Tumor Lysis Syndrome in a Retroperitoneal Sarcoma.
Bottom Line: The patient would become progressively obtunded at which time the family opted for hospice care.The patient eventually succumbed peacefully 3 days after her last admission.In this case report, we briefly review the literature on TLS in solid tumors, and we present a rare case of spontaneous TLS in a retroperitoneal sarcoma.
Affiliation: Georgia Regents University, Augusta, GA, USA.
In the present case, a 49-year-old white female presented to the clinic with a 2-month history of nausea, vomiting, and right upper quadrant pain. On examination a 3-cm mass on the right anterior scalene muscle was noted. A computed tomography scan was performed revealing a 8.7 × 7.7 × 6.1 cm retroperitoneal mass with possible invasion of the inferior vena cava and right renal and left common iliac veins. An excisional biopsy was performed with pathology compatible with spindle cell sarcoma. The patient was then sent for follow-up at the sarcoma clinic as an outpatient. However, before chemotherapy was to be started the patient would be admitted to the hospital with progressively worse nausea and vomiting. At that time the patient's lab work showed lactic acidosis, acute renal failure, hyperuricemia, hyperphosphatemia, and hypocalcemia, which met the Cairo-Bishop criteria for tumor lysis syndrome (TLS). The patient was admitted to the intensive care unit and kidney dialysis initiated. The patient would become progressively obtunded at which time the family opted for hospice care. The patient eventually succumbed peacefully 3 days after her last admission. In this case report, we briefly review the literature on TLS in solid tumors, and we present a rare case of spontaneous TLS in a retroperitoneal sarcoma.
No MeSH data available.
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Mentions: An excisional biopsy was performed that revealed an undifferentiated tumor suggestive of a spindle cell sarcoma. The tumor showed positive immunostaining for vimentin and caldesmon, with focal minimal positivity for desmin, as seen in Figure 2. While in the hospital the patient experienced a pulmonary embolus, which complicated her initial admission. At this time the patient was stabilized and discharged home to follow-up with the sarcoma clinic and start chemotherapy as an outpatient. However, the patient returned to the emergency room a few days before chemotherapy was to be initiated with worsening symptoms of nausea and vomiting.
No MeSH data available.