An unusual cause of tumor lysis syndrome: Cholangiocarcinoma

Kolanjiyokarsinomlu bir hastada bilinmeyen bir nedenle gelişen tümör lizis sendromunu rapor etmeyi amaçladık. 63 yaşında erkek hasta bulantı, kusma ve baş dönmesi ile başvurdu. Laboratuar testlerinde hiperürisemi, hipo-kalemi, hiperfosfatemi, normokalsemi ve üremisi olduğu saptandı. Ayrıca karaciğer fonksiyon testleri yüksek olarak bulundu. Tümör belirteçleri CA 19-9 dışında nor-mal sınırlarda idi. Renal bozukluk diyalize gerek olmadan hidrasyonla tedavi edildi. Abdominal ultrasonografi nor-mal sınırlarda iken; magnetik rezonans kolanjiopankre-atografide sol ana hepatik kanal uç kesimde, sağ ana hepatik kanalda, ana safra kanalları boyunca uzanan ve ana hepatik kanala sınırlı darlıklar tespit edildi. Buradan yapılan ince iğne aspirasyonu ile malign hücre varlığı gösterildi. Kolanjiyokarsinom tanısı sitomorfolojik ve immünhistokimyasal olarak gösterildi. Hastanın genel durumu kötü olduğundan spesifik bir tedavi uygulana-madı ve tümörün saptanmasından 7 hafta sonra hasta kaybedildi. Bu vaka sunumu ile, yavaş büyüme hızına sahip tümörlerden biri olarak bilinen kolanjiyokarsinoma bağlı da tümör lizis sendromu gelişebileceğini vurgula-mayı amaçladık.

Tümör lizis sendromunun nadir bir sebebi: Kolan-jiyokarsinom

We report a patient with cholangiocarcinoma who developed tumor lysis syndrome with an unknown mechanism. A 63-year-old man admitted with nausea, vomiting and dizziness. Laboratory results revealed hyperuricemia, hypokalemia, hyperphosphatemia, normocalcemia, and uremia. Also liver enzymes were high. Tumor markers were all in normal ranges except CA 19-9. Renal impairment was successfully managed with hydration without requiring dialysis. Abdominal ultrasonography was normal. However, magnetic resonance cholangiopancreatography showed an evidence of narrowness appearances in the left main hepatic duct distal cut, right main hepatic duct, and through the major bile ducts that are bounded to the main hepatic duct. Fine needle aspiration of the aspiration smears revealed the presence of malignant cells. The accuracy of the cytomorphologic and immunocytochemical diagnosis was defined as cholangiocarcinoma. No spesific treatment modality was performed because of his poor general condition. The patient died seven weeks after the detection of tumor. We aimed to emphasize that tumor lysis syndrome may also occur during the course of a slow tumor growth fraction like cholangiocellular cancer.

Kaynakça

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