Sarcomatoid malignant pleural mesothelioma: a case of long-term recurrence-free survival following curative intent surgery alone

TL;DR

A patient with aggressive sarcomatoid mesothelioma survived 10 years without recurrence after surgery alone, challenging standard treatment approaches.

Contribution

Reports a rare long-term recurrence-free survival in sarcomatoid MPM treated with surgery alone.

Findings

A patient with sarcomatoid MPM remained recurrence-free for 10 years after curative surgery.

Surgical intervention may offer improved outcomes for some sarcomatoid MPM cases.

The case challenges the conventional view that surgery alone is ineffective for this aggressive subtype.

Abstract

Curative intent surgery may be indicated for some patients with resectable early stage malignant pleural mesothelioma (MPM). However, sarcomatoid MPM is a highly aggressive subtype for which curative intent surgery is generally not recommended.

We present the case of a 63-year-old man who presented with dyspnea and chest tightness. Computed tomography revealed pleural thickening and nodular lesions. A pleural biopsy confirmed lymphohistiocytoid MPM (cT1N0M0, stage IA), prompting surgical intervention. The patient underwent left extrapleural pneumonectomy (EPP), and the final diagnosis was sarcomatoid MPM (pT2N0M0, stage IB). Although post-operative chemotherapy was planned, the patient refused additional treatment, because of the introduction of home oxygen therapy, and has remained recurrence-free for 10 years after the surgery.

This case presents a noteworthy instance of achieving long-term recurrence-free survival solely through curative intent surgery for sarcomatoid MPM. It highlights the potential efficacy of surgical intervention in managing this aggressive subtype, offering a glimmer of hope for improved outcomes. Further research is warranted to better define the role of surgery in the treatment of sarcomatoid MPM.

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