SHM Converge Scientific Abstract ePoster Gallery-A Solid Surprise: Spontaneous Tumor Lysis Syndrome in Metastatic Breast Cancer

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This case describes a 38-year-old woman with a year-long history of an untreated right breast mass who presented for a second opinion after being told abroad to transition to comfort care. On exam, she was tachycardic and tachypneic, with a diffusely enlarged, firm right breast. Initial labs showed hypercalcemia, mild renal dysfunction, and elevated lactate. Imaging revealed widely metastatic disease involving the calvarium, thoracic spine, and liver.<br /><br />She was admitted for hypercalcemia of malignancy and further evaluation. A core biopsy confirmed aggressive hormone receptor–negative, HER2-negative, grade 3 invasive ductal carcinoma of the breast. Although oncology initially considered hormonal therapy, she developed acute encephalopathy on hospital day 1. Laboratory abnormalities and clinical course were consistent with spontaneous tumor lysis syndrome (TLS), an oncologic emergency caused by rapid tumor cell breakdown. Her TLS was managed aggressively with high-rate IV fluids, bicarbonate, sodium zirconium, IV furosemide, and a single dose of rasburicase.<br /><br />Despite treatment, she deteriorated quickly, transitioned to comfort care, and died shortly afterward.<br /><br />The discussion emphasizes that TLS is most commonly seen after treatment of hematologic malignancies, but it can also occur spontaneously in solid tumors, including breast cancer. Fewer than 40 spontaneous TLS cases in solid tumors and fewer than 10 in breast cancer have been reported. Mortality appears higher in solid tumors, and spontaneous TLS may be especially lethal because diagnosis can be delayed.<br /><br />The key takeaway is to maintain a high index of suspicion for TLS in all cancer patients, including those with solid tumors who are untreated, especially when electrolyte disturbances or renal dysfunction are present.

Asset Subtitle

Vineet Gupta

Meta Tag

Author List Brian K. Kwan, Deepak Asudani, Lobna Shahatto, Reid Sasaki, Vineet Gupta, Wei Jenny Yang

Category Clinical Vignettes

Concept Tumor Lysis Syndrome

Concept Spontaneous Tumor Lysis Syndrome

Concept Rasburicase

Concept Electrolyte Abnormality

Concept Renal Dysfunction

Distinguished Non-Finalist

Presenter Organization University of California, San Diego (UCSD)

Presenting Author Vineet Gupta

Track Adult

Keywords

breast cancer

spontaneous tumor lysis syndrome

metastatic disease

invasive ductal carcinoma

hypercalcemia of malignancy

HER2-negative

hormone receptor-negative

rasburicase

oncologic emergency

solid tumor

Tumor Lysis Syndrome

Spontaneous Tumor Lysis Syndrome

Rasburicase

Electrolyte Abnormality

Renal Dysfunction