TN 53 (08-22)

DI 23022.587 Sarcomatoid Mesothelioma




Carcinosarcoma of the Lung; Fibrous Mesothelioma; Sarcomatous Mesothelioma; Lung Sarcomatoid Cancer; Pulmonary Carcinosarcoma; Pulmonary Sarcomatoid Cancer; Sarcomatoid Cancer of the Lung; Spindle Cell Mesothelioma; Spindle Malignant Fibrous Mesothelioma Spindled Mesothelioma


Sarcomatoid Mesothelioma is a rare cell type of cancer caused by asbestos exposure. This condition is a mixed disease with both sarcomatous (affecting connective tissue) and epithelial (related to cells that line the organs) elements. Sarcomatoid cells are recognized by their oval or spindle-like shape.

Sarcomatoid Mesothelioma occurs in multiple organ settings, including the uterus, kidneys, lungs, and peritoneum. It accounts for between 10 and 20 percent of all mesothelioma diagnoses.


Diagnostic testing: Diagnosis of Sarcomatoid Mesothelioma is difficult because the patient presents with symptoms that are the same as other more common illnesses. Most patients begin the process of diagnosis when they seek medical help for shortness of breath or chest pain.

The diagnosis of Sarcomatoid Mesothelioma is made by:

  • Chest x-ray;

  • Computed tomography (CT) scan;

  • Echocardiogram;

  • Positron emission tomography (PET) scan;

  • Magnetic resonance imaging (MRI);

  • Blood tests; and

  • Tissue biopsy.

Physical findings: Symptoms of Sarcomatoid Mesothelioma may include:

  • Pain in the chest, back, shoulders, and ribs;

  • Coughing;

  • Shortness of breath;

  • Decreased appetite;

  • Fatigue and muscle weakness;

  • Nausea and vomiting;

  • Blood in feces, vomit, or sputum; and

  • Weight loss.

ICD-9: 163.9

ICD-10: C45.9


Sarcomatoid Mesothelioma forms in separate nodes or lesions and can metastasize, or spread, quickly to distant organs. Sarcomatoid carcinomas of the lung have poor prognosis and are aggressive cancers. Small early (stage I) carcinosarcoma can have a cure rate of 50% or more if fully resected. More advanced local cancers or metastatic carcinosarcoma have rapid growth and poor response. Stage II-IV tumors have a much less favorable prognosis, with survival of only 2-3 years. Median survival for Stage IV metastatic carcinosarcoma is less than 1 year.


There is no standard treatment for Sarcomatoid Mesothelioma. Sarcomatoid Mesothelioma is one of the most difficult types of mesothelioma to treat. The type of treatment depends on the stage and location of the cancer, and the overall health of the patient. Treatment options may include chemotherapy, which is often used as the first choice of treatment because it is fast-acting, and can be effective in slowing or stopping progression of the cancer; radiation, which is often used as a palliative treatment to shrink the mesothelioma cells; and surgery, which is used to treat patients that present with the disease in just a few places within the body.


Suggested MER for Evaluation:

  • Clinical history and examination that describes the diagnostic features of the impairment;

  • Biopsy reports; and

  • Imaging reports (e.g. chest x-rays, CT scan, PET scan, or MRI scan).

Suggested Listings for Evaluation:





13.15 A

Sarcomatoid mesothelioma meets listing 13.15 A if the cancer is in the pleura.


13.15 A

Sarcomatoid mesothelioma equals listing 13.15 A if the cancer is not in the pleura.

* Adjudicators may, at their discretion, use the Medical Evidence of Record or the listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

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DI 23022.587 - Sarcomatoid Mesothelioma - 08/10/2022
Batch run: 08/17/2022