Tumor lysis syndrome, an oncological emergency, is characterized by laboratory parameters such as
hyperuricemia,
hyperkalemia,
hyperphosphatemia, and
hypocalcemia, as well as renal injury with an elevated
creatinine.
Tumor lysis syndrome is seen in patients with aggressive
malignancies and high
tumor burden. More frequently, it occurs in individuals with
hematologic malignancies such as
high-grade lymphomas (such as
Burkitt lymphoma) and
leukemia (such as
acute lymphocytic leukemia). It also, albeit less commonly, can be seen in patients with widespread solid
tumors that are rapidly proliferating and are markedly sensitivity to
antineoplastic therapy.
Tumor lysis syndrome is usually preceded by
cancer-directed
therapy; however, the syndrome can present spontaneously prior to the individual receiving
malignancy-directed treatment. We reported a man with metastatic salivary duct
carcinoma who had cutaneous
metastases that presented as
carcinoma hemorrhagiectoides. Microscopic examination demonstrated that the metastatic
tumor cells had infiltrated and replaced the entire dermis. After the patient received his first dose of
antineoplastic therapy, he had an excellent response and the cutaneous
metastases developed into
ulcers; we hypothesize that most of the dermis, which had been replaced by
tumor cells, disappeared as a result of the therapeutic response, and the overlying epidermis became necrotic and shed, leaving an
ulcer. His dramatic response to treatment prompted us to propose a new classification of
tumor lysis syndrome, which should include the systemic form of the condition as well as the new variant: cutaneous
tumor lysis syndrome. We anticipate that, with improvement in targeted
therapies, there may be an increase in
therapy-associated cutaneous
tumor lysis syndrome.