Spontaneous Tumor Lysis Syndrome in an Adenocarcinoma of Unknown Origin

Abstract

Spontaneous tumor lysis syndrome (STLS) is a rare oncologic emergency caused by massive cancer cell lysis or necrosis without a precipitating factor. Although tumor lysis syndrome (TLS) is most commonly associated with hematologic malignancies, a small number of cases in solid tumor malignancies have been reported. We present a case of spontaneous tumor lysis syndrome in a 77-year-old female with a widely metastatic, poorly differentiated adenocarcinoma of unknown origin. She presented in distributive shock, and laboratory testing at admission revealed acute renal failure, high anion gap metabolic acidosis, hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia. Rasburicase and continuous renal replacement therapy were initiated, however, her condition deteriorated. Treatment was withdrawn and she died four days after admission.

Keywords: adenocarcinoma; tumor lysis.

Figure 1. Abdominal CT scan showing hepatic (A) 17.5 mm hypodense segment 4 lesion and (B) 21 mm hypodense segment 1 lesion

Figure 2. High grade poorly differentiated carcinoma with squamous and glandular features, liver core biopsy x40