Salvage resection after immunotherapy for giant undifferentiated pleomorphic sarcoma of the chest wall

Our plain-English summary of Salvage resection after immunotherapy for giant undifferentiated pleomorphic sarcoma of the chest wall, by A. Nakamura, A. Kuroda, M. Hashimoto, et al (Journal of Surgical Case Reports, 2025).

The study

• Authors: A. Nakamura, A. Kuroda, M. Hashimoto, N. Kondo, T. Yamasaki, K. Kuribayashi, T. Kijima, S. Hasegawa, S. Funaki
• Journal: Journal of Surgical Case Reports
• Published: 2025;2025(10):rjaf747
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We present a rare case of primary undifferentiated pleomorphic sarcoma (UPS) of the chest wall in a 45-year-old male, initially diagnosed as sarcomatoid pleural mesothelioma via computed tomography (CT)-guided biopsy. CT revealed a large tumor measuring 13 × 12 cm occupying the left thoracic cavity, with extensive invasion into the left first through fifth ribs and the adjacent lung parenchyma. The patient was referred to our hospital and treated with a combination of nivolumab and ipilimumab, resulting in marked tumor regression. Upon reevaluation, the diagnosis was revised to sarcoma, and the patient subsequently underwent salvage surgery, including resection of the left upper lung lobe and first through fifth ribs. Histopathology confirmed tumor mutational burden-high UPS. The patient has remained disease-free for two and a half years postoperatively. This case demonstrates the potential efficacy of immune checkpoint inhibitors in multimodal treatment for select cases of chest wall UPS.

© The Author(s) 2025. Published by Oxford University Press and JSCR Publishing Ltd.

In plain English

This case report describes a 45-year-old man in Japan with a 13 × 12 cm tumor in the left chest that had invaded his first through fifth ribs and left lung. A CT-guided needle biopsy was first read as sarcomatoid pleural mesothelioma, and he was treated with the immunotherapy drugs nivolumab plus ipilimumab. A re-examination of the biopsy ruled out pleural mesothelioma, and the diagnosis was changed to sarcoma. After four treatment cycles the tumor shrank from 139 × 122 mm to 97 × 76 mm, although it regrew during the 4-week wait before surgery. Surgeons removed the first through fifth ribs and the upper lobe of the left lung, and the surgical margins were free of tumor. Final testing diagnosed undifferentiated pleomorphic sarcoma (UPS) with a high tumor mutational burden. The patient remained disease-free two and a half years after surgery without further chemotherapy. The authors concluded that the case suggests immunotherapy may be effective for this rare cancer, but they stated that a definitive causal link cannot be established. The article does not mention asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 45-year-old man with left anterior chest pain, treated at Hyogo Medical University, Japan; dates of treatment not given
• Exposure: No asbestos or other occupational exposure is reported. The treatment described was four cycles of nivolumab plus ipilimumab followed by salvage surgery.
• Main results:
  • Re-evaluation of the biopsy initially read as sarcomatoid pleural mesothelioma found BAP1 retained, MTAP status inconclusive and no CDKN2A/CEP9 probe deletion, ruling out pleural mesothelioma; the final biopsy diagnosis was sarcoma
  • After four cycles of nivolumab plus ipilimumab, the tumor decreased from 139 × 122 mm to 97 × 76 mm
  • The tumor regrew during the 4-week interval between the last immunotherapy dose and surgery
  • Surgery removed the first through fifth ribs and the left upper lobe; operation time was 252 minutes and blood loss 490 ml; the patient was discharged on postoperative day seven
  • Surgical margins were histologically negative (R0 resection); parts of the tumor showed fibrosis and hyalinization without viable tumor cells; Ki-67 labeling index was 70%
  • Mesothelioma and lung cancer markers were negative and the final diagnosis was UPS; genomic profiling showed a tumor mutational burden-high result with no targetable genetic alterations
  • The patient remained disease-free for two and a half years after surgery without adjuvant chemotherapy
• The authors' conclusion: The authors concluded that, consistent with recent reports, this case suggests the potential efficacy of immunotherapy for this rare cancer, and that further investigation is needed to clarify efficacy and identify predictive biomarkers
• Limitations the authors state:
  • The authors state that the tissue changes seen may reflect immune-mediated tumor regression, but a definitive causal relationship with the treatment cannot be established
  • The authors note that clinical evidence is limited and treatment responses are heterogeneous
  • PD-L1 expression was not assessed

Topics

Medical terms in this study, explained in our Lexicon: Immunotherapy, Pleomorphic, Sarcoma, Sarcomatoid, Pleural Mesothelioma, Biopsy, Parenchyma, Nivolumab (Opdivo).

Related studies

• En bloc resection of the recurrent pleural mesothelioma and reconstruction of the chest wall after immunotherapy: A case report — C. Qin, Q. Xia, et al. (2023)
• Mediastinal undifferentiated pleomorphic sarcoma with pleural effusion cytopathologically misdiagnosed as epithelial malignant pleural mesothelioma: An autopsy case report — K. Matsumoto, Y. Nakamura, et al. (2021)
• Pericardial effusion secondary to epicardial undifferentiated pleomorphic sarcoma in a young cat — M.D. Stone, R.K. Davies, et al. (2023)
• Incidence and Risk Factors of Chest Wall Metastasis at Biopsy Sites in Patients with Malignant Pleural Mesothelioma — M. Hashimoto, M. Yuki, et al. (2022)
• Malignant mesothelioma presenting as a giant chest, abdominal and pelvic wall mass — Z.H. Shao, X.L. Gao, et al. (2011)
• Massive chest wall resection and reconstruction for malignant disease — C.N. Foroulis, A.D. Kleontas, et al. (2016)

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