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Sarcomatoid Mesothelioma

Sarcomatoid mesothelioma is the least common and most aggressive mesothelioma cell type. The spindle-like sarcomatoid cells don’t stick together and are more likely to spread through the body. However, doctors hope new treatment options will prove more effective against sarcomatoid mesothelioma.

Medically Reviewed and Fact-Checked by: Dr. Mark Levin

Updated by: Laura Wright on

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What Is Sarcomatoid Mesothelioma?

Sarcomatoid mesothelioma describes a type of malignant mesothelioma tumor that is made up of sarcomatoid cells. According to the American Cancer Society (ACS) and the medical organization Pathology Outlines, between 10% and 20% of mesothelioma cases are sarcomatoid.

Microscopic view of sarcomatoid mesothelioma cells
Illustration of sarcomatoid mesothelioma cells under a microscope

Like the other mesothelioma cell types (epithelioid and biphasic), the only known cause of sarcomatoid mesothelioma is asbestos exposure.

Sarcomatoid cells are shaped like spindles, similar to long cylinders. Instead of growing in place, sarcomatoid cells tend to move around the body easily and quickly. This means cancer metastasis is common.

Metastasis is the spread of cancer to distant parts of the body. Once the spread occurs, mesothelioma cancer becomes harder to treat.

Thankfully, the Mesothelioma Hope team can help you after a sarcomatoid mesothelioma diagnosis. Our Patient Advocates have relationships with top doctors treating mesothelioma, and we can also help secure financial aid on your behalf if you qualify.

Learn more in our Free Mesothelioma Guide, shipped overnight to you.

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Sarcomatoid Mesothelioma Symptoms

There are several different symptoms of sarcomatoid mesothelioma. These mesothelioma symptoms usually take between 10 and 50 years to develop.

Early major symptoms that patients may experience include:

  • Chest pain
  • Coughing
  • Shortness of breath

Other, more specific symptoms may develop over time.

Later-stage sarcomatoid mesothelioma symptoms may include:

  • Blood in feces or vomit
  • Bloody sputum (saliva/mucus mixture)
  • Coughing up blood
  • Decreased appetite
  • Fatigue
  • Nausea
  • Pain in the shoulders
  • Rib pain
  • Severe coughing
  • Vomiting
  • Weakness
  • Weight loss
  • Vomiting blood
  • Upper back pain

A patient may develop different symptoms depending on where the sarcomatoid tumors form in the body.

If the patient is diagnosed with sarcomatoid pleural mesothelioma (which forms in the lining of the lung, called the pleura), they may develop symptoms like shortness of breath.

Patients with sarcomatoid peritoneal mesothelioma (which forms in the abdominal lining, called the peritoneum) can suffer from nausea or loss of appetite.

Sadly, symptoms usually don’t start to appear until the cancer has already spread through your body.

Sarcomatoid Mesothelioma Diagnosis

To make a diagnosis of sarcomatoid mesothelioma, doctors use a couple of different tests. Most patients begin the mesothelioma diagnosis process when they go to the doctor for shortness of breath or chest pain.

From there, doctors can order tests to determine if mesothelioma or another condition is causing the patient’s symptoms.

Sarcomatoid mesothelioma diagnostic tests may include:

  • Blood tests to look for biomarkers (substances that mesothelioma cells give off)
  • Chest X-rays
  • Computed tomography scans (CT scans)
  • Echocardiograms
  • Magnetic resonance imaging (MRI) scans
  • Positron emission tomography (PET) scans

If mesothelioma is still suspected after these tests, doctors will order a biopsy. Through this test, doctors remove a sample of tissue or fluid and analyze it under a microscope to see what mesothelioma cells (if any) are present.

A biopsy is the only test that can confirm if a patient has sarcomatoid mesothelioma, as it allows doctors to look at the cancer on a cellular level.

Speak to a Mesothelioma Hope Patient Advocate if you’re worried that you have sarcomatoid mesothelioma. We can help you find top medical care and get properly diagnosed.

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Sarcomatoid Mesothelioma Misdiagnosis

Sarcomatoid mesothelioma can be misdiagnosed because this cancer shares symptoms with many other more common health problems. Further, sarcomatoid cells may be mistaken for cells of other cancers under a microscope, making a diagnosis challenging.

Common sarcomatoid mesothelioma misdiagnoses include:

  • Fibrous pleurisy
  • Fibrous tumors
  • Fibrosarcoma
  • Metastasized renal sarcoma (kidney cancer)
  • Non-Hodgkin’s lymphoma
  • Pleural liposarcoma (cancer of fat cells)
  • Sarcomatoid carcinoma
  • Soft tissue sarcomas

A mesothelioma misdiagnosis is very dangerous because it prevents patients from getting the right treatments to extend their lives. However, patients can ensure they’re correctly diagnosed by getting a second opinion from another doctor.

Subtypes of Sarcomatoid Mesothelioma

Some patients may be diagnosed with a subtype of sarcomatoid mesothelioma. Doctors can determine the cell subtype when reviewing biopsy samples under a microscope.

