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Qasim H, Mahadevia HJ, Ponvilawan B, Hamdan H, Shrestha A. Post-operative Tumor Lysis Syndrome in High-Grade Uterine Sarcoma. Cureus 2023; 15:e37956. [PMID: 37220456 PMCID: PMC10200365 DOI: 10.7759/cureus.37956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Tumor lysis syndrome (TLS) is a well-known oncologic emergency. It is a constellation of metabolic derangements usually observed in hematological malignancies due to rapid cell lysis, typically due to chemotherapy or radiotherapy initiation. Spontaneous TLS is an unusual complication in solid malignancies, and only a few cases have previously been reported for spontaneous TLS in gynecological malignancies. We report a case of TLS in a 50-year-old female patient shortly after resection of high-grade uterine sarcoma. We review previous TLS cases in uterine malignancies and the associated morbidity and mortality.
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Affiliation(s)
- Hana Qasim
- Internal Medicine, University of Missouri, Kansas City, USA
| | - Himil J Mahadevia
- Internal Medicine, Mayo Clinic, Jacksonville, USA
- Internal Medicine, University of Missouri, Kansas City, USA
| | - Ben Ponvilawan
- Internal Medicine, University of Missouri, Kansas City, USA
| | - Hana Hamdan
- Pathology, University of Missouri, Kansas City, USA
| | - Anuj Shrestha
- Hematology and Oncology, University of Missiouri, Kansas City, USA
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Alqurashi RM, Tamim HH, Alsubhi ZD, Alzahrani AA, Tashkandi E. Tumor Lysis Syndrome in Patients With Solid Tumors: A Systematic Review of Reported Cases. Cureus 2022; 14:e30652. [DOI: 10.7759/cureus.30652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
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Luminais SN, Chen XT, Roman D, Ma B, Christ AB, Hu JS. Tumor lysis syndrome following ifosfamide monotherapy in metastatic osteosarcoma: a case report and review of the literature. J Med Case Rep 2022; 16:252. [PMID: 35761364 PMCID: PMC9238137 DOI: 10.1186/s13256-022-03469-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 05/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Tumor lysis syndrome is an oncologic emergency that involves multiple metabolic abnormalities and clinical symptoms such as acute renal failure, cardiac arrhythmias, seizures, and multiorgan failure, and may be fatal if not promptly recognized. Tumor lysis syndrome occurs most often in patients with hematologic malignancies, and relatively few cases have been described in patients with sarcoma. Case presentation A 64-year-old male of Asian heritage presented to his primary care physician with a right lower-extremity mass and was ultimately diagnosed with widely metastatic osteosarcoma. He was treated with one cycle of cisplatin and doxorubicin that was complicated by hypervolemia and hypoxic respiratory failure. Given concerns for volume overload, therapy was changed to single-agent, dose-reduced ifosfamide. After receiving one dose of ifosfamide 1 g/m2 (1.8 g total) intravenously over 1 hour, the patient developed renal failure, hyperuricemia, hyperkalemia, hyperphosphatemia, and lactic acidosis. The patient ultimately died from severe electrolyte abnormalities associated with tumor lysis syndrome. Conclusion This is the first instance of tumor lysis syndrome described in a patient with osteosarcoma undergoing ifosfamide monotherapy. Clinicians must be vigilant in identifying tumor lysis syndrome regardless of the malignancy type or chemotherapy regimen in order to prevent potentially fatal complications.
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Affiliation(s)
- Steven N Luminais
- Department of Internal Medicine, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Xiao T Chen
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Darwin Roman
- Department of Oncology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Brian Ma
- Department of Pathology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Alexander B Christ
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - James S Hu
- Department of Oncology, Keck School of Medicine of USC, Los Angeles, CA, USA.
