A Case of Spontaneous Tumor Lysis Syndrome in Malignant Melanoma

Abstract

A 62-year-old man with a complaint of back pain lasting 2 months was admitted. He also presented a huge abdominal tumor. Diagnostic imaging showed metastatic tumors in the liver, lumbar vertebrae and bilateral lung. An ultrasound-guided needle biopsy revealed a lung tumor containing melanic tissue. Subsequently, there was an evident elevation in uric acid, phosphoric acid, potassium and lactate dehydrogenase concentrations in serum. Continuous hemodiafiltration and administration of rasburicase was initiated following the diagnosis of tumor lysis syndrome (TLS). However, he died on the fourth day owing to arrhythmia. An autopsy revealed metastatic deposits in the liver, lung, spine, ribs, and lymph nodes along the biliary system. Microscopic examinations revealed massive necrosis of normal hepatocytes and tumor cells with disseminated tumor thrombi in the portal system. The catastrophic progression of TLS appears to be influenced by a persistent portal blood flow deficiency by portal tumor thrombus in this case.

Tumor Lysis Syndrome in Solid Tumors: A Comprehensive Literature Review, New Insights, and Novel Strategies to Improve Outcomes

“…Interestingly, the autopsy revealed a key finding of massive necrosis of normal hepatocytes and melanoma cells within the liver as well as disseminated tumor thrombi in the portal system. Additionally, they found extensive necrosis within a large pulmonary tumor [26]. Moreover, similar findings were reported by Kearney et al where an autopsy in a patient with STLS revealed extensive tumor necrosis, widespread tumor thrombi in portal venous branches, pulmonary tumor deposits, and near-total replacement of lymph nodes with tumor and necrosis [27].…”

“…Several documented case reports of TLS in humans appear to echo animal model findings, as microemboli appear to play a direct role in widespread tissue damage [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The demographics, clinicopathologic features, autopsy findings, and outcomes are summarized in Table 2.…”

From skin to spontaneous lysis: A case of spontaneous tumor lysis syndrome in metastatic melanoma

“…After careful literature review, only three other cases report STLS associated with melanoma. 17–19 Similar to our case, these melanoma patients had multiple sites of metastases, high tumor burden, and passed away within several days of initial hospitalization. The included table describes other unique similarities that may correlate to STLS specifically in metastatic melanoma.…”

Intricate Interplay of Entwined Metabolic and Inflammatory Life-threatening Processes in Tumor Lysis Syndrome Complicating Prostate Cancer: A Systematic Review with a Single Institution Experience

“…Studies in mice found disseminated microemboli from lysed tumor cells during the histopathological postmortem examination; these result in widespread tissue damage, multiorgan failure, and death [34][35]. Those findings closely mimic the human autopsy findings of disseminated tumor embolism leading to massive tissue organ necrosis and death [36][37]. Furthermore, concurrent disseminated intravascular coagulation was proposed as a probable mechanism that could synergistically lead to increased mortality in patients with TLS through common pathogenesis and pro-inflammatory cytokine-mediated processes [13][14].…”