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Kidney Week

Abstract: PO1861

Case of Spontaneous Tumor Lysis Syndrome in Metastatic Prostate Cancer

Session Information

Category: Onco-Nephrology

  • 1500 Onco-Nephrology

Authors

  • Al-Hasan, Mohammad, Albany Medical Center, Albany, New York, United States
  • Monrroy, Mauricio, Albany Medical Center, Albany, New York, United States
Introduction

Tumor lysis syndrome has been described in hematological malignancies mainly where there is a large tumor burden that lyse in relatively short period of time causing a large burden of metabolites that causes AKI. In this case, we will present a case of spontaneous tumor lysis syndrome caused by widespread metastatic cancer prostate which is an unusual cancer to cause such syndrome. That metastasis was mainly to the bone marrow causing a picture of pancytopenia, which also raises the possibility that the tumor lysis syndrome could be due to the breakdown of the cells of the bone marrow rather than the lysis of the prostate cancer cells.

Case Description

65-year-old male patient presented with altered mental status upper GI bleed, hyperkalemia of 6.2, severe acidosis with bicarbonate of 7 and AKI with a creatinine of 7.32 and BUN of 181, calcium 9.3, phosphorus 7.4, uric acid 41.5, bilirubin of 2.9 and LDH was high at 789, alkaline phosphatase was 345, patient had severe anemia with hemoglobin of 2.6, white count 12,600 and thrombocytopenia with platelet count of 6000. urine analysis showed uric acid crystals. flow cytometry analysis of peripheral blood did not reveal a clonal population of cells or expanded population of blasts. CT scan chest abdomen pelvis suggested diffuse osseous lytic and blastic metastatic lesions. Serum immuno-electrophoresis was negative. PSA level of more than 1400.

Discussion


The severe AKI along with the significant elevated serum uric acid level, and presence of uric acid crystals in the urine sediment, made it highly likely the diagnosis of TLS. The presence of diffuse osseous lesions and a PSA above the level that can be measured were consistent with metastatic prostate cancer as the underlying malignancy. No history of treatment was obtained.
TLS in solid malignancies is extremely rare , especially without anti-neoplastic therapy.
In this case, the presence of severe anemia and thrombocytopenia were highly suspicious for bone marrow invasion, and possible contributor to TLS. Regretfully, a bone marrow biopsy couldn't be obtained before patient expired.
Conclusion: TLS can be caused by solid cancers like prostate cancer if it is widely metastasized. Bone marrow extension with lysis of bone marrow cells maybe a contributing factor.