Acute tumor lysis syndrome after transarterial chemoembolization for hepatocellular carcinoma

Abstract

A 77-year-old-man was admitted to hospital for treatment of a huge hepatocellular carcinoma by transarterial chemoembolization. After treatment, the patient developed acute tumor lysis syndrome with hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, metabolic acidosis and acute renal failure, which was successfully treated. In the treatments of solid organ tumors, acute tumor lysis syndrome is an extremely rare complication. To the best of the authors' knowledge, this patient is the third case of such a complication after transarterial chemoembolization for a hepatocellular carcinoma in the English literature.

Figure 1

Computed tomography during arterial portography before transarterial chemoembolization revealed a huge hepatocellular carcinoma (arrow) occupying both hepatic lobes.

Figure 2

Plain computed tomography after transarterial chemoembolization revealed iodized oil esters accumulation (arrow) in the huge hepatocellular carcinoma of the right hepatic lobe.

Figure 3

Changes in laboratory data of metabolic profiles and liver function after transarterial chemoembolization (TACE). (a) Y‐axis shows values of creatinine (mg/dL), potassium (mmol/L), calcium (mg/dL), phosphate (mg/dL) and uric acid (mg/dL). (b) Y‐axis shows values of alanine aminotransferase (IU/L) and YY‐axis shows values of lactate dehydrogenase (IU/L). All laboratory data was improved by intravenous hydration with sodium bicarbonate and administration of allopurinol.