SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Tumor Lysis Syndrome in Squamous Cell Carcinoma of the Lung: A Catastrophe Without a Catalyst

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This case report describes a fatal example of spontaneous tumor lysis syndrome (sTLS) in a 68-year-old woman with previously undiagnosed, widely metastatic, poorly differentiated squamous cell carcinoma of the lung. TLS is a dangerous metabolic emergency usually seen after chemotherapy in high-burden cancers, but it can rarely occur spontaneously, including in solid tumors.<br /><br />The patient initially presented with constipation, fecal incontinence, and progressive fatigue. Imaging revealed a large necrotic right lower lobe/infrahilar lung mass and multiple liver lesions suspicious for metastatic disease. Chest CT also showed pleural nodules, osseous metastases, and possible pericardial invasion. She later developed rapidly worsening metabolic abnormalities consistent with TLS, including hyperkalemia, hyperphosphatemia, elevated uric acid, acute kidney injury, severe transaminitis, rising lactate, and oliguria. Her laboratory values also showed markedly elevated LDH, liver dysfunction, and coagulopathy, reflecting extensive tumor burden and systemic deterioration.<br /><br />Despite treatment with aggressive IV fluids, diuretics, and corticosteroids, her condition worsened. She became hypotensive and tachypneic, required ICU transfer, vasopressor support, and continuous renal replacement therapy, but progressed to refractory shock. After goals-of-care discussions, she was transitioned to comfort-focused care and died shortly thereafter. Biopsy results returned after her death and confirmed high-grade carcinoma most consistent with poorly differentiated squamous cell carcinoma of the lung.<br /><br />The authors emphasize that sTLS, though rare in solid tumors and especially uncommon in squamous cell lung cancer, should be considered in patients with bulky, untreated metastatic disease—particularly with liver involvement, elevated LDH, and extensive necrosis—because early recognition and intervention may be lifesaving.

Asset Subtitle

Thomas P. Albertson Jr.

Meta Tag

Author List Bojan Lazarevic, Evan Nardone, Michael Predi, Thomas P. Albertson Jr., Vibhuti Mishra

Category Clinical Vignettes

Concept Tumor Lysis Syndrome

Concept Spontaneous Tumor Lysis Syndrome

Concept Hyperkalemia

Concept Hyperphosphatemia

Concept Hyperuricemia

Distinguished Non-Finalist

Presenter Organization Philadelphia College of Osteopathic Medicine

Presenting Author Thomas P. Albertson Jr.

Track Adult

Keywords

spontaneous tumor lysis syndrome

sTLS

squamous cell carcinoma

lung cancer

metastatic disease

hyperkalemia

acute kidney injury

hyperphosphatemia

liver metastases

critical care

Tumor Lysis Syndrome

Spontaneous Tumor Lysis Syndrome

Hyperkalemia

Hyperphosphatemia

Hyperuricemia