Abstract Malignant mesothelioma (MM) is a rare tumor that associated with asbestos exposure. For the reliable diagnosis, the adequate representative tissue samples are essential for the histology and immunohistochemical staining. We report a case of desmoplastic malignant mesothelioma (DMM), accounting for only 5-10% of all MM and having poor prognosis. A 76-year-old male visited emergency room presenting with chest pain. Chest computed tomography showed focal lobulated pleural enhancing mass in posterior aspect of left upper lobe. After video-assisted thoracoscopic surgery and several immunohistochemical stains, we could diagnose as DMM. The patient refused chemotherapy, but received analgesics and palliative radiation for the painful back area. Subsequently, he was dead after 17 months from appearance of the initial symptom.