Rare Case of Spontaneous Tumor Lysis Syndrome (TLS) in a Patient with Germ Cell Tumor (GCT): Literature Review and Approach to Management

Abstract

Tumor Lysis Syndrome (TLS) is an oncologic emergency caused by destruction of malignant cells and release of intracellular components into the blood stream leading to numerous electrolyte abnormalities. Spontaneous TLS in solid tumors, without the presence of precipitating chemotherapy, has rarely been described. Germ cells tumors are the most common malignancy among men age 15-35 years of age. Due to the dramatic sensitivity of germ cell tumors to platinum based chemotherapy, systemic treatment in combination with surgical resection lead to cure rates ranging from 50%-90%. In a patient with spontaneous TLS, prior to initiation of chemotherapy, careful consideration of the treatment regimen is required. Although there are potential adverse effects of chemotherapy in any patient, these side effects may be further exacerbated in patients with significant co-morbidities. We will review a case of metastatic germ cell cancer presenting with spontaneous TLS and discuss implications for management in the acute setting.