Learn more about rare subtypes of sarcomatoid mesothelioma below.

Transitional Mesothelioma

This type is very rare, accounting for less than 1% of patients with sarcomatoid mesothelioma. The cells still have somewhat of a spindle shape, but they are plumper and rounder. Because of this, they can be misdiagnosed as epithelial mesothelioma cells in some cases.

Desmoplastic Mesothelioma

Desmoplastic sarcomatoid mesothelioma makes up 10% of cases. A report from the Annals of Thoracic Surgery notes that this subtype is particularly hard to diagnose because the tumors are often made up of a lot of noncancerous tissue, making the cancer cells hard to spot.

Regardless of subtype, however, sarcomatoid mesothelioma patients can still get cancer treatments to improve their life expectancy or ease their symptoms. A mesothelioma specialist can determine what treatments will work best for a patient.

Get the answers you need after getting a sarcomatoid mesothelioma diagnosis. Download our Free Questions to Ask Your Doctor Checklist right now.

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Sarcomatoid Mesothelioma Prognosis

The prognosis (disease outlook) for patients with sarcomatoid mesothelioma is not as good as it is for mesothelioma patients with other cell types.

  • The average life expectancy for sarcomatoid mesothelioma is 4-7 months.
  • The five-year sarcomatoid mesothelioma survival rate (percent of patients still living) is less than 5%.

Sarcomatoid mesothelioma has a poor prognosis because the cells quickly travel and spread to other parts of the body.

That said, mesothelioma prognosis may vary depending on the age, gender, and health of the patient. Some patients with sarcomatoid mesothelioma can go on to live for much longer than originally expected with medical care.

Further, cases diagnosed in the early stages of mesothelioma are typically easier to treat since the cancer hasn’t spread, so these patients have a better prognosis.

Treatment for Sarcomatoid Mesothelioma

Sarcomatoid mesothelioma tumor cells are resistant to many mesothelioma treatments, and they spread quickly throughout the body. However, there are still several treatment options open to patients with sarcomatoid mesothelioma.

The type of treatment doctors choose depends largely on the stage and location of the sarcomatoid mesothelioma, as well as the overall health of the patient.

Sarcomatoid Mesothelioma and Chemotherapy

Mesothelioma chemotherapy is often the first choice for treating sarcomatoid mesothelioma. It is fast-acting and can be effective in slowing or stopping progression during treatment.

Sarcomatoid mesothelioma can sometimes live longer with chemotherapy. Sarcomatoid mesothelioma patients lived for nearly 11 months on average when treated with chemotherapy in a 2021 study.

Chemotherapy is used because it can treat the sarcomatoid mesothelioma cells throughout the entire body.

Radiation for Sarcomatoid Mesothelioma

Radiation therapy is also used in some sarcomatoid mesothelioma patients. It is often used as a palliative (symptom-reducing) treatment to shrink the sarcomatoid mesothelioma cells.

Radiation is not very effective at slowing or stopping cell growth or movement. However, it can be helpful in improving symptoms and making the patient more comfortable, leading to a higher quality of life.

Find out which treatments are right for you: Download our Free Questions to Ask Your Doctor Checklist and get the answers you need when meeting with a mesothelioma specialist.

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Sarcomatoid Mesothelioma Surgeries

Surgery is used to treat sarcomatoid mesothelioma in patients that present with the disease in just a few places within the body.

Pleural sarcomatoid mesothelioma patients lived for 5.5 months when treated with surgery, according to a report from the Annals of Thoracic Surgery.

Surgery options for eligible patients with pleural sarcomatoid mesothelioma include extrapleural pneumonectomy and pleurectomy with decortication. Cytoreductive surgery with HIPEC (heated chemotherapy) may be used for sarcomatoid peritoneal mesothelioma.

Sarcomatoid Mesothelioma Immunotherapy

Immunotherapy is a newer treatment for sarcomatoid mesothelioma in which medications enhance the body’s immune system so more cancer can be destroyed.

Immunotherapy drugs Opdivo® and Yervoy® were approved by the U.S. Food and Drug Administration (FDA) in October 2020 to treat pleural mesothelioma.

The approval came after a study found that immunotherapy could greatly help malignant pleural mesothelioma patients — particularly those with sarcomatoid or biphasic cell types. These patients lived for over 16 months when treated with immunotherapy, much longer than if treated with chemotherapy.

Other Treatment

Studies of new treatments for sarcomatoid mesothelioma are currently being done in clinical trial settings as well. The hope is to find potentially more effective treatments through clinical trials.

For example, the University of Chicago is currently studying how patients with sarcomatoid mesothelioma (as well as those with other mesothelioma cell types) respond to a new immunotherapy drug called Keytruda®.

Other treatment options for sarcomatoid mesothelioma may include:

  • Viral introduction therapies
  • Cancer vaccines
  • Antibody therapies

Doctors will be able to determine the right treatment or clinical trials for patients, depending on the stage and location of the malignant sarcomatoid mesothelioma.

