Spontaneous tumor lysis syndrome in T-cell malignancy: two case reports

Abstract

Tumor lysis syndrome (TLS) refers to a constellation of metabolic abnormalities that result from release of intracellular solutes (potassium, phosphate, and nucleic acid metabolites) from rapidly dying tumor cells. While TLS most commonly occurs following chemotherapy, spontaneous TLS can rarely occur in rapidly dividing liquid or solid malignancies. Here, we report the cases of two patients who presented with non-specific symptoms and were found to have spontaneous TLS. Work-up in both cases led to a diagnosis of T-cell malignancy (i.e., acute lymphoblastic leukemia and angioimmunoblastic lymphoma). Given that spontaneous TLS can be the first manifestation of an underlying malignancy, all physicians should be familiar with this oncologic emergency. Early recognition and prompt management can be lifesaving for patients with an otherwise curable malignancy.

Spontaneous Tumor Lysis Syndrome

“…The target urine quantity is 80–100 mL per hour [ 6 ]. Hydration should be continued as long as signs of tumor cell death are evident [ 2 , 9 , 10 , 22 ].…”

“…Significant tumor-associated factors include a high tumor load, a high proliferation rate, and the chemosensitivity of the underlying disease [ 2 , 7 , 8 , 9 ], along with clinical and individual risk factors, such as advanced age, pre-existing renal insufficiency or hyperuricemia, and reduced volume status [ 6 ]. In rare cases, TLS can also occur spontaneously [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. The condition must be actively tracked in regular laboratory checks for detection.…”

Spontaneous Tumor Lysis Syndrome in T-Cell Leukemia

“…However, the entity -spontaneous TLSis rarely observed among hematologic malignancies without the precipitating factors of chemotherapy, radiation, or immunotherapy [2]. Spontaneous tumor lysis syndrome is described as tumor lysis occurring in the absence of definitive chemotherapy [2]. It was reported in patients with Burkitt's lymphoma/leukemia, diffuse large B-cell lymphoma, anaplastic large T-cell lymphoma, acute myeloid leukemia, adenocarcinoma of the lung, breast cancer, gastric cancer, and myelofibrosis [3][4][5].…”

“…The exact mechanism of how spontaneous TLS occurs remains unclear [2,4]. It has been suggested that rapid tumor necrosis releasing intracellular metabolites may be a component in the development of spontaneous TLS [6][7].…”

Skin involvement in Burkitt lymphoma: rare clinical case

“…С другой стороны, развитие синдрома острого лизиса опухоли могло произойти в связи с хирургическим воздействием (повышение внутрибрюшного давления, манипу-ляции в ходе биопсии) [10]. Но не стоит забывать и о синдроме спонтанного опухолевого лизиса при ЛБ, описанном в литературе [11][12][13][14]. Провести адекватную интенсивную терапию с привлечением методов заместительной почечной терапии оказалось возможно в условиях реанимации и интенсивной терапии.…”