Abstract

We report a case of primary pleural sarcoma in a 75-year-old male with asbestos exposure, initially suspected as sarcomatoid mesothelioma. Immunohistochemical analysis confirmed the diagnosis with Vimentin positivity and negativity for mesothelial markers (Calretinin, WT-1, D2-40) and epithelial markers; focal ERG positivity was noted, but CD31 and CD34 negativity excluded angiosarcoma. The patient began chemotherapy with Adriamycin and Dacarbazine, but serial F-18 FDG PET/CT after the third cycle revealed significant metabolic progression, indicating chemotherapy refractoriness. The regimen switched to Gemcitabine and Docetaxel, but the disease remained refractory, and the patient died three months post-diagnosis. This case highlights the diagnostic complexity of primary pleural sarcoma with asbestos exposure and the critical role of serial FDG PET/CT in early metabolic progression detection. Our findings suggest early metabolic imaging integration is essential in rapidly progressing pleural malignancies to identify treatment resistance and facilitate timely clinical management adjustments.

Key words: Primary pleural sarcoma, Asbestos exposure, Sarcomatoid mesothelioma, F-18 FDG PET/CT, Chemorefractoriness, Case report