Hata Akito, Harada Yuka, Seo Ryutaro, Takeshim Yoshimi, Nishimura Takashi, Tomii Keisuke, Katakami Nobuyuki, Ishihara Kyosuke, Imai Yukihiro, Fujita Shiro
Department of Respiratory Medicine, Kobe City Medical Center (General Hospital).
Nihon Kokyuki Gakkai Zasshi. 2009 Jul;47(7):585-90.
A 34-year-old pregnant woman was diagnosed with pneumonia at another hospital in her 26th week of pregnancy. Antibiotics were administered, but they were not effective. She was then introduced and admitted to our hospital. Lung cancer was suspected from her chest-CT scan on admission. Caesarian section was performed on the day after admission at 33 weeks of gestation. Adenocarcinoma of the lung was diagnosed based on the results of a right-axillary lymph node biopsy performed simultaneously with the caesarian section. On the 8th day after admission, we began to administer gefitinib. We expected positive results from gefitinib, because the patient fitted the optimal profile: female, never smoker, adenocarcinoma histology. Her respiratory condition had worsened dramatically after her caesarian section, so she was given noninvasive positive pressure ventilation from the 13th day after admission. Disseminated intravascular coagulation progressed, and her chest X-ray showed bilateral extensive infiltration. Moreover, tests showed that her tumor was negative for epidermal growth factor recepter mutation, so we judged that gefitinib was not effective for her. Although her performance status was very poor, she and her family strongly desired further chemotherapy. We thus began to administer gemcitabine, but her respiratory condition deteriorated further, and she died on the 17th day after admission. Lung cancer combined with pregnancy is a very rare situation, so we report this case with some references.
一名34岁的孕妇在怀孕26周时于另一家医院被诊断为肺炎。使用了抗生素，但未见效。随后她被转诊并入住我院。入院时胸部CT扫描怀疑为肺癌。入院次日在孕33周时进行了剖宫产。根据剖宫产同时进行的右腋窝淋巴结活检结果诊断为肺腺癌。入院第8天，我们开始给予吉非替尼治疗。我们期望吉非替尼能取得阳性效果，因为该患者符合最佳适用特征：女性、从不吸烟、腺癌组织学类型。她剖宫产术后呼吸状况急剧恶化，因此自入院第13天起给予无创正压通气。弥散性血管内凝血进展，胸部X线显示双侧广泛浸润。此外，检测显示她的肿瘤表皮生长因子受体突变阴性，所以我们判断吉非替尼对她无效。尽管她的身体状况很差，但她和家人强烈希望进行进一步化疗。于是我们开始给予吉西他滨治疗，但她的呼吸状况进一步恶化，于入院第17天死亡。肺癌合并妊娠是一种非常罕见的情况，因此我们报告此病例并附上一些参考文献。
