Acute bilateral pulmonary emboli occurring while on adjuvant aromatase inhibitor therapy with anastrozole: case report and review of the literature

Abstract

Hormonal therapy is the mainstay of adjuvant treatment for women with early-stage estrogen receptor-positive breast cancer. Recently, the aromatase inhibitors have moved to the forefront of adjuvant hormonal therapy, however, the adverse effects of these agents are not yet fully understood. It is generally accepted that tamoxifen, but not the aromatase inhibitors, is associated with an increased risk of thrombosis in women with breast cancer. Studies comparing aromatase inhibitors to tamoxifen in the adjuvant setting have reported a lower rate of venous thromboembolism with the aromatase inhibitors, yet the incidence of venous thromboembolism with these new agents is higher than that expected in the general population. Here we report a case of acute bilateral pulmonary emboli occurring while on adjuvant aromatase inhibitor therapy with anastrozole, and review the literature on the incidence of venous thromboembolism during the use of aromatase inhibitors in the adjuvant setting.

Gastric Antral Vascular Ectasia (GAVE): An Update on Clinical Presentation, Pathophysiology and Treatment

“…This seems to be independent from the presence of cirrhosis as Quintero et al [18] only report on cirrhotic patients and Gostout et al [11] report on a mixed patient group with a predominance of autoimmune diseases. Quintero et al [18] found gastrin levels to be significantly raised in 8 of 11 patients with GAVE and cirrhosis when compared with control patients (0 of 13) and with cirrhosis patients without gastric mucosal changes (2 of 18).…”

“…In non-cirrhotic patients with GAVE autoimmune diseases are most common, with incidences of 62% for autoimmune connective tissue disorders, 31% for Raynaud’s phenomenon and 20% for sclerodactily [11]. Other conditions described in GAVE patients include scleroderma, bone marrow transplantation, chronic renal failure, ischaemic heart disease, hypertension, valvular heart disease, familial Mediterranean fever and acute myeloid leukaemia [11,12,13,14].…”

“…Other conditions described in GAVE patients include scleroderma, bone marrow transplantation, chronic renal failure, ischaemic heart disease, hypertension, valvular heart disease, familial Mediterranean fever and acute myeloid leukaemia [11,12,13,14]. …”

“…Whereas the majority of non-cirrhotic GAVE patients are females (71%), with a mean age of 73 years, cirrhotic GAVE patients tend to be younger (mean age 65 years) and male (75%) [11, 17]. This is most likely explained by the age and sex distribution of patients suffering from either connective tissue disorder or liver cirrhosis.…”

“…Some authors have linked GAVE with achlorhydria, raised levels of gastrin and low levels of pepsinogen [11, 18]. This seems to be independent from the presence of cirrhosis as Quintero et al [18] only report on cirrhotic patients and Gostout et al [11] report on a mixed patient group with a predominance of autoimmune diseases.…”