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

Our plain-English summary of Sarcomatoid malignant pleural mesothelioma: a case of long-term recurrence-free survival following curative intent surgery alone, by M. Kanayama, M. Takenaka, K. Yoshimatsu, et al (Surgical Case Reports, 2024).

The study

• Authors: M. Kanayama, M. Takenaka, K. Yoshimatsu, H. Matsumiya, M. Mori, K. Kuroda, A. Nawata, M. Yasuda, F. Tanaka
• Journal: Surgical Case Reports
• Published: 2024;10(1):134
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: 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.

Case Presentation: 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.

Conclusions: 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.

© 2024. The Author(s).

In plain English

This article is a case report about one patient. A 63-year-old man with a history of asbestos exposure was referred to the authors' hospital with shortness of breath and left-sided chest tightness. Scans showed thickening and nodules in the lining of the left lung, with fluid around it. A pleural biopsy was read as lymphohistiocytoid malignant pleural mesothelioma at stage IA, and the team operated. He underwent a left extrapleural pneumonectomy (removal of the lung and its lining), with removal and reconstruction of the pericardium and diaphragm. His recovery was uneventful and he left hospital 19 days after surgery. Examination of the removed tissue changed the diagnosis to sarcomatoid malignant pleural mesothelioma, stage IB. Surgery is generally not recommended for this subtype. Chemotherapy was planned, but he refused further treatment after he needed home oxygen. He remained recurrence-free 10 years after surgery. The authors concluded that this was a noteworthy instance of long-term recurrence-free survival after surgery alone for sarcomatoid mesothelioma, and that further research is needed. A single case does not show how often this happens.

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
• Who was studied: One 63-year-old man with dyspnea and left-sided chest tightness, referred to the authors' hospital (authors based in Japan); about 10 years of follow-up after surgery
• Exposure: A history of asbestos exposure; fiber type, job and dose are not described
• Main results:
  • The pleural biopsy was read as lymphohistiocytoid malignant pleural mesothelioma, clinical stage cT1N0M0, stage IA
  • The patient underwent left extrapleural pneumonectomy with resection and reconstruction of the pericardium and diaphragm. The operation lasted 8 h 30 min with 190 mL blood loss, the postoperative course was uneventful, and he was discharged on postoperative day 19
  • The final diagnosis from the surgical specimen was sarcomatoid malignant pleural mesothelioma, pT2N0M0, stage IB. The lymphohistiocytoid type seen at biopsy was barely detectable in the excised specimens
  • Planned postoperative chemotherapy was not given because the patient refused additional treatment after home oxygen therapy was introduced following surgery
  • The patient remained recurrence-free 10 years after surgery
• The authors' conclusion: The authors concluded that this case is a noteworthy instance of long-term recurrence-free survival achieved solely through curative intent surgery for sarcomatoid MPM, that it highlights the potential efficacy of surgery in this subtype, and that further research is warranted to define the role of surgery, possibly combined with other therapies

Topics

Medical terms in this study, explained in our Lexicon: Sarcomatoid, Pleural Mesothelioma, Recurrence-Free Survival, Dyspnea, Pleural Thickening, Pleural Biopsy, Lymphohistiocytoid, Stage IA.

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