Acute, Unilateral Breast Toxicity From Gemcitabine in the Setting of Thoracic Inlet Obstruction
| Autor: | Jennifer L. Caswell, Thomas Lew, Arpeet T. Shah, Joel W. Neal, Kipp Weiskopf, David W Creighton, David Ouyang, Melinda L. Telli, Lawrence V. Hofmann |
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| Rok vydání: | 2016 |
| Předmět: |
Antimetabolites
Antineoplastic medicine.medical_specialty Lung Neoplasms Thoracic Vein Antecubital Fossa 030232 urology & nephrology Venography Case Report Mastitis Adenocarcinoma 03 medical and health sciences 0302 clinical medicine Forearm Antineoplastic Combined Chemotherapy Protocols medicine Humans Breast Infusions Intravenous medicine.diagnostic_test Oncology (nursing) business.industry Health Policy Organ Size Middle Aged medicine.disease Surgery Venous thrombosis medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Female Axillary vein Complication business Venous return curve |
| Zdroj: | Journal of Oncology Practice. 12:763-764 |
| ISSN: | 1935-469X 1554-7477 |
| DOI: | 10.1200/jop.2016.014241 |
| Popis: | CASE PRESENTATION A 63-year-old woman with metastatic lung adenocarcinoma presented with acute swellingandpainofher left breast.Oneyearbefore admission, she was diagnosed with a 6.0-cm tumor in the left upper lobe and had undergone radiation, chemotherapy, and resection of metastases to treat her disease. Most recently, she was switched to singleagent gemcitabine. She was also taking warfarin for a history of lower extremity deep venous thrombosis. The patient tolerated her first two infusions of gemcitabine without complication. However, 4 hours after the third infusion, she experienced acute onset of left breast swelling and pain, prompting her to present to the emergency department. She was found to have a diffusely enlarged, tender left breast without masses, induration, or fluctuance. Laboratory studies were only remarkable for a C-reactive protein (CRP) that was elevated to 6.6 mg/dL (normal,, 0.9 mg/dL). The patient was started on broad-spectrum antibiotics for a presumed soft tissue infection, but her condition progressed over the next 2 days. Her left breast became twice the size of her right breast, with erythema, warmth, and severe tenderness to light palpation (Fig 1A). Dilated veins were prominent on her left anterior chest. There were no abnormalities of the ipsilateral antecubital fossa or forearm. Her CRP had increased to 19.7 mg/dL, yet she remainedafebrile,with anormalwhiteblood cell count and serum lactate level. The patient had received the first two gemcitabine infusions in her right arm, whereas the most recent infusion was administered through a peripheral intravenous catheter in her left arm. Furthermore, a recent chest computed tomography scan demonstrated the tumor in her left upper lobe invaded into the first and second ribs, with compression of the left subclavian and brachiocephalic veins. It was therefore suspected that her breast toxicity was a result of the gemcitabine infusion.Antibioticswere discontinued, and the patient was treated with oral prednisone 40mg per day for 5 days. The patient’s CRP decreased to 5.6 mg/dL after 3 days of treatment, and her erythema and tenderness resolved. The patient underwent placement of a port in her right upper chest and received subsequent gemcitabine infusions through the port without complication. Breast swelling decreased by 50% over 1 month, and stenting was considered to improve central venous return. Left arm venography demonstrated complete occlusion of the left subclavian vein with reversed flow through paired lateral thoracic veins into the left breast (Fig 1B). Stenting was deferred given the diminutive size (3 mm) of the axillary vein. |
| Databáze: | OpenAIRE |
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