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.