Tumor lysis syndrome (TLS) is an oncologic emergency characterized by metabolic and electrolyte abnormalities, observed during the destruction of tumor cells. While it is commonly seen during cytotoxic treatment of hematologic malignancies, it is rarely seen or suspected in solid tumors. The incidence of spontaneous tumor lysis (before cancer treatment) in solid malignancies is even rarer. Herein, we present the case of a spontaneous tumor lysis syndrome (STLS) in a woman who presented with chest pain and was found to have metastatic ductal cell carcinoma of the breast. She presented with acute renal failure and demonstrated all laboratory derangements consistent with TLS, despite not being on chemotherapy. Fortunately, her clinical status improved with prompt treatment, but the long-term effects of TLS can be fatal if not recognized and managed immediately. This case highlights that early recognition and appropriate treatment can be lifesaving. Furthermore, it demonstrates the importance of maintaining a high clinical suspicion in all patients with malignancy, whether hematologic or solid, of the possibility of TLS, even in the absence of chemotherapy.
Anal cancer, despite being a rare malignancy, is increasing in incidence, accounting for 0.5% of all new cancer cases in the United States, with rate of new cases being 1.9 per 100,000 men and women. It is common in immunocompromised individuals, especially those with malignancy, human immunodeficiency virus (HIV) and human papillomavirus (HPV) infection. Despite similar treatment of anal cancer in both HIV-positive and negative patients, guidelines for prevention and treatment of therapy-related side effects are rarely studied. While these patients have a better prognosis on HAART, limited guidelines exist regarding appropriate therapy. There is a common link between HPV and HIV and the transmission of one is associated with increased risk of transmission of the other. HPV vaccine which is known to prevent highgrade cervical intraepithelial neoplasia is thought to also decrease the incidence of anal intraepithelial neoplasia. The association of HPV vaccine in the prevention of anal cancer in high-risk groups with HIV is a scarcely studied subject that requires further research.
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