Of the three most common types of mesothelioma cells, there are fewer cases of sarcomatoid cells than any other. Sarcomatoid tumors are known to be hard to diagnose, aggressive and difficult to treat.
Up to 15 percent of all mesothelioma cases involve sarcomatoid cells. Under a microscope, researchers have found that sarcomatoid cells are elongated and spindle shaped. They look disorganized and have no central nucleus. The tissue itself is firm, rubbery and looks woody. In many cases, sarcomatoid cells look like healthy tissue, making a clear-cut diagnosis even more difficult. Sarcomatoid tissue is also called sarcomatous and diffused malignant fibrous.
In making a diagnosis, doctors utilize several types of diagnostic testing, including CT scans and MRIs. If these tests reveal an abnormality, a biopsy is ordered. However, the normal methods of biopsy are not accurate in this case because they often give false information. The small samples are often hard to distinguish from normal fibrous tissue.
Because of the indistinguishable nature of sarcomatoid cells, there are several common misdiagnoses, including localized fibrous tumors and renal cell carcinoma. It’s important that a doctor get a large enough biopsy for an accurate diagnosis.
Sarcomatoid cells are also difficult to diagnose because there are several cell variations that look like sarcomatoid cells. This includes transitional and desmoplastic cell types, which are both very rare.
Like other types of mesothelioma cell, a sarcomatoid cell type does not significantly change a course of treatment or the overall prognosis. But when doctors know what kind of cells they are working with, especially when it comes to aggressive ones, they can tailor the treatment. In most cases, doctors use a multimodal treatment with a combination of surgery, chemotherapy and radiation. This is used in curative and palliative measures.
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Some sarcomatoid patients may be eligible for advanced and experimental treatments that include immunotherapy and gene therapy. Both have shown promise for asbestos-cancer patients.
Symptoms and Prognosis
Sarcomatoid cells do not cause any different asbestos-cancer symptoms than any other cell variation. For pleura sarcomatoid mesothelioma, the symptoms include shortness of breath, weight loss and general weakness. For peritoneal sarcomatoid mesothelioma, the symptoms include chest pains, abdominal swelling and general malaise.
Sarcomatoid cells lead to a poor prognosis because these cells are so aggressive and resistant to treatment. Researchers have found that surgery is usually ineffective because sarcomatoid tumors are very rigid and spread easily. The cells are also known to not respond to chemotherapy.
Patients who present with sarcomatoid tumors usually survive about seven months after an initial diagnosis, but some have been found to live much longer than that. Several factors, including age, general health and early diagnosis, can greatly influence the prognosis. In addition, many patients choose to take part in clinical trials designed specifically for those with the sarcomatoid cell type. Talk to your mesothelioma specialist about clinical trials that are best for you and your diagnosis.
Modern Pathology (2010). Sarcomatoid mesothelioma: a clinical–pathologic correlation of 326 cases. Retrieved from http://www.nature.com/modpathol/journal/v23/n3/pdf/modpathol2009180a.pdf
Chaft, JE, et al. “Clinical outcomes with perioperative chemotherapy in sarcomatoid carcinomas of the lung.” Journal of Thoracic Oncology. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22895138