Sarcomatoid Mesothelioma

Quick Summary

Sarcomatoid mesothelioma is the least common cell type of mesothelioma and known for its abnormal spindle shape. It can occur in the linings of the lungs, abdomen, and heart. Chemotherapy and radiation are the most common treatment options.

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Understanding Sarcomatoid Cell Type

Sarcomatoid mesothelioma accounts for about 10-15% of all mesothelioma cases. Few veterans are diagnosed with this cell type. Sarcomatoid mesothelioma has a poor prognosis because it is often diagnosed in later stages. Patients diagnosed early have a wider array of treatment options, including surgery.

Pathology of Sarcomatoid Mesothelioma

In sarcomatoid mesothelioma, the cancerous mesothelial cells are random and irregular in shape. They are large, elongated, and spindle-shaped. This is where the nickname “spindled mesothelioma” comes from. Sarcomatoid cells may make up part of or the entirety of mesothelioma tumors. Some patients have a mix of sarcomatoid and epithelioid cells. This is called biphasic mesothelioma.

A subtype of sarcomatoid mesothelioma is desmoplastic mesothelioma. It often resembles normal cell types under the microscope. This can make it difficult to diagnose, especially when no other cancerous cell types are nearby.

Pathologists may use immunohistochemistry to identify the difference between normal tissue and sarcomatoid mesothelioma. Immunohistochemistry uses special stains on the microscope slide. The immunohistochemical stains stick to antibodies and proteins found on sarcomatoid mesothelioma cells. This makes it easier to see under the microscope if the cells are sarcomatoid mesothelioma.

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Signs and Symptoms of Sarcomatoid Mesothelioma

A history of asbestos exposure and certain symptoms can hint if a diagnosis indicates sarcomatoid tumors.

Common sarcomatoid symptoms include:

  • Shortness of breath from fluid in the lungs or abdomen
  • Excess fluid in the abdomen or chest wall, which can contain cancer cells
  • Unexplained weight loss or fevers
  • Chest pain or abdominal pain

Many conditions share these symptoms. So doctors and pathologists have to dig further to make a concrete diagnosis.

Diagnosing Sarcomatoid Mesothelioma

After the doctor becomes suspicious of cancer, he or she will order imaging tests. They can take X-rays to look for thickening of the pleura, enlarged lymph nodes, and fluid around the lung (pleural effusion), abdomen, or heart. They may also order a CT scan, MRI, or PET scan.

A PET scan can be particularly useful to find sarcomatoid cells. These cells divide rapidly. And they have a higher rate of metabolism than normal tissue. PET scans can highlight areas with sarcomatoid cells.  and fibrous tumors.

Biopsies of sarcomatoid mesothelioma help tell the disease apart from other types of cancer. Sarcoma-like cancers look very similar. Sometimes a core biopsy may not look much different than scar tissue under the microscope. Special testing may be needed to reach a conclusive diagnosis.

An accurate diagnosis is important to ensure the right kind of mesothelioma treatment.

Treatment of Sarcomatoid Mesothelioma

The treatment of all types of mesothelioma depends on the cancer stage and cell type. The mainstays of therapy for sarcomatoid mesothelioma are chemotherapy and radiation.

Surgery may not be an option if the cells have spread at the time of discovery. Surgery at this stage often does more harm than good, but palliative surgery can make you more comfortable, especially if your cancer is in stage 3 or 4.

If you are eligible for surgery, you may undergo pleurectomy with decortication or extrapleural pneumonectomy if you have pleural sarcomatoid mesothelioma. If your cancer is affecting your peritoneum (lining of the abdomen), you may qualify to undergo cytoreductive surgery with HIPEC.

Because surgery is often unhelpful in sarcomatoid mesothelioma, chemotherapy is the next best option.

Some chemotherapy regimens combine different chemotherapy drugs. The most common combination is Alimta and cisplatin. Patients who don’t respond to these drugs might receive doxorubicin or gemcitabine.

Some regimens are more complex. You might receive a combination of Adriamycin, dacarbazine, vincristine, and cyclophosphamide. Your mesothelioma specialist will choose drugs based on your medical history, health, and diagnosis.

Radiation is reserved for areas of cancer that are clustered in one spot. Radiation therapy can reduce symptoms but cannot cure the disease.

Prognosis of Sarcomatoid Mesothelioma

Many cases of sarcomatoid mesothelioma are resistant to treatment. This is part of the reason for the survival statistics of this disease. The average sarcomatoid mesothelioma survival rate is around six months from the time of diagnosis.

Did you know?

Many doctors now prescribe a combination of chemotherapy and a drug called Avastin (bevacizumab). This is often a prescription for patients with inoperable mesothelioma.

Avastin restricts blood flow in tumors. When blood flow is restricted, tumors can’t grow. The goal of chemotherapy is to kill the stunted tumors. This treatment has added precious time to the median survival of many patients.

If it’s an option for you, surgery is the best chance for improving your prognosis. Whether surgery is possible often depends on your cell type, disease stage, and mesothelioma type (malignant pleural mesothelioma, peritoneal mesothelioma, etc.).

Doctors often use a special system to determine how advanced your disease is. They look at the organs that your mesothelioma has traveled to. They also consider lymph node involvement, and they look at the tumors themselves.

If there are few signs of cancer spread to organs and lymph nodes, you’ll have an earlier stage. However, sarcomatoid cells spread quickly, so a decision to operate must also be quick.

When deciding if surgery is a good idea, “doctors often use a simpler system based on whether the cancer is likely to be resectable (where all visible tumor can be removed by surgery) or unresectable,” says the American Cancer Organization.

Finding the Right Treatment

There are several options for veterans who have sarcomatoid mesothelioma. Surgery is possible for some who are diagnosed early enough. If surgery isn’t possible, chemotherapy, radiation, and clinical trials are your best choices.

Important aspects of sarcomatoid mesothelioma:

  • Sarcomatoid mesothelioma spreads faster than other cell types.
  • It’s imperative to get treatment quickly.
  • No matter your cell type, you can improve your prognosis.

There are clinical trials across the country testing surgical and non-surgical treatments of mesothelioma. Most trials use both traditional chemotherapy along with new medicine. While clinical trials have risks, patients in these trials improve their chances of living longer.

Learn more about treating sarcomatoid cell mesothelioma in our free Mesothelioma Veterans Packet today.

Veterans Support Team
Todd Gersten, MD PhotoReviewed by:Todd Gersten, MD

Double Board-Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Todd Gersten, MD is a double board-certified medical oncologist and hematologist specializing in general adult oncology and hematologic disease. He is a physician partner with the Florida Cancer Specialists and practices in Wellington, Florida.

Dr. Todd Gersten is an independently paid medical reviewer.

Christopher Dryfoos PhotoWritten by:

Contributing Author

Christopher Dryfoos is a journalist and member of the American Medical Writers Association (AMWA). As the grandson of the U.S. Navy’s first forensic pathologist, he aims to help veterans with mesothelioma access needed care.

View Sources

American Cancer Society. “Early Detection, Diagnosis, and Staging.” Retrieved from: Accessed on August 21st, 2017.

“Bevacizumab for newly diagnosed Pleural Mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial.” Retrieved from: Accessed on August 21st, 2016.

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