SHM Converge Scientific Abstract ePoster Gallery-An Unsuspected Fatal Oncologic Emergency

Pdf Summary

This case report describes a rare, fatal example of spontaneous tumor lysis syndrome (STLS) in a 76-year-old man with newly diagnosed gastric signet ring cell adenocarcinoma. TLS is an oncologic emergency caused by rapid breakdown of tumor cells, leading to metabolic disturbances such as hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and acute kidney injury. STLS occurs without prior chemotherapy and is uncommon in solid tumors.<br /><br />The patient was admitted with two weeks of abdominal distention, dyspnea on exertion, and a 29-pound weight gain. Examination showed a firm, distended abdomen with ascites. Initial labs revealed renal dysfunction (creatinine 2.68 mg/dL) with otherwise near-normal electrolytes. Paracentesis removed 6 liters of fluid, and cytology showed adenocarcinoma of unclear origin. Common tumor markers, including CEA, CA 19-9, and PSA, were negative.<br /><br />During hospitalization, he developed worsening renal failure along with marked hyperuricemia and hypocalcemia, suggesting TLS. Further evaluation with EGD and endoscopic ultrasound identified a nodular gastric mass on the lesser curvature. Fine needle aspiration confirmed signet ring cell adenocarcinoma of gastric origin. Based on Cairo-Bishop criteria, he met laboratory and clinical criteria for TLS.<br /><br />He was treated with rasburicase, allopurinol, and hemodialysis, but his condition deteriorated into multi-organ failure, and he could not tolerate dialysis. He ultimately chose comfort-focused care and died in the fourth week of admission.<br /><br />The authors emphasize that STLS, though rare, can occur in gastric adenocarcinoma and other solid tumors. Because delayed recognition can be fatal, clinicians should consider TLS even in patients with untreated solid malignancies.

Asset Subtitle

Saad Malik

Meta Tag

Author List Anunaya Aashish, Dipaben Patel, Lavina Lakdawala, Saad Malik

Category Clinical Vignettes

Concept Tumor Lysis Syndrome

Concept Spontaneous Tumor Lysis Syndrome

Concept Cairo-Bishop Criteria

Concept Hyperuricemia

Concept Hypocalcemia

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton

Presenting Author Saad Malik

Track Adult

Keywords

spontaneous tumor lysis syndrome

gastric adenocarcinoma

signet ring cell carcinoma

hyperuricemia

acute kidney injury

rasburicase

allopurinol

hemodialysis

Cairo-Bishop criteria

solid tumor oncology

Tumor Lysis Syndrome

Spontaneous Tumor Lysis Syndrome

Cairo-Bishop Criteria

Hyperuricemia

Hypocalcemia