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

Abstract

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response and the cutaneous metastases developed into ulcers; we hypothesize that most of the dermis, which had been replaced by tumor cells, disappeared as a result of the therapeutic response, and the overlying epidermis became necrotic and shed, leaving an ulcer.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.

Atezolizumab-induced psoriasiform drug eruption successfully treated with ixekizumab: a case report and literature review

“…However, bevacizumab has been reported to increase the risk of hand-foot skin syndrome, also known as palmar-plantar erythrodysesthesia, when used in conjunction with multikinase inhibitors [10]. Furthermore, bevacizumab has been reported to cause cutaneous tumor lysis syndrome during the treatment of metastatic salivary duct carcinoma in combination with temsirolimus [11]. It is unlikely that the psoriasiform eruption described in the current case is due to bevacizumab since VEGF inhibitors have not been reported to cause psoriasiform eruptions.…”

Spontaneous Tumor Lysis Syndrome in Prostate Cancer

“…TLS is an oncological emergency characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, and is caused by massive destruction of neoplastic cells [1,3]. Further, acute kidney failure is a common consequence, and metabolic acidosis may occur [4].…”

Drug-Induced Severe Cutaneous Adverse Reactions: Insights Into Clinical Presentation, Immunopathogenesis, Diagnostic Methods, Treatment, and Pharmacogenomics

“…TLS is a life-threatening hemato-oncological emergency ( Howard et al, 2011 ) Hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcaemia, and metabolic acidosis can all result from the fast disintegration of cancer cells. Systemic tumor lysis syndrome and spontaneous (idiopathic) cutaneous tumor lysis syndrome are the two most common types ( Cohen et al, 2021 ). This cutaneous TLS might be idiopathic (unrelated to therapy) or therapy-related.…”