Abstract B041: Spontaneous Tumor Lysis Syndrome Associated with Pancreatic Adenocarcinoma: A Case Report

Abstract Background: Spontaneous tumor lysis syndrome (sTLS) is a rare, life-threatening oncologic emergency caused by rapid tumor cell breakdown without cytotoxic therapy, leading to severe metabolic derangements (hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia). While typically associated with hematologic malignancies, sTLS rarely occurs in solid tumors. Pancreatic adenocarcinoma involvement is exceptionally uncommon, often linked to high tumor burden or metastatic disease, and carries >50% mortality. Case Presentation: A 57-year-old female with metastatic pancreatic adenocarcinoma (7 cm pancreatic mass with lung/liver metastases) presented with GI symptoms and weight loss. Before treatment initiation, she developed acute kidney injury (creatinine ↑1.3 to 1.8 mg/dL), hyperkalemia (5.8 mmol/L), hyperphosphatemia (6.2 mg/dL), and hyperuricemia (16.5 mg/dL), fulfilling Cairo-Bishop criteria for sTLS. Management included aggressive IV hydration, rasburicase, electrolyte correction, and close monitoring, resulting in metabolic stabilization. Conclusions: This case highlights sTLS as a critical consideration in advanced solid tumors like pancreatic adenocarcinoma, particularly with bulky/metastatic disease. Early recognition and intervention (hydration, rasburicase) are vital to mitigate acute complications. Despite prompt stabilization, the prognosis remains poor due to advanced disease, often necessitating palliative care. This report underscores heightened clinical vigilance for sTLS in similar presentations and contributes to sparse literature on pancreatic cancer-associated sTLS. Citation Format: Manas Pustake, Ritwik Dey, Edwin Mendoza, Suyog Patel, Aymara Chang Lopez, Lisa Amiee Hechanova, Javier Corral, William Wells-Gatnik. Spontaneous Tumor Lysis Syndrome Associated with Pancreatic Adenocarcinoma: A Case Report [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research—Emerging Science Driving Transformative Solutions; Boston, MA; 2025 Sep 28-Oct 1; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2025;85(18_Suppl_3):Abstract nr B041.