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Thoracic Surgery Clinics May 2017Superior sulcus tumors have posed a formidable therapeutic challenge since their original description by Pancoast and Tobias in the early twentieth century. Initial... (Review)
Review
Superior sulcus tumors have posed a formidable therapeutic challenge since their original description by Pancoast and Tobias in the early twentieth century. Initial therapeutic efforts with radiotherapy were associated with high rates of relapse and mortality. Bimodality therapy with complete surgical resection in the 1960s paved the way for trimodality therapy as the current standard of care in the treatment of superior sulcus tumors. The evolution of treatment approaches over time has provided outcomes that come increasingly closer to rivaling those of similarly staged nonapical lung cancer.
Topics: Carcinoma, Non-Small-Cell Lung; Chemoradiotherapy, Adjuvant; Humans; Neoadjuvant Therapy; Neoplasm Invasiveness; Neoplasm Staging; Pancoast Syndrome; Pneumonectomy; Thoracic Surgery, Video-Assisted
PubMed: 28363369
DOI: 10.1016/j.thorsurg.2017.01.008 -
The Malaysian Journal of Pathology Aug 2023Hepatocellular carcinoma is the most common primary liver malignancy, and sarcomatoid hepatocellular carcinoma is a rare malignancy containing both carcinomatous and...
INTRODUCTION
Hepatocellular carcinoma is the most common primary liver malignancy, and sarcomatoid hepatocellular carcinoma is a rare malignancy containing both carcinomatous and sarcomatous components.
CASE REPORT
We report a 64-year-old male patient treated with open right trisectionectomy for a 16cm right hemiliver tumour. The diagnosis of sarcomatoid hepatocellular carcinoma was confirmed on histology. Five months after hepatic resection, patient had symptoms suggestive of Horner's syndrome along with left sided shoulder pain, hand weakness, reduced power of the intrinsic hand muscles and reduced pain perception over the C8/T1 dermatome. Magnetic Resonance Imaging (MRI) showed a mass at the left lung apex/superior sulcus involving the left C8, T1 nerve roots, scalene muscles, and brachial plexus. The mass closely abutted the left first rib and partially encased the left subclavian artery. The patient was managed with palliative chemoradiotherapy for Pancoast syndrome.
DISCUSSION
Hepatocellular carcinoma pulmonary metastasis causing Pancoast syndrome is a rare occurrence with only four prior reports, and to the best of our knowledge, pulmonary metastasis from sarcomatoid hepatocellular carcinoma causing Pancoast syndrome is unreported. In this report, we will discuss the clinicopathological characteristics of this case which may provide insight into diagnosis and management of other sarcomatoid hepatocellular carcinoma patients.
PubMed: 37658538
DOI: No ID Found -
Journal de Mycologie Medicale Sep 2021Pancoast's syndrome and subclavian arteritis are rarely caused by Aspergillus sp. . Here we report a case of a 22-yr-old, immunocompetent male who presented with fever,...
Pancoast's syndrome and subclavian arteritis are rarely caused by Aspergillus sp. . Here we report a case of a 22-yr-old, immunocompetent male who presented with fever, weight loss, right-sided facial anhidrosis and hand weakness of six months duration. Neurological examination confirmed right Horner's syndrome and weakness of small muscles of right hand. Contrast MRI of neck and chest revealed a pleural-based right apical mass abutting subclavian artery and C8-T1 root and multiple enlarged lymph nodes. He developed right hemiataxia due to cerebellar infarct before the planned excision of mass. Surgical exploration showed abscess encasing subclavian artery. Biopsy of the mass resulted in accidental injury of subclavian artery which was repaired. He developed bleeding from suture site postoperatively due pseudo-aneurysm of the subclavian artery which was stented. Histopathology of mass was suggestive of Aspergillus sp. . He was successfully treated with voriconazole. This is probably the first report of Pancoast's syndrome and large vessel angiitis caused by Aspergillus fumigatus which has been successfully managed.
Topics: Aspergillosis; Humans; Male; Pancoast Syndrome; Stroke
PubMed: 34147761
DOI: 10.1016/j.mycmed.2021.101154 -
Zentralblatt Fur Chirurgie Jun 2018Pancoast or superior pulmonary sulcus tumour is a subset of lung carcinoma that invades the structures of the thoracic inlet - first ribs, distal roots of the brachial... (Review)
Review
Pancoast or superior pulmonary sulcus tumour is a subset of lung carcinoma that invades the structures of the thoracic inlet - first ribs, distal roots of the brachial plexus, stellate ganglion, vertebrae, and subclavian vessels. The first symptom is usually shoulder pain; consequently, most patients are initially treated for osteoarthritis. Late diagnosis is common. Success of therapy depends on an accurate staging: standard imaging with CT scan of the chest, PET-CT scan, brain MRI are needed to rule out distant metastases, endobronchial ultrasound-guided needle biopsy (EBUS-TBNA) or mediastinoscopy are mandatory for reliable nodal staging. An MRI of the thoracic inlet allows to clearly define the boundaries of local invasion. Modern management of Pancoast tumour includes induction concurrent chemoradiotherapy followed by surgical resection. As compared with historical series treated by preoperative radiation, a trimodally approach did enhance complete resection rates and perhaps long-term survival - from about 30% 5-year survival rate to 60% in R0-resected patients. In patients who have unresectable but non-metastatic Pancoast tumours and appropriate performance status, definitive concurrent chemoradiotherapy and radiotherapy are recommended options.
