SHM Converge Scientific Abstract ePoster Gallery-Rare and Rapid: Tumor Lysis Syndrome in Renal Soft Tissue Sarcoma

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This case describes a 39-year-old man with a rapidly enlarging left renal/retroperitoneal mass initially found on CT. An initial biopsy was inconclusive, but repeat imaging showed progression with peritoneal nodules and suspected lung and liver metastases. A repeat biopsy identified soft tissue sarcoma. Before chemotherapy was started, the patient already had lab abnormalities consistent with spontaneous tumor lysis syndrome (TLS), a rare but life-threatening oncologic emergency in solid tumors. TLS is usually seen after treatment begins, but can rarely occur spontaneously, as in this case.<br /><br />The patient was started on inpatient doxorubicin, but his disease progressed rapidly with worsening renal function. Given the advanced metastatic sarcoma and poor prognosis, he chose comfort-focused care.<br /><br />The key takeaways are:<br />- TLS requires immediate recognition and urgent treatment, even if tissue diagnosis is not yet definitive.<br />- Although TLS is much more common in hematologic cancers, it can occur in solid tumors and has a higher mortality rate in this setting.<br />- Hospitalists play an important role in coordinating multidisciplinary care, monitoring cancer-related complications, and facilitating communication among oncology, nursing, social work, and case management teams.<br />- Hospitalist co-management may improve hospital outcomes and support timely goals-of-care discussions, hospice planning, and discharge coordination.<br /><br />Overall, the case highlights the importance of maintaining a high index of suspicion for spontaneous TLS in patients with aggressive solid tumors and emphasizes the hospitalist’s role in managing both the medical complexity and end-of-life needs of advanced cancer patients.

Asset Subtitle

Megan T. Frame

Meta Tag

Author List Chelsey Williams, Madison Mumpower, Megan T. Frame, Megan Wolak

Category Clinical Vignettes

Concept Tumor Lysis Syndrome

Concept Electrolyte Abnormality

Concept Oncologic Emergency

Concept Cardiac Arrhythmia

Concept Seizure

Distinguished Non-Finalist

Presenter Organization The University of Kentucky

Presenting Author Megan T. Frame

Track Adult

Keywords

spontaneous tumor lysis syndrome

solid tumor

soft tissue sarcoma

retroperitoneal mass

renal mass

metastatic disease

doxorubicin

acute kidney injury

hospitalist co-management

goals of care

Tumor Lysis Syndrome

Electrolyte Abnormality

Oncologic Emergency

Cardiac Arrhythmia

Seizure