[A Case of Recurrent Breast Cancer with Drug-Induced Interstitial Pneumonia Triggered by the Switch from an Original to a Generic Aromatase Inhibitor].

We report the case of a 72-year-old woman who had undergone mastectomy for left breast cancer 9 years ago and had received anastrozole for 6 years after the operation. A year ago, she experienced a breast cancer recurrence in the thoracic wall and lymph nodes and was re-administered anastrozole, leading to a shrinking of the recurrent tumor. After the change from anastrozole to a generic product 2 months ago, she experienced respiratory distress. A CT scan showed bilateral reticular and ground-glass shadows in the lung fields, leading to the diagnosis of interstitial pneumonia, which was treated with steroids. When the generic product was restarted after the symptom had resolved, a recurrence of the lung lesions was observed. Therefore, VATS was performed and a histopathological diagnosis of interstitial pneumonia was posed. We then switched to letrozole, but because of the reappearance of the same lung lesions, the drug was discontinued, and the course was observed. Six months after, the re-expansion of breast cancer metastases was observed. When exemestane was initiated, the lung lesions recurred. The patient's condition improved on a steroid pulse and artificial respiration; however, she died of aspiration pneumonia. We report a case of recurrent breast cancer with drug-induced interstitial pneumonia triggered by the switch from an original to a generic aromatase inhibitor.

A Case of Immediate Anastomotic Leakage After Low Anterior Resection for Rectal Cancer.

A man in his seventies was referred to our hospital for radical therapy for advanced rectal cancer with multiple liver metastases. A colonic stent had already been placed in his rectum at the previous hospital because of malignant colorectal obstruction, so our therapeutic strategy was to perform systematic chemotherapy after resection of the primary tumor. Laparoscopic low anterior resection with a covering stoma was performed under general anesthesia. At about one hour after the surgery, the patient had sudden abdominal pain with watery diarrhea, and a similar discharge from his drainage tube. We suspected peritonitis caused by bowel perforation and emergency surgery was performed. The operative findings showed that his peritonitis was caused by anastomotic leakage from the rectum. Radical lavage of the abdominal space and reconstruction of colostomy was performed. The patient gradually recovered and we were able to start systematic chemotherapy at one month after the surgery. Anastomotic leakage immediately after anterior resection caused by watery diarrhea is rare, and it may be concerned with several issues. The covering stoma is intended to stop anastomotic leakage but it cannot prevent all cases of leakage especially when obstruction is present. We recommend that preventive measures be taken against anastomotic leakage, including intraoperative leakage tests or anal decompression tube placement.