胸膜间皮瘤相关小肠受累致回肠穿孔1例并文献复习OA

Pleural mesothelioma(PM)usually manifests as local intrathoracic invasion,and small intestinal in-volvement is rare.A 37-year-old man with initially diagnosed stage IV diffuse PM and no definite history of asbestos exposure or other specific occupational or environmental exposure except for long-term smoking was reported.After first-line treatment with Pemetrexed,Carboplatin and Bevacizumab,the disease remained stable.However,acute abdomen occurred during main-tenance therapy,and emergency surgery confirmed terminal ileal perforation.Postoperative pathology suggested PM-related ileal involvement/metastatic involvement,with a higher Ki-67 proliferation index than that of the primary lesion.Because only perforation repair rather than segmental bowel resection was performed,the available pathological material could not deter-mine whether full-thickness bowel-wall involvement was present or the direction of tumor invasion.Imaging findings,intra-operative findings and pathological results did not support primary peritoneal mesothelioma or direct contiguous invasion of the ileum by the diaphragmatic lesion;however,microscopic peritoneal dissemination with secondary bowel-wall involvement could not be completely excluded.The aim of this report,together with literature review,is to summarize the diagnostic chal-lenges,management strategies and clinical implications of PM-related small intestinal involvement.