has been reported in solid tumors like breast or small cell lung cancer.[3,4]
We present a case of spontaneous TLS in retroperitoneal sarcoma

Summary

Introduction

Tumor lysis syndrome (TLS) is a medical emergency caused by massive lysis of malignant cells and release of intracellular components into the blood stream. This can cause numerous different electrolyte abnormalities, including hyperuricemia, hyperkalemia, and hyperphosphatemia, which result in deposition of calcium phosphate crystals in renal tubules. This deposition leads to the consumption of calcium and can cause obstructive nephropathy.[1] Clinical and laboratory criteria for TLS have been proposed by the Cairo–Bishop definition in 2004, wherein laboratory TLS is defined by any change of 25% above or below normal for any 2 or more abnormal lab values (Table 1), within 3 days before or 7 days after the initiation of chemotherapy.[2]

Results

Conclusion