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Chapel DB, Nucci MR, Quade BJ, Parra-Herran C. Epithelioid Leiomyosarcoma of the Uterus: Modern Outcome-based Appraisal of Diagnostic Criteria in a Large Institutional Series. Am J Surg Pathol 2022; 46:464-475. [PMID: 34419987 DOI: 10.1097/pas.0000000000001795] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Epithelioid leiomyosarcoma of the uterus is rare and poorly understood. Herein, we characterize a large institutional series of epithelioid leiomyosarcomas aiming to define outcome-determinant diagnostic pathologic features. We also retrieved epithelioid smooth muscle tumors of unknown malignant potential and evaluated a consecutive cohort of leiomyomas for epithelioid subtypes. Of a total of 1177 uterine leiomyosarcomas, 81 (7%) were categorized as epithelioid after review. Epithelioid leiomyosarcoma was strictly defined as having round to polygonal cells with visible pink cytoplasm and round to ovoid nuclei in ≥50% of the tumor volume. Average age was 55 years (range: 26 to 81 y). Median tumor size was 11 cm; tumor was >5 cm in 93% of subjects; 47% were stage 1 at presentation. An infiltrative tumor border was observed, grossly and/or microscopically, in 89% of cases; necrosis was noted in 80%, and vascular invasion in 47%. Mitotic count in 2.4 mm2 (totalling 10 high-power fields, each field 0.55 mm in diameter) ranged from 3 to 100 (median: 26). All cases had moderate, severe or highly pleomorphic atypia. All cases had 2 or 3 of the following: necrosis, at least moderate atypia and ≥4 mitoses in 2.4 mm2. Immunohistochemistry revealed frequent expression of smooth muscle markers including SMA (96%), desmin (95%), and caldesmon (81%). HMB45 and Melan-A were negative in 92% and 100% of cases, respectively. Estrogen and progesterone receptors were expressed by 65% and 54% of tumors, respectively. Follow-up information was available in 68 subjects (median: 23 mo, range: 1 to 254); cancer-related death occurred in 63%, and an additional 15% had recurrent or metastatic disease at last follow-up. Disease-specific survival was shorter in epithelioid leiomyosarcoma patients (median: 44 mo; 35% at 5-y) than in a matched cohort of nonepithelioid leiomyosarcoma (median: 55 mo; 46% at 5-y) (P=0.03). Three epithelioid smooth muscle tumors of unknown malignant potential were evaluated, all <5 cm in size and with atypia and/or irregular borders but mitotic count below the threshold for malignancy. Two of these had follow-up available, which was uneventful. Of 142 consecutive leiomyomas assessed, none had epithelioid morphology as defined. Epithelioid leiomyosarcoma is an aggressive neoplasm, sometimes with a remarkably low mitotic count. In the setting of an epithelioid smooth muscle tumor of the uterus, we postulate that the diagnosis of malignancy is made in the presence of ≥2 of the following: moderate or severe atypia, ≥4 mitoses/2.4 mm2 and tumor cell necrosis. In their absence, the finding of tumor size ≥5 cm, vascular invasion, infiltrative edges or atypical mitoses should be treated with caution, and designation as of at least uncertain malignant potential is warranted.
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Affiliation(s)
- David B Chapel
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA
- Department of Pathology, University of Michigan-Michigan Medicine, Ann Arbor, MI
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA
| | - Bradley J Quade
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA
| | - Carlos Parra-Herran
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital-Harvard Medical School, Boston, MA
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Castellano T, Bulard BA, Staley A, Moore KN. Tumor lysis syndrome in gynecologic cancers: An uncommon but important diagnosis to recognize. Gynecol Oncol Rep 2019; 30:100514. [PMID: 31788528 PMCID: PMC6880131 DOI: 10.1016/j.gore.2019.100514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 12/04/2022] Open
Abstract
TLS treated with rasburicase is rare and associated with approximately 5% of gynecologic cancers. TLS is most frequently associated with new diagnosis of high-grade gynecologic malignancies. The most common presenting symptoms of TLS include acute kidney injury and electrolyte derangement. Early recognition and treatment of TLS can rapidly improve uric acid and electrolyte derangements.
