High-Risk Pregnancy with Solid Pseudopapillary Tumor of the Pancreas Complicated by Obstetric Antiphospholipid Syndrome: A Case Report.

Background: Antiphospholipid syndrome(APS) is a common cause of recurrent miscarriage.This case report presents a rare case of a high-risk pregnancy complicated by the concurrent solid pseudopapillary neoplasm (SPN) and obstetric antiphospholipid syndrome (OAPS). Case: A 35-year-old patient was diagnosed with SPN at the age of 27, accompanied by extensive abdominal metastases, and underwent palliative metastatic tumor resection and chemotherapy, achieving stable disease. After a 24-month treatment-free interval, pregnancy was attempted. She had a history of five adverse pregnancy outcomes (one intrauterine fetal demise at 28 weeks, three instances of embryonic arrest, and one biochemical pregnancy). OAPS was diagnosed based on persistent positivity (≥12 weeks apart) for lupus anticoagulant, anti-β2 glycoprotein I antibody, and anti-cardiolipin antibody. Following a multidisciplinary evaluation, she was treated with a combination of tacrolimus, hydroxychloroquine, and prednisone to control antibody levels before planning for pregnancy. During the pregnancy, low molecular weight heparin combined with aspirin was administered, and ultimately, a healthy live baby was delivered via cesarean section at 36 weeks of gestation, with favorable maternal and neonatal outcomes. Currently, the patient remains disease-free with regular oncology follow-up and has preserved ovarian function. Conclusion: This case suggests that for patients with tumors and pathological pregnancies, screening for the presence of antiphospholipid syndrome should be emphasized. Although SPN poses risks such as tumor growth and hemorrhage during pregnancy, patients with long-term stable disease may attempt pregnancy under close monitoring. It is important to balance the risks of anticoagulation with those of tumor-related bleeding during pregnancy.