Spontaneous Tumor Lysis Syndrome as Presenting Sign of Metastatic Prostate Cancer

Batra, Vivek; Sunder, Tara; Rizk, Sanaa

doi:10.7759/cureus.3706

Cited by 9 publications

(10 citation statements)

References 11 publications

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“…It is the third leading cause of death from cancer in men in Canada [ 1 ]. It can masquerade as a clinical picture of just anemia and thrombocytopenia due to infiltration of bone marrow [ 2 ], thrombotic thrombocytopenic purpura (TTP), complement mediated hemolytic uremic syndrome [ 3 ], and/or tumor lysis syndrome [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…In literature, there are limited cases of TLS secondary to metastatic prostate cancer with and without treatment. Our literature review for “prostate cancer” and “spontaneous tumor lysis syndrome” revealed four cases of treatment naïve prostate cancer associated with TLS [ 3 , 5 , 6 , 7 ]. Out of these four cases, three had a pre-existing diagnosis of prostate cancer, and only one was a diagnostic mystery [ 3 ] such as ours.…”

Section: Discussionmentioning

confidence: 99%

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Urate Nephropathy from Tumor Lysis Syndrome in an Undiagnosed Case of Prostate Cancer

Javed

2021

Current Oncology

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Prostate cancer can masquerade as just normocytic anemia and thrombocytopenia, thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), or tumor lysis syndrome (TLS). We are reporting an intriguing case of metastatic prostate cancer which remained undiagnosed until the patient showed signs of tumor lysis syndrome (TLS), leading to urate nephropathy requiring urgent hemodialysis. Tumor lysis syndrome is an oncological emergency but an exceedingly rare complication in non-hematological malignancies, including prostate cancer. It is challenging to recognize features of TLS in a case such as this with an unknown diagnosis. In the case of an established diagnosis of malignancy, however, checking baseline renal function, uric acid, lactate dehydrogenase (LDH), potassium, and phosphate to monitor for TLS as well as considering urate lowering therapy can help prevent adverse outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Urate Nephropathy from Tumor Lysis Syndrome in an Undiagnosed Case of Prostate Cancer

Javed

2021

Current Oncology

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“…Systemic tumor lysis syndrome b [1,2, Spontaneous (idiopathic) c [1,2,[6][7][8][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Hematologic malignancies [1,6,10,[12][13][14][15] Solid tumors [2,7,8,10,11,[15][16][17][18][19][20][21][22][23] Therapy-associated d [1,2,[9][10][11]15,17,20,21,[23]…”

Section: Subtype References Aunclassified

“…Spontaneous (idiopathic) systemic tumor lysis syndrome is less common than therapy-associated tumor lysis syndrome. However, multiple reports now document its occurrence [1,2,[6][7][8][10][11][12][13][14][15][16][17][18][19][20][21][22][23].…”

Section: Spontaneous (Idiopathic) Systemic Tumor Lysis Syndromementioning

confidence: 99%

“…Similar to individuals with associated hematologic malignancies, spontaneous (idiopathic) systemic tumor lysis syndrome may occur in patients with recently diagnosed, but untreated, visceral cancers, or it may be an initial clinical feature that heralds the diagnosis of an unsuspected solid tumor. Although solid tumor-associated idiopathic systemic tumor lysis syndrome is uncommon, reports of individuals in whom this occurs seem to be increasing [2,7,8,10,11,[15][16][17][18][19][20][21][22][23].…”

Section: Spontaneous (Idiopathic) Systemic Tumor Lysis Syndromementioning

confidence: 99%

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Tumor Lysis Syndrome: Introduction of a Cutaneous Variant and a New Classification System

Cohen¹,

Prieto

Kurzrock

2021

Cureus

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Tumor lysis syndrome, an oncological emergency, is characterized by laboratory parameters such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, as well as renal injury with an elevated creatinine. Tumor lysis syndrome is seen in patients with aggressive malignancies and high tumor burden. More frequently, it occurs in individuals with hematologic malignancies such as high-grade lymphomas (such as Burkitt lymphoma) and leukemia (such as acute lymphocytic leukemia). It also, albeit less commonly, can be seen in patients with widespread solid tumors that are rapidly proliferating and are markedly sensitivity to antineoplastic therapy. Tumor lysis syndrome is usually preceded by cancer-directed therapy; however, the syndrome can present spontaneously prior to the individual receiving malignancydirected treatment. We reported a man with metastatic salivary duct carcinoma who had cutaneous metastases that presented as carcinoma hemorrhagiectoides. Microscopic examination demonstrated that the metastatic tumor cells had infiltrated and replaced the entire dermis. After the patient received his first dose of antineoplastic therapy, he had an excellent response and the cutaneous metastases developed into ulcers; we hypothesize that most of the dermis, which had been replaced by tumor cells, disappeared as a result of the therapeutic response, and the overlying epidermis became necrotic and shed, leaving an ulcer. His dramatic response to treatment prompted us to propose a new classification of tumor lysis syndrome, which should include the systemic form of the condition as well as the new variant: cutaneous tumor lysis syndrome. We anticipate that, with improvement in targeted therapies, there may be an increase in therapyassociated cutaneous tumor lysis syndrome.

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Spontaneous tumor lysis syndrome in patients with solid tumors: a scoping review of the literature

Papapanou,

Athanasopoulos,

Georgiadi

et al. 2023

Med Oncol

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No systematic synthesis of all cases of spontaneous tumor lysis syndrome (STLS) in adult patients with solid tumors is available to date. Herein, we aim to recognize specific STLS characteristics and parameters related to a worse prognosis. We conducted a systematic search for randomized controlled trials, cohorts, case-control studies, and case reports. The primary endpoints were death and the need for renal replacement therapy (RRT) due to STLS. We estimated crude odds ratios (ORs) with 95% confidence intervals (95%CI) via univariate binary logistic regression. We included one cohort of 9 patients and 66 case reports of 71 patients [lung cancer 15(21.1%)]. Regarding the case reports, most patients [61(87.1%)] had metastatic disease [liver 46(75.4%)], developed acute kidney injury [59(83.1%)], needed RRT [25(37.3%)], and died due to STLS [36(55.4%)]. Metastatic disease, especially in the liver [p = 0.035; OR (95%CI): 9.88 (1.09, 89.29)] or lungs [p = 0.024; 14.00 (1.37, 142.89)], was significantly associated with STLS-related death compared to no metastasis. Cases resulting in death had a significantly higher probability of receiving rasburicase monotherapy than receiving no urate-lowering agents [p = 0.034; 5.33 (1.09, 26.61)], or the allopurinol-rasburicase combination [p = 0.023; 7.47 (1.40, 39.84)]. Patients receiving allopurinol were less likely to need RRT compared to those not receiving it or those receiving rasburicase. In conclusion, current anecdotal evidence demonstrated that metastatic disease, especially in the liver and lungs, may be associated with STLS-related death compared to no metastatic status. Careful surveillance of high-risk cases within larger studies is essential to identify markers predicting morbidity or mortality.

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Spontaneous Tumor Lysis Syndrome as Presenting Sign of Metastatic Prostate Cancer

Cited by 9 publications

References 11 publications

Urate Nephropathy from Tumor Lysis Syndrome in an Undiagnosed Case of Prostate Cancer

Urate Nephropathy from Tumor Lysis Syndrome in an Undiagnosed Case of Prostate Cancer

Tumor Lysis Syndrome: Introduction of a Cutaneous Variant and a New Classification System

Spontaneous tumor lysis syndrome in patients with solid tumors: a scoping review of the literature

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