Conclusions

Spontaneous TLS should be considered in patients presenting with unexplained acute kidney injury and characteristic metabolic abnormalities, even in the absence of a previously established cancer diagnosis. Although uncommon, advanced ovarian carcinoma, diagnosed here through integrated clinical, radiographic, immunohistochemical, and serologic findings, may rarely present with spontaneous TLS before initiation of anticancer therapy.

In this patient, early recognition, prompt administration of urate-lowering therapy, aggressive supportive care, and coordinated multidisciplinary management were associated with reversal of life-threatening metabolic complications and allowed progression to definitive oncologic treatment. At approximately seven months after cytoreductive surgery (from October 2025 to May 2026), the patient remained in complete clinical and radiographic remission. While causality cannot be established from a single case, this favorable course suggests that early diagnosis and treatment may support both renal and oncologic recovery in this rare presentation.