El Rhalete Abdelilah, Rhazi Inas, Bkiyer Houssam, Housni Brahim
Faculty of Medicine and Pharmacy, Mohammed VI.
Department of Anesthesia and Resuscitation, Hospital University Center Mohammed VI, Oujda, Morocco.
Ann Med Surg (Lond). 2023 Apr 7;85(5):1966-1970. doi: 10.1097/MS9.0000000000000516. eCollection 2023 May.
Lung cancer can be revealed by thromboembolic complications. Its association with pregnancy is becoming more frequent due to the increasing number of smoking women. The care of a pregnant woman with cancer is quite delicate because it requires finding a balance between the treatment of the mother and the potential foetal risk.
The authors report the case of a 38-year-old patient, with a twin pregnancy of 16 weeks, complicated by proximal and distal peripheral venous thrombosis of the left lower limb under low molecular weight heparin therapy at a curative dose. A week later, the patient presented to the emergency room with respiratory distress associated with chest pain and low-abundance metrorrhagia. The obstetrical ultrasound performed confirmed the vitality of only one of the two foetuses. The transthoracic ultrasound objectified a very abundant pericardial effusion producing a tamponade, which was drained percutaneously and whose cytological study revealed a liquid rich in tumour cells. After the unfortunate death of the second twin and an endouterine evacuation, a chest computed tomography angiogram demonstrated a bilateral proximal pulmonary embolism associated with bilateral moderate pulmonary effusion as well as multiple thrombosis and secondary aspect liver lesions with a suspicious parenchymal lymph node of the upper lung lobe. A liver biopsy concluded to a secondary hepatic localization of a moderately differentiated adenocarcinoma whose immunohistochemical complement revealed a pulmonary origin. A multidisciplinary consultation meeting leaned towards treatment with neoadjuvant chemotherapy. The patient died 7 months later.
Venous thromboembolic disease is more common in pregnant women. Delayed diagnosis is common in these cases, resulting in a high rate of locally advanced or metastatic disease. Since the treatment of pregnancy-associated cancer does not rely on a standardized approach, the decision on how to proceed must be made by a multidisciplinary team.
The cornerstone of management remains to find the balance between treating the mother as well as possible while preventing the foetus from the possible harm of cytotoxic drugs frequently used to treat lung cancer. Because of the delayed diagnosis, the maternal prognosis often remains poor.
肺癌可通过血栓栓塞并发症发现。由于吸烟女性数量增加，其与妊娠的关联愈发常见。癌症孕妇的护理相当棘手，因为需要在母亲的治疗与潜在胎儿风险之间找到平衡。
作者报告了一例38岁患者，怀有16周双胎妊娠，在接受治疗剂量的低分子量肝素治疗时并发左下肢近端和远端外周静脉血栓形成。一周后，患者因呼吸窘迫伴胸痛和少量子宫出血就诊于急诊室。产科超声检查证实仅两个胎儿中的一个存活。经胸超声检查发现大量心包积液导致心包填塞，经皮引流，其细胞学检查显示液体富含肿瘤细胞。在第二个胎儿不幸死亡并进行子宫排空后，胸部计算机断层血管造影显示双侧近端肺栓塞伴双侧中度胸腔积液以及多处血栓形成和肝脏继发性病变，上肺叶实质淋巴结可疑。肝脏活检诊断为中度分化腺癌的肝脏继发性定位，其免疫组化补充检查显示起源于肺部。多学科会诊倾向于新辅助化疗。患者7个月后死亡。
静脉血栓栓塞性疾病在孕妇中更为常见。这些病例中诊断延迟很常见，导致局部晚期或转移性疾病的发生率很高。由于妊娠相关癌症的治疗不依赖于标准化方法，如何进行治疗的决定必须由多学科团队做出。
管理的基石仍然是在尽可能治疗母亲的同时，防止胎儿受到常用于治疗肺癌的细胞毒性药物的可能伤害之间找到平衡。由于诊断延迟，母亲的预后往往仍然很差。
