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胸膜间皮瘤转移至腹膜和胆囊，表现为复发性急性胆囊炎。

Metastatic spread of pleural mesothelioma to the peritoneum and gallbladder presenting as recurrent acute cholecystitis.

作者信息

Fouad Mina, Zaitoun Abed M, Lobo Dileep N

机构信息

Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, Nottinghamshire, United Kingdom.

NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH, Nottinghamshire, United Kingdom.

出版信息

Oxf Med Case Reports. 2025 Jun 27;2025(6):omaf082. doi: 10.1093/omcr/omaf082. eCollection 2025 Jun.

DOI:10.1093/omcr/omaf082
PMID:40585446
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12202293/
Abstract

Malignant pleural mesothelioma, a rare, aggressive cancer primarily associated with asbestos exposure, is characterised by poor prognosis and limited treatment options. Distant metastases are uncommon, and peritoneal involvement is rare, while metastasis to the gallbladder is extremely unusual. We report the case of a patient with malignant pleural mesothelioma undergoing immunotherapy with nivolumab and ipilimumab, who developed recurrent acute cholecystitis. Imaging revealed features of acute cholecystitis with gallstones. She eventually underwent a laparoscopic cholecystectomy because immunotherapy could not be continued in the presence of infection. Histopathological and immunohistochemical analysis confirmed metastatic epithelioid mesothelioma. The gallbladder metastasis was likely haematogenous or from peritoneal seeding, rather than direct spread. This case underscores the importance of a high index of suspicion when evaluating atypical presentations of mesothelioma, particularly in the context of immunotherapy.

摘要

恶性胸膜间皮瘤是一种罕见的侵袭性癌症，主要与接触石棉有关，其特点是预后差且治疗选择有限。远处转移不常见，腹膜受累罕见，而转移至胆囊极为罕见。我们报告一例接受纳武单抗和伊匹单抗免疫治疗的恶性胸膜间皮瘤患者，该患者出现复发性急性胆囊炎。影像学检查显示有胆结石伴急性胆囊炎的特征。由于感染存在无法继续免疫治疗，她最终接受了腹腔镜胆囊切除术。组织病理学和免疫组织化学分析证实为转移性上皮样间皮瘤。胆囊转移可能是血行转移或腹膜播散，而非直接蔓延。该病例强调了在评估间皮瘤的非典型表现时保持高度怀疑的重要性，尤其是在免疫治疗背景下。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8291/12202293/bc62414f78ae/omaf082f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8291/12202293/c3f6351d9705/omaf082f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8291/12202293/82c3af3fb75d/omaf082f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8291/12202293/bc62414f78ae/omaf082f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8291/12202293/c3f6351d9705/omaf082f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8291/12202293/82c3af3fb75d/omaf082f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8291/12202293/bc62414f78ae/omaf082f3.jpg

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本文引用的文献

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JTO Clin Res Rep. 2023 Aug 2;4(9):100557. doi: 10.1016/j.jtocrr.2023.100557. eCollection 2023 Sep.
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Considerations for Imaging of Malignant Pleural Mesothelioma: A Consensus Statement from the International Mesothelioma Interest Group.恶性胸膜间皮瘤影像学检查的考量：国际间皮瘤利益集团的共识声明
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Tongue: the unusual site in malignant pleural mesothelioma.舌部：恶性胸膜间皮瘤的罕见部位。
BMJ Case Rep. 2021 Apr 12;14(4):e241166. doi: 10.1136/bcr-2020-241166.
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Acute Cholecystitis Following Ipilimumab and Nivolumab Treatment for Metastatic Melanoma.伊匹单抗和纳武单抗治疗转移性黑色素瘤后发生的急性胆囊炎
Am Surg. 2023 Feb;89(2):312-313. doi: 10.1177/0003134820966274. Epub 2020 Oct 20.
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Radiologic Considerations and Standardization of Malignant Pleural Mesothelioma Imaging Within Clinical Trials: Consensus Statement from the NCI Thoracic Malignancy Steering Committee - International Association for the Study of Lung Cancer - Mesothelioma Applied Research Foundation Clinical Trials Planning Meeting.临床试验中恶性胸膜间皮瘤影像学的放射学考虑和标准化：NCI 胸部恶性肿瘤指导委员会-国际肺癌研究协会-间皮瘤应用研究基金会临床试验计划会议的共识声明。
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CA Cancer J Clin. 2019 Sep;69(5):402-429. doi: 10.3322/caac.21572. Epub 2019 Jul 8.
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