Delayed Solitary Adrenal Metastasis in Malignant Pleural Mesothelioma with Long-Term Survival under Immunotherapy

Malignant pleural mesothelioma (MPM) is a rare and aggressive neoplasm with limited long-term survival. We report a case of a 72-year-old woman diagnosed with epithelioid MPM and NF2 mutation in 2018, who presented with a solitary adrenal metastasis six years after initial diagnosis. After initial surgery and chemotherapy, disease progressed within one year. Immunotherapy with ipilimumab and nivolumab resulted in long-term disease control. This case highlights an exceptionally delayed metachronous adrenal metastasis and prolonged survival under sustained immunotherapy.