Help for Patients With Sarcomatoid Mesothelioma

A sarcomatoid mesothelioma diagnosis affects more than just your health. It can touch just about every area of your life.

Sarcomatoid mesothelioma is particularly scary as it’s often the hardest type of mesothelioma to treat. However, treatments and clinical trials can help you live longer or with less pain after your diagnosis.

Our team has helped hundreds with mesothelioma find top doctors, get information on treatment options, and pursue financial aid. Get our Free Mesothelioma Guide now and learn more.

Sarcomatoid Mesothelioma FAQs

Is sarcomatoid mesothelioma hard to diagnose?

It can sometimes be difficult to make a sarcomatoid mesothelioma diagnosis.

This illness shares many symptoms with more common health problems and doctors need to carefully examine cell samples under a microscope to diagnose a patient correctly.

If you or a loved one are concerned that you have sarcomatoid mesothelioma, see a doctor right away to get a diagnosis.

You can also seek out a second opinion if you believe you’ve been misdiagnosed.

How is sarcomatoid mesothelioma diagnosed?

Sarcomatoid mesothelioma is diagnosed using a couple of different tests, including imaging scans and a biopsy.

Mesothelioma pathologists (doctors that evaluate tissue or fluid samples) may use immunohistochemistry or other techniques to find antibodies unique to the sarcomatoid cell type when confirming a biopsy.

Studies have shown that a biopsy that tests positive for calretinin and D2-40 with the antibody pancytokeratin often means a patient has sarcomatoid mesothelioma.

What's the average sarcomatoid mesothelioma life expectancy?

Sarcomatoid mesothelioma patients have a generally low life expectancy of just 4-7 months.

However, getting cancer treatments can help some sarcomatoid mesothelioma patients live much longer.

For example, immunotherapy has been shown to help non-epithelial pleural mesothelioma patients (those with sarcomatoid or biphasic mesothelioma) live for over 16 months.

Reviewed by:Dr. Mark Levin

Certified Oncologist and Hematologist

  • Fact-Checked
  • Editor

Mark Levin, MD has over 30 years of experience in academic and community hematology and oncology. In addition to serving as Chief or Director at four different teaching institutions throughout his life, he is also still a practicing clinician, has taught and designed formal education programs, and has authored numerous publications in various fields related to hematology and oncology.

Dr. Mark Levin is an independently paid medical reviewer.

  • Board Certified Oncologist
  • 30+ Years Experience
  • Published Medical Author
Written by:

Lead Editor

Laura Wright is a journalist and content strategist with more than 15 years of professional experience. She attended college at the University of Florida, graduating magna cum laude with a bachelor’s degree in journalism in 2008. Her writing has been featured in The Gainesville Sun and other regional publications throughout Florida.

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  1. Amin, W., Linkov, F., Landsittel, D., Silverstein, J., Bashara, W., Gaudioso, C., . . . Becich, M. (2018, August 3). Factors influencing malignant mesothelioma survival: A retrospective review of the National Mesothelioma Virtual Bank cohort. Retrieved December 5, 2022, from

  2. Avadhani, V. (2022). Mesothelioma — Sarcomatoid. Retrieved December 5, 2022, from

  3. Brockwell, N., Alamgeer, M., Kumar, B., Rivalland, G., John, T., & Parker, B. (2020, June). Preliminary study highlights the potential of immune checkpoint inhibitors in sarcomatoid mesothelioma. Retrieved December 5, 2022, from

  4. Cedres, S., Assaf, J., & Et al. (2021, July 9). Efficacy of Chemotherapy for Malignant Pleural Mesothelioma According to Histology. Retrieved December 5, 2022, from

  5. Clopton, B., & Et al. (2022, November 19). Sarcomatoid mesothelioma: Unusual findings and literature review. Retrieved December 5, 2022, from

  6. Nakajima, E., Vellanki, P., Larkins, E., Chatterjee, S., Mishra-Kalyani, P., Bi, Y., . . . Donoghue, M. (2022, February 1). FDA approval summary: Nivolumab in combination with ipilimumab for the treatment of unresectable malignant pleural mesothelioma. Retrieved December 5, 2022, from

  7. Pavlisko, E., & Roggli, V. (2015, November). Sarcomatoid Peritoneal Mesothelioma: Clinicopathologic Correlation of 13 Cases. Retrieved December 5, 2022, from

  8. Sakai, T., & Et al. (2018, February 21). Utility of Site-Specific Biopsy for Diagnosis of Desmoplastic Malignant Mesothelioma. Retrieved December 5, 2022, from

  9. U.S. National Library of Medicine. (2022, April 25). Pembrolizumab in treating patients with malignant mesothelioma. Retrieved December 5, 2022, from

  10. Verma, V., Bueno, R., Burt, B., Wolf, A., Baud, M., Taioli, E., . . . Bovolato, P. (2018, September 29). Is there a role for cancer-directed surgery in early-stage sarcomatoid or biphasic mesothelioma? Retrieved December 5, 2022, from

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