Abstract
Tumor lysis syndrome, an oncological emergency, is characterized by laboratory parameters such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, as well as renal injury with an elevated creatinine. Tumor lysis syndrome is seen in patients with aggressive malignancies and high tumor burden. More frequently, it occurs in individuals with hematologic malignancies such as high-grade lymphomas (such as Burkitt lymphoma) and leukemia (such as acute lymphocytic leukemia). It also, albeit less commonly, can be seen in patients with widespread solid tumors that are rapidly proliferating and are markedly sensitivity to antineoplastic therapy. Tumor lysis syndrome is usually preceded by cancer-directed therapy; however, the syndrome can present spontaneously prior to the individual receiving malignancy-directed treatment. We reported a man with metastatic salivary duct carcinoma who had cutaneous metastases that presented as carcinoma hemorrhagiectoides. Microscopic examination demonstrated that the metastatic tumor cells had infiltrated and replaced the entire dermis. After the patient received his first dose of antineoplastic therapy, he had an excellent response and the cutaneous metastases developed into ulcers; we hypothesize that most of the dermis, which had been replaced by tumor cells, disappeared as a result of the therapeutic response, and the overlying epidermis became necrotic and shed, leaving an ulcer. His dramatic response to treatment prompted us to propose a new classification of tumor lysis syndrome, which should include the systemic form of the condition as well as the new variant: cutaneous tumor lysis syndrome. We anticipate that, with improvement in targeted therapies, there may be an increase in therapy-associated cutaneous tumor lysis syndrome.
Highlights
BackgroundTumor lysis syndrome is an oncological emergency
We suggest that cutaneous tumor lysis syndrome refers to the lysis of neoplastic cells located within the dermis from either hematologic malignancies or solid tumors
We previously described a man with metastatic salivary duct carcinoma whose cutaneous metastases presented as a dermal infiltration of the tumor cells which became necrotic and developed into ulcers after he received his first dose of antineoplastic therapy
Summary
Tumor lysis syndrome is an oncological emergency. It most commonly occurs in patients with hematologic malignancies. We observed therapy-associated cutaneous tumor lysis syndrome in a man whose metastatic salivary duct carcinoma demonstrated rapid cell death and presented as necrosis and ulcers within days after receiving his initial cycle of dual-agent (bevacizumab and temsirolimus) antineoplastic therapy [3,4,5]. Our patient was a 70-year-old man with metastatic salivary duct carcinoma (a disease pathologically reminiscent of ductal breast cancer) developed what appeared to be therapy-associated cutaneous tumor lysis syndrome after receiving his first cycle of bevacizumab and temsirolimus. Eleven months earlier, his salivary duct carcinoma presented as a left preauricular parotid gland mass. It is reasonable to postulate that bevacizumab’s ability to block the activity of dermal vessel vascular endothelial growth factor may have resulted in sufficient vascular damage to result in anoxia and subsequent lysis of the metastatic tumor cells in the dermis and the prompt development of skin ulcers where the cutaneous metastases had previously been located
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