Tumor lysis syndrome (TLS) consists of a rapid tumor cell breakdown that ends in multiple metabolic derangements and can occur spontaneously or be triggered by oncological therapies. It is a serious oncological emergency, primarily seen in hematological malignancies like non-Hodgkin lymphomas and particularly Burkitt's lymphoma, as well as in certain bulky solid tumors like neuroblastoma. This report discusses a case of spontaneous TLS in a patient with metastatic cholangiocarcinoma. We present a case of a 72-year-old Hispanic male with a history of hypertension, tobacco use disorder, and alcoholism who was admitted for 20 days of worsening abdominal distention, edema, dyspnea, cough, and hyporexia. Physical examination revealed jaundice and signs of ascites. Laboratory studies showed mildly elevated liver enzymes and a resolved hepatitis B infection. A multiphase computerized tomography (CT) scan of the abdomen revealed a large heterogeneous hepatic mass, ascites, lymphadenopathy, and portal vein thrombosis. Chest CT showed nodules with perilymphatic distribution. A paracentesis yielded 3000 cc of ascitic fluid, showing a serum-ascites albumin gradient of 1.81 g/dL and neutrophil predominance. Tumor markers indicated elevated CA 19-9 levels. Subsequent liver biopsy confirmed moderately differentiated adenocarcinoma, and the immunohistochemistry supported a diagnosis of cholangiocarcinoma. On day 5 of hospitalization, the patient's renal function worsened, leading to spontaneous TLS. Overall, TLS is a life-threatening emergency in cancer patients, necessitating regular lab tests for early diagnosis, especially in those on chemotherapy or with known solid tumors. There is no consensus on diagnosing spontaneous TLS.
Lasprilla-Pallares et al. (2026) studied this question.