Hyperuricemic Renal Failure in Nonhematologic Solid Tumors: A Case Report and Review of the Literature

Abstract

Tumor lysis syndrome (TLS) is an oncologic emergency that is caused by massive tumor cell lysis. It is commonly associated with hematological cancers like leukemia and lymphoma and uncommonly with solid nonhematologic tumors as well. However, spontaneous tumor lysis syndrome (STLS) without any cytotoxic chemotherapy rarely occurs in solid tumors. We describe a case of STLS in a metastatic adenocarcinoma of unknown primary and review the literature of STLS in solid non-hematologic tumors to identify various risk factors for pathogenesis of this entity.

Spontaneous Tumor Lysis Syndrome in an Adenocarcinoma of Unknown Origin

“…Additionally, the preceding acute kidney injury in our patient may have contributed to the precipitation of STLS. While our case is not the first case of STLS by an undifferentiated adenocarcinoma of unknown origin, Saini et al [ 8 ] reported a mass that stained positive for CK7, CK20, mucicarmine, and villin, but negative for ER, mammaglobin, TTF-1, napsinA, CDX2, p63, calretinin and hepatocyte antigen that was suggestive of a non-colorectal gastrointestinal origin. This staining differs from our patient’s adenocarcinoma, and the group did not report serum tumor markers [ 8 ].…”

“…Though spontaneous tumor lysis syndrome is associated with hematologic malignancies, case reports in solid malignancies appear to show a common feature, namely a high tumor burden in the liver. Our patient shared this feature [7][8][9][10][11][12][13][14][15][16]. Additionally, the preceding acute kidney injury in our patient may have contributed to the precipitation of STLS.…”

“…These metabolic derangements have serious complications that precipitate renal failure, seizures, cardiac arrhythmia, and death [1]. Spontaneous tumor lysis syndrome is a rare manifestation of this complication without any preceding chemotherapeutic intervention and is most commonly associated with hematologic malignancies [4][5][6][7][8][9][10][11][12][13][14][15][16].…”

“…Occurrences are rare with one retrospective study of patients with acute renal failure found that spontaneous TLS was the culprit of 1.1% of cases [4]. Spontaneous TLS (STLS) is most commonly associated with hematologic malignancies [4][5][6], but a small number of cases have resulted from metastatic solid malignancies such as hepatocellular carcinoma [7], poorly differentiated adenocarcinoma of unknown origin [8][9][10][11][12][13][14][15][16][17], cholangiocarcinoma [9], melanoma [10], small cell neuroendocrine carcinoma [11], colon adenocarcinoma [12], gastric cancer [13], prostate adenocarcinoma [14], lung adenocarcinoma [15], and pheochromocytoma [16]. We present a case of an STLS from a patient with an occult undifferentiated adenocarcinoma of unknown origin.…”

Spontaneous clinical tumor lysis syndrome in solid renal tumor: first case report in non-metastatic renal carcinoma

“…Nephrotoxic agents like non-steroidal anti-inflammatory drugs, antibiotics, contrast, and drugs that interfere with uric acid excretion (thiazide diuretics, acetylsalicylic acid) should be avoided. 10…”