Saint-Georges F, Mulliez P, Darras A, Smith M
Service de Pneumologie, Hôpital Saint-Philibert, 115, rue du Grand-But, 59462 Lomme Cedex.
Rev Pneumol Clin. 2004 Sep;60(4):229-33. doi: 10.1016/s0761-8417(04)72105-7.
Spontaneous pneumothorax is an uncommon inaugural presentation of malignant pleural mesothelioma. We report three cases in men aged 65, 30 and 76 years. The diagnosis was suggested at medical imaging and was confirmed at histological analysis of biopsies obtained by thoracoscopy in two patients and thoracotomy in one. The first patient (age 65 years) died two months after the initial diagnosis. The second patient (age 30 years) was alive 40 months after 15 chemotherapy cycles using a platinim-gemcitabine combination. Complete tumor response was achieved in the third patient (age 76 years) after 9 chemotherapy cycles with the same combination. Since mid-term prognosis is fatal for this type of tumor, we propose thoracoscopy in all patients over 30 years who develop spontaneous pneumothorax with no morphological features increasing the risk of pneumothorax, and particularly in patients with asbestos exposure.
自发性气胸是恶性胸膜间皮瘤一种不常见的首发表现。我们报告了3例分别为65岁、30岁和76岁男性的病例。医学影像检查提示了诊断，其中2例患者通过胸腔镜活检及1例患者通过开胸手术活检的组织学分析得以确诊。首例患者（65岁）在初次诊断后两个月死亡。第二例患者（30岁）在使用铂类-吉西他滨联合方案进行15个化疗周期后存活了40个月。第三例患者（76岁）在使用相同联合方案进行9个化疗周期后实现了肿瘤完全缓解。鉴于这类肿瘤的中期预后是致命性的，我们建议，对于所有30岁以上发生自发性气胸且无增加气胸风险形态学特征的患者，尤其是有石棉接触史的患者，均应进行胸腔镜检查。