Objectives To describe the incidence, treatment and outcomes associated with tumor lysis syndrome (TLS) in women with gynecologic cancer (GOC). Methods A retrospective multi-institutional review of TLS associated with GOC. Women presenting with an elevated serum uric acid managed with intravenous (IV) rasburicase were included. Descriptive statistics of patient demographics, clinical findings, and outcome data was completed. Results From two large academic institutions N = 18 patients were found to meet inclusion criteria from 2008 to 2018, reflecting an approximate 5% incidence of clinically treated TLS associated with GOC in our cohort. Median age was 60 years, a majority were Caucasian (n = 11, 61.1%), median BMI was 36.2. TLS was associated with a high-grade GOC in n = 17 (94.4%) cases. TLS was commonly diagnosed with a new GOC (n = 12, 70.6%) and following receipt of chemotherapy in n = 9 (50.0%) cases. Six (66.7%) patients were treated with paclitaxel or combination, five (55.5%) with a platinum or combination, and two (22.2%) with a CD47 inhibitor. Chief complaints included electrolyte and renal abnormalities (n = 11, 73.3%). Peak serum uric acid, potassium, creatinine and phosphorus levels were 14.1 mg/dL, 5.7 mEq/L, 5.1 mg/dL, and 6.8 mg/dL, respectively. Nine patients received hospice during their admission with 3 (20%) deaths occurring as inpatients. There were 12 deaths with median OS of 16 d (range: 2–87 d). Conclusions Though rare, TLS can be associated with GOC. Early recognition of presenting symptoms, laboratory findings and expedited treatment may help with electrolyte recovery; however, TLS associated with GOC may herald a rapidly deteriorating state with significant associated mortality.
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Affiliation(s)
- T Castellano
- Stephenson Cancer Center at The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - B A Bulard
- Stephenson Cancer Center at The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - A Staley
- University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - K N Moore
- Stephenson Cancer Center at The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Ahmed Z, Barefah A, Wasi P, Jones G, Ramsay J. Tumour lysis syndrome in a patient with undifferentiated endometrial stromal sarcoma. Gynecol Oncol Rep 2019; 28:41-43. [PMID: 30834285 PMCID: PMC6384315 DOI: 10.1016/j.gore.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/29/2019] [Accepted: 02/14/2019] [Indexed: 11/29/2022] Open
Abstract
Tumour lysis syndrome is an oncologic emergency. Tumour lysis syndrome is most commonly encountered in hematologic malignancies. Herein we report a case of tumour lysis syndrome in an endometrial stromal sarcoma.
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Affiliation(s)
- Zeeshan Ahmed
- McMaster University, Chief Cardiology resident, Division of Cardiology, Canada
| | | | - Parveen Wasi
- Department of Medicine, Division of Oncology, McMaster University, Canada
| | - Graham Jones
- Divisions of Critical Care & Respirology, Department of Medicine, McMaster University, Canada
| | - Jennifer Ramsay
- Pathology and Molecular Medicine, McMaster University, Canada
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Pabon C, Esnakula AK, Daily K. Tumour lysis syndrome following eribulin for metastatic uterine leiomyosarcoma. BMJ Case Rep 2018; 11:11/1/e224576. [PMID: 30573532 DOI: 10.1136/bcr-2018-224576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A middle-aged woman with a history of leiomyosarcoma of the uterus treated with surgery and adjuvant chemotherapy suffered a bulky metastatic recurrence 1 year later. She elected treatment with palliative eribulin, presenting with acute renal failure and electrolyte abnormalities consistent with tumour lysis syndrome on cycle 1 day 8. Despite aggressive supportive care and treatment including intravenous hydration, bicarbonate and rasburicase, she continued to decline, ultimately foregoing haemodialysis in favour of palliative care and passed away in the hospital.
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Affiliation(s)
- Cindy Pabon
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Ashwini K Esnakula
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Karen Daily
- Department of Hematology and Oncology, University of Florida, Gainesville, Florida, USA
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Spontaneous Tumor Lysis Syndrome due to Uterine Leiomyosarcoma with Lung Metastases. Case Rep Crit Care 2017; 2017:4141287. [PMID: 29130003 PMCID: PMC5654283 DOI: 10.1155/2017/4141287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 07/06/2017] [Accepted: 07/30/2017] [Indexed: 11/18/2022] Open
Abstract
Tumor lysis syndrome (TLS) is an oncologic emergency characterized by a combination of metabolic derangements (hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia) caused by rapid turnover from cell destruction in certain cancers. These metabolic derangements can lead to seizures, cardiac arrhythmias, renal failure, and death. TLS is usually seen after the initiation of chemotherapy for hematologic malignancies. TLS occurring spontaneously, without initiation of chemotherapy, is rare and its occurrence in solid tumors is rarer still. We report a case of spontaneous TLS in a patient with leiomyosarcoma of the uterus, with metastasis to lung. Such a case has never been reported before.
