# 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.

## Key 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.