Gemcitabine-induced acute coronary syndrome: a case report

To report a case of metastatic leiomyosarcoma, in which a patient developed chest pain accompanied by acute left bundle-branch block [LBBB] after gemcitabine infusion. Clinical Presentation and Intervention: A 59-year-old woman admitted with bilateral pulmonary nodules had classic risk factors for coronary heart disease and coronary stenosis as demonstrated by previous coronary angiography. She was treated with gemcitabine infusion, and 30 min later she experienced severe chest pain accompanied by acute LBBB confirmed by ECG. We suspected gemcitabine-induced coronary vasospasm exacerbated by the preexisting coronary artery disease as the cause of the acute coronary syndrome. The patient was subsequently treated with antianginal therapy and percutaneous coronary intervention. Her chest pain resolved and LBBB disappeared. She was discharged 2 days later without any further cardiac events. No additional cancer therapy was given and she died 5 months later, due to disease progression. This case showed that chemotherapeutic agents must be administered with intensive cardiac monitoring especially in patients with cardiac disease and well-known risk factors to prevent the development of cardiac complications, despite an agent not being known to be 'cardiotoxic'

Polymyositis and hepatitis concurrent with breast cancer

To present a rare case of breast cancer associated with both inflammatory muscle disease and liver disease as a paraneoplastic syndrome. Clinical Presentation and Intervention: A woman with breast cancer presented with elevated liver enzymes and progressive proximal muscle weakness. Liver biopsy was consistent with hepatitis and muscle biopsy revealed myositis. The start of corticosteroid therapy was followed by relief of the myopathic symptoms and regression of hepatitis histopathologically. A case of polymyositis and hepatitis associated with breast cancer and their flare-up with recurrence of malignancy is presented. In this case, the temporal relation with malignancy following its concurrent remission and relapse suggests a paraneoplastic mechanism

Primary mediastinal yolk sac tumor in a 66-year-old woman

To report a rare case of nonseminomatous extragonadal germ cell tumor in a 66-year-old female with primary yolk sac tumor of the mediastinum. Clinical Presentation and Intervention: A 66-year-old female was admitted to our hospital with a history of chest pain for 1 month. Computerized tomography of the thorax showed a left paracardiac mass adjacent to the aortic arch, left main pulmonary artery and pericardium. Total surgical excision could not be performed, but several biopsies which were taken through a thoracotomy revealed yolk sac tumor of the mediastinum. Systemic chemotherapy was started, but no response was observed and the patient died after one course of chemotherapy. Nonteratomatous mediastinal germ cell tumors are virtually nonexistent in women. To our knowledge, this is the oldest female patient with a primary mediastinal germ cell tumor. Chemotherapy was not effective especially in an old patient. We suggest surgery should be considered as primary treatment modality if diagnosis is made at an early stage