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A Rare Case of Spontaneous Tumor Lysis Syndrome in Small Cell Lung Cancer FREE TO VIEW

Abhishek Jaiswal, MBBS; Gaurang Vaidya, MBBS; Dipti Baral, MBBS; Mijung Lee, MD
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SUNY Upstate Medical University, Syracuse, NY

Chest. 2015;148(4_MeetingAbstracts):569A. doi:10.1378/chest.2281864
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SESSION TITLE: Lung Cancer Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Tumor lysis syndrome (TLS) is an oncologic emergency characterized by an array of metabolic derangements such as hyperuricemia, hyperphosphatemia, hyperkalemia and hypocalcemia from release of cellular components into circulation. It is most commonly seen after initiation of chemotherapy in patients with hematologic malignancies and rarely in patients with solid tumors; spontaneous tumor lysis syndrome is very infrequent in any cancer and is rare in solid tumors.

CASE PRESENTATION: 71 yo Caucasian female, recently diagnosed with SCLC with liver metastasis, presented to oncologic clinic for her first cycle of carboplatin and etoposide therapy. She was found to be in respiratory distress with her saturation on room air dropping to low 80s even on minimal exertion. She was admitted for management of her worsening SOB. Her past medical history was significant for COPD and cervical cancer status post TAH with BSO. Her family history was positive for lung cancer in her father. She had 100 pack year smoking history. On examination, she was tachycardic with heart rate of 116 and tachypneic at 20 and was desaturating on exertion; so was placed on 2L O2 via nasal cannula. She had prolonged expiration with occasional wheezing. She had potassium of 5.2, BUN of 35, Creatinine 1.3, bicarbonate of 20, uric acid 7.8, LDH 755, total bilirubin 2.1, ALT 104, AST 137, and alkaline phosphatase 626. CT chest had shown a lobulated mass in the left upper lobe measuring 13x19x27 mm. CT abdomen showed multiple low-density lesions throughout the entire liver. She was started on aggressive intravenous hydration and allopurinol. Her SOB was managed as acute exacerbation of COPD. She improved symptomatically. Her potassium, uric acid and kidney function normalized and her LDH trended down.

DISCUSSION: The first case of spontaneous tumor lysis (STL) syndrome in small cell lung cancer was reported in 2012 and to the best of our knowledge this is the second such reported case. STL refers to spontaneous breakdown of tumor cells in the absence of chemo-radiation treatment, dumping intracellular material massively into the intravascular space. STL has been reported in hematologic malignant diseases due to high tumor burden, but it is very rare in solid tumors. Most of the reported cases have liver metastases potentially indicative of high tumor burden. Inpatient observation may be warranted in patients with high risk for TLS like patients with high tumor burden, pre-existing renal failure and chemosensitive tumor.

CONCLUSIONS: 1.The prevalence of TLS in solid tumors may be higher than previously thought of with many patients remaining asymptomatic. 2.Mortality in tumor lysis syndrome can be up to 50%. With early detection and treatment which is mainly supportive, the mortality may be reduced.

Reference #1: Vaidya GN, Acevedo R. Tumor lysis syndrome in metastatic breast cancer after a single dose of paclitaxel. Am J Emerg Med.2015 Feb;33(2):308.e1-2.doi:10.1016/j.ajem.2014.07.039

DISCLOSURE: The following authors have nothing to disclose: Abhishek Jaiswal, Gaurang Vaidya, Dipti Baral, Mijung Lee

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