Tumor lysis syndrome complicating chemotherapy for non-small this website cell lung cancer is very rare and to date there have been only four such cases that have been reported in literature [10], [11], [12] and [13]. A 59-year old African American male former heavy smoker (40 pack years) with no significant past medical history presented to our hospital with non-productive cough and shortness of breath on exertion of three months duration. He

did not report any history of hemoptysis, weight lost, night sweats or fever. His vitals were stable and thorough physical examination did not reveal any abnormal findings. Chest X-ray (Fig. 1) revealed collapse of the right upper lobe (RUL). CT scan of the chest (Fig. 2A and B) showed a 4 × 3.7 × 4 cm3 mass with areas of calcification abutting and compressing the right upper lobe bronchus with atelectasis of the RUL. Flexible bronchoscopy revealed an endobronchial lesion which completely occluded the right upper lobe bronchus and partially occluded the bronchus intermedius. Endobronchial biopsy and brushing taken from the mass was positive for a poorly differentiated primary lung adenocarcinoma that www.selleckchem.com/products/AZD2281(Olaparib).html stained positive for AE1/AE3,

CK 7, TTF1, CD45 and Napsin A. Test for EGFR mutation was negative but tests for p53 and Ki-67 were positive. His hospital stay was complicated by development of focal seizure and weakness involving the right upper extremity. Magnetic resonance imaging (MRI) of brain revealed multiple ring enhancing lesions consistent with brain metastasis. Positron emission tomography showed increased uptake in right upper lobe and right hilar lymph node but no evidence of metastasis elsewhere. He received 6 cycles of combination chemotherapy consisting of carboplatin, paclitaxel and bevacizumab;

whole brain radiation was given for his brain metastasis. Repeat CXR (Fig. 3) and CT scan (Fig. 4) after three months of initiation of chemotherapy showed re-expansion of the right L-NAME HCl upper lobe and replacement of the mass with large air filled cystic space that communicated with right main stem bronchus and bronchus intermedius. Repeat laboratory investigation revealed WBC of 14,500 cell/μl, serum creatinine of 0.9 mg/dL, serum potassium of 4.1 mEq/dL, serum calcium of 9.8 mg/dl, serum phosphate 4 mEq/dL, serum uric acid level of 5.4 mg/dl (normal range 3.5–7.2 mg/Dl) and serum LDH level of 187 IU/L (71–200 IU/L). This was consistent with complete lysis of the lung tumor without the metabolic derangements of tumor lysis syndrome. He was initially maintained on bevacizumab but later switched to erlotinib (EGFR inhibitor) due to hemoptysis. Most recent CT scan after 18 months of chemotherapy (Fig. 5) showed a further decrease in the size of the cystic lesion. Except for recurrent seizures he continues to do well after almost 30 months of his diagnosis with metastatic lung cancer.