P2249 - A Rare Case of Spontaneous Tumor Lysis Syndrome From Metastatic Cecal Adenocarcinoma

Minira Aslanova, DO, Lesley Wu, MD, Karishma Rupani, MD, Michelle Shah, DO
Mount Sinai Beth Israel Medical Center, New York, NY

Introduction: Tumor lysis syndrome (TLS) is an oncologic emergency most often occurring in hematologic
malignancies following chemotherapy initiation. The most common cause of TLS is
chemotherapy, followed by immunotherapy, glucocorticoid treatment, and radiotherapy.
Spontaneous tumor lysis syndrome (STLS) describes the unexpected event that cell lysis
occurs without active cytotoxic or definite treatment and is most often seen in hematologic
malignancies with large tumor burden. We report a rare case of STLS in metastatic cecal
adenocarcinoma.

Case Description/Methods: A 65-year-old female with atrial fibrillation, diabetes, hypertension, hyperlipidemia, asthma,
presented to the hospital with voluminous watery diarrhea and was found to have new iron
deficiency anemia with CT abdomen revealing a partially obstructing cecal mass (Image 1) with metastasis
to the liver, lung and abdominal wall. Patient underwent colonoscopy with biopsy, which showed
a fungating, partially obstructing large mass found in the distal ascending colon, and pathology
demonstrated moderately differentiated colonic adenocarcinoma with positive proficient
mismatch repair. Patient was discharged to a nursing home with oncology follow up for
treatment initiation.
Several months later, the patient returned to the hospital without having initiated treatment for
newly diagnosed colon cancer with worsening dyspnea, failure to thrive, and progressive
decrease in urine output. She was found to have acute renal failure and met criteria for STLS
diagnosis (see table), therefore was started on rasburicase and underwent hemodialysis.
Although the electrolyte abnormalities improved, the hospital course was complicated by septic
shock requiring vasopressors, acute respiratory failure requiring mechanical ventilation, and
multi-organ failure. Given her unstable condition, a shared medical decision was made to
pursue hospice care and she soon passed away.

Discussion: STLS refers to a condition characterized by hyperphosphatemia, hypocalcemia, hyperkalemia,
hyperuricemia, and renal failure in patients with malignancies without initiating cytotoxic therapy.
STLS diagnosed in solid malignancies is extremely rare, and limited studies have demonstrated
that risk factors for solid tumor associated STLS include large tumor burden, baseline impaired
renal function, extensive liver metastasis, and elevated LDH. Given the high mortality risk, early
recognition and treatment should be initiated in any patient with suspicion of STLS.


Figure: Image 1: Fungating cecal mass seen on CT Abdomen/Pelvis

	Normal Range	Result
Creatinine	0.6-1.2 mg/dL	4.2 mg/dL
Potassium	3.4-5.0 mEq/L	7.5 mEq/L
Calcium, serum	8.5-10.5 mg/dL	4.8 mg/dL
Calcium, ionized	1.15-1.30 mmol/L	< .7 mmol/L
Phosphorous	3.0-4.5 mg/dL	9.0 mg/dL
Uric Acid	3.0-6.0 mg/dL	25.3 mg/dL

Table: Table 1: Laboratory Data


Disclosures:
Minira Aslanova indicated no relevant financial relationships.
Lesley Wu indicated no relevant financial relationships.
Karishma Rupani indicated no relevant financial relationships.
Michelle Shah indicated no relevant financial relationships.


Minira Aslanova, DO, Lesley Wu, MD, Karishma Rupani, MD, Michelle Shah, DO. P2249 - A Rare Case of Spontaneous Tumor Lysis Syndrome From Metastatic Cecal Adenocarcinoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.