Spontaneous Tumor Lysis Syndrome (STLS) is a rare oncologic condition caused by the breakdown of neoplastic tissue in the absence of traditional anti-tumor therapy. It is postulated that cancers with rapidly dividing ...Spontaneous Tumor Lysis Syndrome (STLS) is a rare oncologic condition caused by the breakdown of neoplastic tissue in the absence of traditional anti-tumor therapy. It is postulated that cancers with rapidly dividing cells lead to increased cell turnover which exceeds the kidneys’ ability to adequately filtrate by-products of cellular breakdown (i.e., phosphate, potassium, anduric acid), leading to end organ damage. It has been reported in the past that kidney failure is a sequelae of Tumor Lysis Syndrome (TLS), but there have been no reports that demonstrate acute kidney injury (AKI) preceding TLS. The case presented here demonstrates TLS in a patient with no formal cancer diagnosis, who had received no chemotherapy or radiation that was precipitated by an iatrogenic AKI with chlorthalidone and ibuprofen. This unusual pattern of AKI preceding STLS may provide insight into the pathophysiology of the condition and could possibly lead to greater understanding of this phenomenon.展开更多
The most common treatment of spontaneous tumor rupture hemorrhage(STRH)is transcatheter arterial embolization(TAE)followed by liver resection,and surgical navigation using near-infrared fluorescence is effective metho...The most common treatment of spontaneous tumor rupture hemorrhage(STRH)is transcatheter arterial embolization(TAE)followed by liver resection,and surgical navigation using near-infrared fluorescence is effective method for detecting hidden lesions and ill-defined tumor boundaries.However,due to the blockage of the tumor-supplying artery after effective TAE treatment,it is difficult to deliver sufficient fluorescent probes to the tumor region.In this study,we report on the successful application of superstable homogeneous intermixed formulation technology(SHIFT)in precise conversion hepatectomy for ruptured hepatocellular carcinoma(HCC).A homogeneous lipiodol-ICG formulation obtained by SHIFT(SHIFT-ICG)was developed for clinical practice for STRH.A ruptured HCC patient received the combined protocol for embolization and fluorescence surgical navigation and exhibited excellent hemostatic effect.Lipiodol and ICG were both effectively deposited in the primary lesion,including a small metastatic lesion.In follow-up laparoscopic hepatectomy,SHIFT-ICG could clearly and precisely image the full tumor regions and boundaries in real time,and even indistinguishable satellite lesions still expressed a remarkable fluorescence intensity.In conclusion,the simple and green SHIFT-ICG formulation can be effectively used in emergency embolization hemostasis and later precise fluorescence navigation hepatectomy in patients with ruptured HCC bleeding and has high clinical application value.展开更多
文摘Spontaneous Tumor Lysis Syndrome (STLS) is a rare oncologic condition caused by the breakdown of neoplastic tissue in the absence of traditional anti-tumor therapy. It is postulated that cancers with rapidly dividing cells lead to increased cell turnover which exceeds the kidneys’ ability to adequately filtrate by-products of cellular breakdown (i.e., phosphate, potassium, anduric acid), leading to end organ damage. It has been reported in the past that kidney failure is a sequelae of Tumor Lysis Syndrome (TLS), but there have been no reports that demonstrate acute kidney injury (AKI) preceding TLS. The case presented here demonstrates TLS in a patient with no formal cancer diagnosis, who had received no chemotherapy or radiation that was precipitated by an iatrogenic AKI with chlorthalidone and ibuprofen. This unusual pattern of AKI preceding STLS may provide insight into the pathophysiology of the condition and could possibly lead to greater understanding of this phenomenon.
基金supported by the National Key R&D Program of China(2019YFA0110600).
文摘The most common treatment of spontaneous tumor rupture hemorrhage(STRH)is transcatheter arterial embolization(TAE)followed by liver resection,and surgical navigation using near-infrared fluorescence is effective method for detecting hidden lesions and ill-defined tumor boundaries.However,due to the blockage of the tumor-supplying artery after effective TAE treatment,it is difficult to deliver sufficient fluorescent probes to the tumor region.In this study,we report on the successful application of superstable homogeneous intermixed formulation technology(SHIFT)in precise conversion hepatectomy for ruptured hepatocellular carcinoma(HCC).A homogeneous lipiodol-ICG formulation obtained by SHIFT(SHIFT-ICG)was developed for clinical practice for STRH.A ruptured HCC patient received the combined protocol for embolization and fluorescence surgical navigation and exhibited excellent hemostatic effect.Lipiodol and ICG were both effectively deposited in the primary lesion,including a small metastatic lesion.In follow-up laparoscopic hepatectomy,SHIFT-ICG could clearly and precisely image the full tumor regions and boundaries in real time,and even indistinguishable satellite lesions still expressed a remarkable fluorescence intensity.In conclusion,the simple and green SHIFT-ICG formulation can be effectively used in emergency embolization hemostasis and later precise fluorescence navigation hepatectomy in patients with ruptured HCC bleeding and has high clinical application value.
