Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc
Journal website https://www.thejh.org

Case Report

Volume 10, Number 1, February 2021, pages 30-34

Spontaneous Tumor Lysis Syndrome: A Rare Presentation in Plasmablastic Lymphoma

Figures

Figure 1.
Figure 1. Abdominopelvic CT scan displaying a solid polylobulated retroperitoneal mass which invades the bladder wall, measuring approximately 10 × 10 centimeters. CT: computed tomography.
Figure 2.
Figure 2. Evolution of serum phosphate concentration over time, since intensive care admission (day 1). The hyperphosphatemia, although significant, was not as proportionately elevated as the remaining tumor lysis parameters. This, however, changed once chemotherapy was initiated, with a spike from 8 mg/dL to approximately 13 mg/dL, and hence requiring two hemodialysis sessions to correct this serious hyperphosphatemia.
Figure 3.
Figure 3. Pathophysiology of tumor lysis syndrome and its clinical implications.

Tables

Table 1. Blood Workup at Presentation, Showing Kidney failure and Multiple Metabolic Derangements
 
ParameterValue
Hb: hemoglobin; WBC: white blood count; BUN: blood urea nitrogen; LDH: lactate dehydrogenase.
Hb11.5 g/dL
WBC5.39 × 109/L
Platelets307 × 109/L
BUN90 mg/dL
Creatinine14.03 mg/dL
Na+138 mmol/L
K+6.6 mmol/L
Cl-107 mmol/L
LDH2,012 UI/L
Uric acid24.9 mg/dL
Phosphorus7.7 mg/dL
Calcium8.5 mg/dL

 

Table 2. Risk Factors for the Development in TLS in Hematological Malignancies, Which Can Be Divided in Tumor-Related or Patient-Related Factors [12]
 
TLS: tumor lysis syndrome; WBC: white blood count; LDH: lactate dehydrogenase; ULN: upper limit of normal.
Tumor-related factors
  High proliferative rate
  Chemosensitive tumor
  High tumor burden
    Bulky disease (node >10 cm)
    WBC > 50,000/µL
    LDH elevation twice the ULN
    Organ involvement
    Extensive marrow infiltration
Patient-related factors
  Pre-treatment hyperuricemia or hyperphosphatemia
  Pre-existing nephropathy
  Oliguria
  Dehydration or volume depletion during treatment