Acute Spontaneous Tumor Lysis Syndrome as the Initial Presentation of ALK-Positive Diffuse Large B-Cell Lymphoma

Chapman-Fredricks, Jennifer R.; Blieden, Clifford; Sandoval, José; Ernani, Vinicius; Ikpatt, Offiong Francis

doi:10.1097/pai.0b013e3182275c02

Cited by 7 publications

(4 citation statements)

References 14 publications

(19 reference statements)

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“…It affects men more than women (male/female: 5:1), and usually presents as a mediastinal mass or diffuse lymphadenopathy. Approximately half of the patients present with B symptoms[ 1 - 3 , 6 ], whereas a male patient had spontaneous tumor lysis syndrome[ 7 ]. Most cases have no association with immunosuppression, whereas one case was comorbid with an HIV infection[ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Primary anaplastic lymphoma kinase-positive large B-cell lymphoma of the left bulbar conjunctiva: A case report

Guo,

Li,

Cao

et al. 2024

World J Clin Cases

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BACKGROUND Anaplastic lymphoma kinase (ALK)-positive large B-cell lymphoma (LBCL) is an aggressive and rare variant of diffuse LBCL. Herein, we report an uncommon case of stage IE extranodal ALK-positive LBCL initially originating in the bulbar conjunctiva. CASE SUMMARY A 63-year-old woman presented with a mass in the left bulbar conjunctiva that had persisted for six months, accompanied by swelling and pain that had persisted for 3 d. Eye examination revealed an 8 mm slightly elevated pink mass in the lower conjunctival sac of the left eye. Microscopically, the tumor was composed of large immunoblastic and plasmablastic large lymphoid cells with scattered anaplastic or multinucleated large cells. Immunophenotypically, the neoplastic cells were positive for ALK, CD10, CD138, Kappa, MUM1, BOB.1, OCT-2, CD4, CD45, EMA, CD79a, CD38, and AE1/AE3, and negative for CD20, PAX5, Lambda, BCL6, CD30 and all other T-cell antigens. The results of gene rearrangement tests showed monoclonal IGH/IGK/IGL and TCRD rearrangements. Fluorescence in situ hybridization studies did not reveal any BCL2, BCL6 or MYC rearrangements. Furthermore, Epstein-Barr virus was not detected by in situ hybridization in the lesions. Based on the histopathological and imaging examinations, the neoplasm was classified as stage IE ALK-positive LBCL. No further treatments were administered. At the 6, 15, and 21 mo postoperative follow-up visits, the patient was in good condition, without obvious discomfort. This case represents the first example of primary extranodal ALK-positive LBCL presenting as a bulbar conjunctival mass, which is extremely rare and shares morphological and immunohistochemical features with a variety of other neoplasms that can result in misdiagnosis. CONCLUSION Awareness of the condition presented in this case report is necessary for early and accurate diagnosis and appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Primary anaplastic lymphoma kinase-positive large B-cell lymphoma of the left bulbar conjunctiva: A case report

Guo,

Li,

Cao

et al. 2024

World J Clin Cases

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“…DLBCL and non-Hodgkin lymphoma (NHL) with bulky disease de ned as LDH > twice the upper limit of normal or tumour size on CT scan regarded as a mass >10 cm in diameter are categorized as being at the highest risk of developing TLS [2]. TLS has been reported as a recognized complication of hematologic malignant lymphomas including uncommon form of ALK-positive DLBCL, spontaneous or especially induced by chemotherapy, which is associated with signi cant morbidity and mortality [15,16]. Cairo recommended that those at low and intermediate risk should be actively monitored and offered by hydration +/-allopurinol prophylaxis, however, those at the high risk should be offered rasburicase regarded as a highly effective agent [2].…”

Section: Discussionmentioning

confidence: 99%

Rare Multiple Organ Failure Caused by Tumor Lysis and Subsequent Fatal Sepsis After Novel Salvaged Chemotherapy of Rituximab in a Diffuse Large B-cell Lymphoma Patient: A Case Report

Guan¹,

He²,

Wei³

et al. 2020

Preprint

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Background: Tumor lysis syndrome (TLS) ranges from mild asymptomatic electrolyte derangement to severe organ dysfunction, is rarely associated with diffuse large B-cell Lymphoma (DLBCL). Standard chemotherapy of DLBCL is usually for clinical stable patients, however, it is still unclear for those in critical care situation with organ dysfunction. Case presentation: Here, we presented a rare case of aggressive bcl-2 and -myc double-positive DLBCL patient, 59-year-old, male, who rapidly progressed to severe multiple organ failure because of spontaneous TLS, and especially hepatic failure is very uncommon. Although the comprehensive treatments inclusive of early glucocorticoid usage, a stent implantation in superior vena cava, pleural and pericardial puncture drainage, anti-shock, non-invasive ventilator support, continuous renal replacement treatment (CRRT), plasma exchange and antibiotics alleviated or inverted the multiple organ failure, the patient was worsened to septic shock and died on the 12th day after new salvage chemotherapy regime with rituximab and cyclophosphamide under CRRT protection. Conclusions: The current case demonstrated a useful treatment framework to this kind of patient. We should cautiously give glucocorticoid to the patient suspected of lymphoma with high tumor burden. The comprehensive treatments for organ function supporting, especially CRRT, play a crucial role in the recovery of multiple organ failure. In addition, the optimal time and regimen choosing of rescue chemotherapy in severe DLBCL patients still remains a long way to define.

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“…Tumor lysis syndrome (TLS) is an oncologic emergency caused by the rapid necrosis of tumor cells, leading to hyperphosphatemia, hyperkalemia, hyperuricemia and hypocalcemia [ 1 , 2 ]. Consequently, it can lead to acute renal failure, heart failure, cardiac dysrhythmias, seizure and death.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Tumor Lysis Syndrome in Small-Cell Lung Cancer: A Rare Complication!

et al. 2015

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Tumor lysis syndrome (TLS) is a life-threatening condition which consists of a constellation of electrolyte imbalances, acute renal failure, seizure, and arrhythmias. It is most commonly seen with hematologic malignancies after the initiation of chemotherapy. However, it can also occur spontaneously, prior to treatment with cytotoxic agents. TLS has been rarely described with non-hematologic solid tumors, and it is even more uncommon to have spontaneous tumor lysis syndrome (STLS) in solid tumors. To our knowledge, only two cases of STLS in small-cell lung cancer (SCLC) were reported in the literature. Herein, we present the case of a patient with metastatic SCLC who developed STLS. Our case highlights that in the setting of metastatic solid tumors, STLS must be in the differential diagnosis, to allow prompt initiation of prophylaxis and treatment.

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Acute Spontaneous Tumor Lysis Syndrome as the Initial Presentation of ALK-Positive Diffuse Large B-Cell Lymphoma

Cited by 7 publications

References 14 publications

Primary anaplastic lymphoma kinase-positive large B-cell lymphoma of the left bulbar conjunctiva: A case report

Primary anaplastic lymphoma kinase-positive large B-cell lymphoma of the left bulbar conjunctiva: A case report

Rare Multiple Organ Failure Caused by Tumor Lysis and Subsequent Fatal Sepsis After Novel Salvaged Chemotherapy of Rituximab in a Diffuse Large B-cell Lymphoma Patient: A Case Report

Spontaneous Tumor Lysis Syndrome in Small-Cell Lung Cancer: A Rare Complication!

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