Tumor lysis syndrome (TLS) is a severe metabolic and electrolytic disturbance caused by rapid lysis of neoplastic cells, and resulting in various end-organ damages. TLS is frequently encountered in tumors with high cell turnover and growth rates such as hematologic malignancies including acute leukemias, Burkitt lymphoma, and high-grade lymphomas, and is commonly observed in these patients after administration of induction chemotherapy, radiotherapy, or cytolytic antibody therapy [
A 71-year-old man visited our institution in January 2019 with increased nodule size in the right lower lobe (RLL) of the lungs. The RLL nodule was initially found five years prior, but its size had decreased at follow-up and it was regarded as an inflammatory nodule. Computed tomography (CT) showed the development of ill-defined ground-glass opacities in the right upper lobe of the lungs accompanied by multiple lymphadenopathies in the right supraclavicular, prevascular, upper paratracheal, both lower paratracheal, subcarinal, and left paraesophageal lymph nodes, but evidence of hepatic or renal metastasis of solid cancer was not found. The hemogram and peripheral blood smear results of the patient at the first visit were as follows: white blood cells, 6.09×109/L; hemoglobin, 10.3 g/dL; and platelets, 7.0×109/L. The complete blood cell differential count results of the patient at the first visit were as follows: metamyelocytes, 3%; band neutrophils, 12%; segmented neutrophils, 44%; lymphocytes, 33%; monocytes, 7%; basophils, 1%; and the presence of nucleated red blood cells (nRBCs) with a frequency of 5 nRBCs/100 white blood cells. At initial workup, the patient showed increased inorganic phosphate (6.9 mg/dL, reference range, 2.9–4.3), uric acid (11.9 mg/dL, reference range, 2.1–7.4), fibrinogen degradation product (81.99 µg/mL, reference range, <5.00), D-dimer (6.53 µg/mL, reference range, <0.50), lactate dehydrogenase (3922 IU/L, reference range, 106–230), and creatinine (1.77 mg/dL, reference range, 0.60–1.50) levels and prolonged prothrombin time (13.3 s, reference range, 9.3–13.2). The patient also showed normal potassium (4.10 mM/L, reference range, 3.50–5.30) and calcium (8.6 mg/dL, reference range, 7.8–10.0) levels and a decreased fibrinogen (146.0 mg/dL, reference range, 200.0–400.0) level. At the previous visit to another hospital 2 months prior, the patient showed normal uric acid (3.7 mg/dL, reference range, 2.5–8.3) and creatinine (0.78 mg/dL, reference range, 0.6–1.2) levels. For the pathologic diagnosis, endobronchoscopic ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and liquid-based aspiration cytology from the lymph nodes, BM aspiration, and biopsy were performed.
The BM aspiration showed hypocellular marrow due to dilution by peripheral blood with infiltration of small to medium-sized neoplastic cells at a frequency of 56.0%, which showed deeply stained nuclei, finely dispersed nuclear chromatin without distinct nucleoli, scanty amount of cytoplasm, and frequent nuclear moulding defined as conformity of adjacent cell nuclei to one another (
Although TLS is frequently observed in hematologic malignancies, such as acute leukemias or high-grade lymphomas, the incidence of TLS associated with solid tumors remains relatively low because they have such a low proliferative index, and a few case reports of TLS associated with solid cancer support this speculation [
A recent study [
In conclusion, we report here a case of STLS associated with BM metastatic SCLC without hepatic metastasis at diagnosis, and to our best knowledge, this is the first case report of STLS associated with BM metastatic SCLC in Korea.
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Bone marrow aspiration, biopsy, and immunohistochemical stain results of the patient. The bone marrow aspiration