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Mirrakhimov AE, Ali AM, Khan M, Barbaryan A. Tumor Lysis Syndrome in Solid Tumors: An up to Date Review of the Literature. Rare Tumors 2014; 6:5389. [PMID: 25002953 PMCID: PMC4083673 DOI: 10.4081/rt.2014.5389] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 04/08/2014] [Indexed: 12/20/2022] Open
Abstract
Tumor lysis syndrome (TLS) is a potentially deadly complication of tumors or their treatment. This syndrome consists of a constellation of laboratory findings such as hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia, known as laboratory TLS. When clinical complications such as seizures, acute renal failure, and cardiac dysrhythmias occur in patients with laboratory TLS, the syndrome is called clinical TLS. TLS is especially common in patients with hematological malignancies with rapid cellular turnover rates such as acute lymphocytic leukemia and Burkitt lymphoma, but is very rare in patients with solid tumors. Nevertheless, there are multiple reports in the literature on the occurrence of TLS in patients with solid tumors. In this review article, we summarize the current data on the occurrence of TLS in patients with solid tumors. We propose an algorithm of risk stratification and prevention of TLS in patients with solid cancers.
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Taira F, Horimoto Y, Saito M. Tumor lysis syndrome following trastuzumab for breast cancer: a case report and review of the literature. Breast Cancer 2013; 22:664-8. [PMID: 23420376 DOI: 10.1007/s12282-013-0448-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/23/2013] [Indexed: 11/24/2022]
Abstract
Tumor lysis syndrome, a complication of anticancer chemotherapy, results from rapid lysis of malignant cells. We report tumor lysis syndrome in a patient treated with trastuzumab for metastatic breast carcinoma. A 69-year-old woman was diagnosed with multiple liver metastases 1 month after mastectomy. As her liver functions had deteriorated, chemotherapeutic agents were contraindicated and she was treated with trastuzumab alone. On day 6 of the first course of trastuzumab, she developed tumor lysis syndrome. As her liver functions showed deterioration due to multiple hepatic metastases, hemodialysis was contraindicated. Acute renal failure worsened and she died 11 days after the administration of trastuzumab.
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Affiliation(s)
- Fumi Taira
- Department of Breast Oncology, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Yoshiya Horimoto
- Department of Breast Oncology, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mitsue Saito
- Department of Breast Oncology, Juntendo University Hospital, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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12
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An unusual presentation of tumor lysis syndrome in a patient with advanced gastric adenocarcinoma: case report and literature review. Case Rep Med 2012; 2012:468452. [PMID: 22685470 PMCID: PMC3368228 DOI: 10.1155/2012/468452] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/22/2012] [Accepted: 03/13/2012] [Indexed: 11/17/2022] Open
Abstract
Tumor lysis syndrome (TLS) is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and secondary hypocalcemia in patients with a malignancy. When these laboratory abnormalities develop rapidly, clinical complications such as cardiac arrhythmias, acute renal failure, seizures, or death may occur. TLS is caused by rapid release of intracellular contents by dying tumor cells, a condition that is expected to be common in hematologic malignancies. However, TLS rarely occurs with solid tumors, and here we present the second chemotherapy-induced TLS in a patient with advanced gastric adenocarcinoma to be reported in the literature. We also provide information regarding the total cases of TLS in solid tumors reported from 1977 to present day. Our methodology involved identifying key articles from existing reviews of the literature and then using search terms from these citations in MEDLINE to find additional publications. We relied on a literature review published in 2003 by Baeksgaard et al., where they gathered all total 45 cases reported from 1977 to 2003. Then, we looked for new reported cases from 2004 to present day. All reports (case reports, brief reports, letters to editor, correspondence, reviews, journals, and short communications) identified through these searches were reviewed and included.
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