Severe and fatal interstitial lung disease induced by gemcitabine in advanced pancreatic adenocarcinoma: a case report.

Gemcitabine is a cytotoxic drug commonly used in the treatment of several types of cancer. While gemcitabine is generally considered safe and effective, it can cause some side effects, including pulmonary toxicity. Interstitial lung disease is a rare but potentially serious event. We report a case of a 63-year-old patient with advanced pancreatic adenocarcinoma. She received Gemcitabine 1000 mg/m2 on day 1, and day 8, and presented on day 15 of the first cycle with respiratory distress rapidly aggravating. Clinical and radiological findings were concordant with interstitial lung disease. Management consisted of high doses of corticosteroids and oxygen therapy. There was no clinical improvement and the patient passed away after a few days. Despite its low incidence, gemcitabine-induced interstitial lung disease may be responsible for a fatal clinical picture. Clinicians must be aware of this possibility and address respiratory symptoms as soon as possible.

A giant metastatic low-grade endometrial sarcoma requiring surgical management.

INTRODUCTION AND IMPORTANCE: Low-grade endometrial stromal sarcomas are relatively rare tumors. We here report a case of a woman presenting with a giant metastatic low-grade endometrial stromal sarcoma with thromboembolic complications requiring urgent surgical management. CASE PRESENTATION: A 58-year-old obese female was admitted, with a voluminous abdominopelvic mass, due to complications related to its size and extent. The tumor derived from the uterus and invaded the ureters, bladder and rectum. It compressed the right iliac vessels causing both deep vein thrombosis and pulmonary embolism. She developed a painful irreducible umbilical. We proceeded with a debulking surgery (hysterectomy with bilateral salpingo-oophorectomy). Histological findings were consistent with a low-grade endometrial stromal sarcoma. CLINICAL DISCUSSION: Low-grade endometrial stromal sarcomas are generally low-grade malignant neoplasms with an indolent clinical course. Surgery is the cornerstone of treatment. In low-income countries, malignancies are more often diagnosed at a late stage, which limits therapeutic options. Cytoreduction is recommended in advanced tumors with extrauterine manifestation, depending on symptoms and with palliative intent. CONCLUSION: Low-grade endometrial stromal sarcomas are indolent uterine malignancies with metastatic potential. Even in advanced cases, cytoreduction must be considered.