探讨妊娠合并恶性间皮瘤(MM)的临床特点。

选择2022年3月，成都市妇女儿童中心医院收治的1例妊娠合并MM患者为研究对象。回顾性分析患者临床病例资料，并结合2022年5月前国内外报道的妊娠合并MM患者临床资料进行分析，总结该类患者诊断、治疗、预后等临床特点。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》。患者对本病的诊断及治疗均知情同意。

①本例妊娠合并MM患者情况：女性，32岁，因"停经29⁺⁵周，不规律下腹痛2 d"入院，伴发热、肩部不适、贫血及血小板升高；因抗感染治疗效果差，行胸腹部增强CT检查提示右肺上叶巨大包块，经会诊考虑肿瘤及感染待排，转入四川大学华西医院；第2次胸部穿刺病理检查及免疫组织化学结果提示：间皮瘤(肉瘤样型)伴深浅淋巴结及颅内转移T4N3M1c ⅣB期(主要出院诊断)。给予抗血管生成及免疫治疗，于产后64 d，患者及家属签字自动出院。②文献复习结果：共计检索到5篇与妊娠合并MM患者相关文献，涉及5例患者(其中1例无法获取文献全文而不纳入分析)，结合本例患者，5例妊娠合并MM患者临床特点如下。平均年龄为31岁，其中3例为恶性腹膜间皮瘤、2例为恶性胸膜间皮瘤。恶性腹膜间皮瘤患者均有腹胀、腹痛，腹壁包块及大量腹水；恶性胸膜间皮瘤患者主要表现为肩背部不适，胸痛及血小板升高。从发现首发症状至明确诊断需3~7个月，最终均以病变组织活检病理学检查结果明确诊断。5例患者仅1例术中完整切除肿瘤，3例采取化疗，1例化疗联合免疫治疗。5例患者共分娩5例活产新生儿，其中3例为早产儿，新生儿及胎盘均无肿瘤转移。2例患者产后死亡，本例患者产后2⁺个月时，尚存活。

妊娠合并MM极其罕见，预后差。临床医师对腹痛、胸痛、胸腹腔积液者，应想到本病可能。尽早进行病变组织病理学检查以明确诊断，并采取手术联合化疗、免疫治疗等综合治疗措施。

To investigate the clinical characteristics of pregnancy complicated with malignant mesothelioma (MM).

A pregnant woman with MM admitted to Chengdu Women′s and Children′s Central Hospital in March 2022 was selected into this study. Her clinical data were analyzed retrospectively, and combined with clinical data of patients of pregnancy with MM reported at home and abroad before May 2022, their clinical characteristics such as diagnosis, treatment and prognosis of them were summarized. The procedure followed in this study was in accordance with the World Medical Association Declaration of Helsinki revised in 2013. The patient of pregnancy with MM had informed consent to the diagnosis and treatment of the disease.

① The pregnant woman with MM′s condition: a 32 years old female was admitted due to ＂menopause for 29^{+ 5} weeks, irregular lower abdominal pain for 2 days＂, accompanied by fever, shoulder discomfort, anemia and thrombocytosis; Due to the poor effect of anti-infection treatment, the chest and abdomen enhanced CT examination were taken and showed there was a huge mass in the upper lobe of right lung. After consultation, the tumor was considered and infection to be excluded and she was transferred to West China Hospital of Sichuan University. After the second chest needle aspiration biopsy, the pathological examination and immunohistochemistry showed that the diagnosis was mesothelioma (sarcomatoid type) with deep and superficial lymph nodes and intracranial metastasis, T4N3M1c ⅣB stage (main discharge diagnosis). Anti angiogenic and immunotherapy were given to the patient, she and her family members signed for automatic discharge 64 d after delivery. ② Literature review results: a total of 5 articles related to pregnancy with MM were retrieved, involving 5 patients (one of whom could not obtain the full text of the literature and was not included in the analysis below). Combined with this patient, the clinical characteristics of 5 pregnancy with MM patients were as follows. The average age was 31 years old, including 3 cases of malignant peritoneal mesothelioma and 2 cases of malignant pleural mesothelioma. All patients with malignant peritoneal mesothelioma had abdominal distension, abdominal pain, abdominal wall mass and a lot of ascites. Patients with malignant pleural mesothelioma mainly showed shoulder and back discomfort, chest pain and elevated platelet. It took 3 to 7 months from the discovery of the first symptom to the definite diagnosis, and the final diagnosis was made by pathological examination of pathological biopsy of the lesion. In 5 patients, only 1 patient underwent complete resection of tumor, 3 patients received chemotherapy, and 1 patient received chemotherapy plus immunotherapy. There were 5 live births in 5 patients, 3 of whom were premature infants, and neither the newborn nor the placenta had tumor metastasis. Two patients died after delivery, and the patient in our hospital was still alive 2⁺ months after delivery.

Pregnancy with MM is extremely rare, and the prognosis is poor. Clinicians should think of the possibility of this disease for patients with abdominal pain, chest pain, and pleural and abdominal effusion. Histopathological examination of the lesions should be carried out as early as possible to confirm the diagnosis, and comprehensive treatment measures such as surgery combined with chemotherapy and immunotherapy should be taken.