The following is a summary of “Spontaneous tumor lysis syndrome (STLS) during biopsy for Burkitt lymphoma: a case report,” published in the March 2024 issue of Pediatrics by Pan et al.

Tumor lysis syndrome (TLS) represents a critical hematologic oncological emergency marked by metabolic derangements and electrolyte imbalances stemming from the rapid breakdown of tumor cells, resulting in the release of substantial quantities of potassium, phosphate, and nucleic acids into the systemic circulation. While TLS predominantly manifests during chemotherapy, instances of spontaneous tumor lysis syndrome (STLS) before the initiation of therapy are exceedingly rare. Here, the researchers present a case wherein a child underwent a biopsy procedure only to experience an abrupt onset of high fever, arrhythmia, severe hyperkalemia, hypocalcemia, and acidosis as the incision was being closed. Timely administration of symptomatic treatment and continuous renal replacement therapy (CRRT) proved instrumental in ameliorating the child’s laboratory abnormalities and restoring organ function to normalcy. Subsequent pathological examination confirmed the diagnosis of Burkitt lymphoma, with the patient currently undergoing maintenance chemotherapy.

This case underscores the potentially life-threatening nature of TLS in hematologic oncology and imparts several critical lessons to clinicians. Firstly, clinicians must maintain a heightened awareness of TLS risk factors and carefully assess the level of risk in individual patients. Secondly, the possibility of STLS during surgical procedures, necessitating meticulous surgical techniques to minimize trauma and expedite operative time, should be diligently considered. Thirdly, proactive preoperative prophylaxis, including aggressive fluid management and judicious use of diuretics and uric-acid-lowering drugs, should be pursued for high-risk TLS patients. Furthermore, the effectiveness of CRRT in managing severe STLS, as evidenced in this case, underscores its importance as a therapeutic modality in such scenarios. These insights highlight the importance of a comprehensive and proactive approach to TLS management in the oncological setting. 

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-04679-1