Background Tumor lysis syndrome is an oncologic emergency that classically occurs following cancer therapy, although spontaneous tumor lysis syndrome can also occur in malignancies, albeit rarely. Spontaneous tumor lysis syndrome has previously been reported in some hematologic malignancies, but it rarely happens in solid tumors and seems to be associated with a higher mortality rate. This is the first case of adrenal adenocarcinoma that developed spontaneous tumor lysis syndrome. Case presentation We present a rare case of spontaneous tumor lysis syndrome occurring in a patient previously diagnosed with adrenal adenocarcinoma. The patient was a 64-year-old Persian man with abdominal pain, hypersomnia, and fatigue who was previously diagnosed with right adrenocortical carcinoma and had undergone right adrenalectomy with regional lymph nodes resection 5 months previously. On physical examination, the patient had abdominal distension and mild tenderness at the right upper quadrant. Pitting edema was detected bilaterally in the lower extremities. Initial imaging revealed multiple and large lesions suggestive of liver metastases. The laboratory data showed hyperkalemia, hyperuricemia, hyperphosphatemia, and elevated serum creatinine level indicative of spontaneous tumor lysis syndrome in the patient. Despite immediate and intensive care with antibiotics, hydration, treatment with a hypouricemic agent, and renal replacement therapy, the patient ultimately died from multiorgan failure. Conclusions Tumor lysis syndrome in solid tumors has high mortality. Patients susceptible to spontaneous tumor lysis syndrome must receive aggressive treatment immediately, which is crucial for preventing morbidity and mortality. Spontaneous tumor lysis syndrome may be underdiagnosed, and a high degree of clinical suspicion is needed to make the diagnosis and proceed with required interventions. Therefore, clinicians should be aware of this rare phenomenon.
Tumor lysis syndrome (TLS) is an oncologic emergency in which tumor cells undergo lysis either spontaneously or due to the initiation of cancer therapy typically presenting with hypocalcemia. We described a 62-year-old male patient with spontaneous TLS and hypercalcemia without a known malignancy, who is later discovered to have plasma cell leukemia.
Objective: Coronavirus disease 2019 (COVID-19) was first reported in Iran in February 2020 and then quickly spread to many cities. Different factors contribute to the numerous psychological problems of this pandemic in patients, healthcare workers and the community. This study investigated the prevalence of perceived stress, anxiety and depression in COVID-19 patients hospitalized between March and April 2020 and revealed associations of these factors with social support received from family. Method: In this cross-sectional study, patients with COVID-19 admitted between 21st of March and 22nd of April 2020 were evaluated by three questionnaires: Anxiety and depression were evaluated using the hospital anxiety and depression scale (HADS), stress levels were evaluated using the four-item perceived stress scale (PSS-4) and family support was evaluated using the perceived social support scale-family (PSS-Fa). In addition to obtaining prevalence of the noted psychological disorders and their relationship with demographic details, relationship of stress, anxiety and depression with family support was also investigated using the Pearson’s correlation coefficient. Results: Participants comprised 100 COVID-19 patients (38 females and 62 males). Findings suggested high levels of perceived stress in 26% of the participants, anxiety symptoms existed in 29% and borderline conditions existed in 17%. Moreover, depressive and its borderline symptoms were respectively observed in 17% and 23%. Family support was found to negatively and significantly correlated with anxiety (Pearson correlation = -0.249, P < 0.05) and depression. (Pearson correlation = -0.221, P < 0.05). Conclusion: Given the high prevalence of anxiety and depression in hospitalized COVID-19 patients, it is recommended to further focus on non-clinical interventions, such as providing psychological first aids, boosting psychological resilience, and enabling greater family support, in efforts to prevent transformation of these psychological symptoms into long-term psychological disorders.
Disseminated intravascular coagulation is a major complication of both solid tumors and hematologic cancers which could result in bleeding in various sites. Our known case of prostate cancer experienced DIC and subdural hemorrhage. this rare incidence indicates that chronic DIC and SDH be suspected in such cases
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