Topics: Humans; Male; Middle Aged; Pancoast Syndrome; Prognosis; Shoulder Pain
PubMed: 29933484
DOI: 10.1055/s-0043-109931 -
The Journal of Small Animal Practice Jun 2022
Topics: Animals; Dog Diseases; Dogs; Pancoast Syndrome
PubMed: 35297502
DOI: 10.1111/jsap.13492 -
HCA Healthcare Journal of Medicine 2021Description The Pancoast tumor is an uncommon type of lung cancer that arises from within the superior sulcus. With most clinical manifestations occurring due to mass...
Description The Pancoast tumor is an uncommon type of lung cancer that arises from within the superior sulcus. With most clinical manifestations occurring due to mass effect, Pancoast syndrome is a known complication that includes shoulder and arm musculoskeletal pain, Horner's syndrome and neurological complications of the upper extremities, including weakness and atrophy. Even though adenocarcinoma is the most common cause of Pancoast syndrome among lung cancers, other malignancies can be responsible as well. Treatment is similar to that of other standard NSCLC treatments that include chemotherapy, radiation, immunotherapy and surgery. Here we report a patient with Pancoast syndrome secondary to a poorly differentiated malignant neoplasm composed of anaplastic cells.
PubMed: 37424884
DOI: 10.36518/2689-0216.1076 -
Acta Neurochirurgica Apr 2023Neuralgic pain related to Pancoast-Tobias syndrome can be difficult to treat. An invasive but effective option for management is open cervical DREZotomy.
BACKGROUND
Neuralgic pain related to Pancoast-Tobias syndrome can be difficult to treat. An invasive but effective option for management is open cervical DREZotomy.
METHOD
This procedure involves the interruption of the dorsal root entry zone (A delta and C fibers) that sustains the nociceptive pathways. After dura opening, the microsurgical steps are micro incisions of the pia mater under each dorsolateral rootlets and contiguous microcoagulations in the posterolateral sulcus downward to the posterior horn.
CONCLUSION
When properly performed in a well-selected patient, DREZotomy is a safe and effective procedure for treating devastating pain related to Pancoast-Tobias syndrome.
Topics: Humans; Spinal Nerve Roots; Neuralgia; Neck; Microsurgery; Pancoast Syndrome
PubMed: 36585975
DOI: 10.1007/s00701-022-05465-7 -
Experimental Oncology Oct 2018To study the nature of different variants of paraneoplastic syndrome (PNPS) in lung cancer, taking into account the features of the tumorous process and the...
AIM
To study the nature of different variants of paraneoplastic syndrome (PNPS) in lung cancer, taking into account the features of the tumorous process and the complications of radiochemotherapy.
PATIENTS AND METHODS
We performed an analysis of the data of 1,669 patients with lung cancer aged between 24 and 87 years, among whom there were 89% of men and 11% of women. The ratio of small cell and non-small-cell histological variants of the lung cancer was 1: 4, IB, IIA, IIB, IIIA, IIIB and IV stages of cancer - 1:2:6:58:43:57.
RESULTS
PNPS developed in 16% of the lung cancer patients, in these patients we have detected a marked increase in the disease incidence in women, the peripheral form of the tumor, the apical variant of Pancoast - Tobias and adenocarcinoma, but no cases of the median lower localization of the tumor. The number of the upper lobar pathology was decreased, while the severity of the cancer was significantly greater, which more often occurred with exudative pleurisy, germination of the tumor into the chest wall and compression of the upper vena cava. The 21 components of PNPS pathology were established. We distributed them conditionally into the musculoskeletal system lesions, variants of skin vasculitis and autoimmune processes, the nature of which depended on the localization and course of the tumorous process, its histological variation and severity of the course. Moreover, PNPS negatively affected the development of radiochemotherapy complications and worsened survival rate.
CONCLUSIONS
The course of PNPS in lung cancer is highly diverse, being a risk factor for a severe tumorous process that worsens the survival of patients.
Topics: Adenocarcinoma of Lung; Adult; Aged; Aged, 80 and over; Chemoradiotherapy; Combined Modality Therapy; Female; Humans; Lung; Male; Middle Aged; Neoplasm Staging; Paraneoplastic Syndromes; Survival Rate
PubMed: 30285007
DOI: No ID Found -
Cureus Nov 2021Musculoskeletal disorders represent a major public health problem and they are frequently managed in primary care centers. Shoulder pain is a frequent musculoskeletal...
Musculoskeletal disorders represent a major public health problem and they are frequently managed in primary care centers. Shoulder pain is a frequent musculoskeletal complaint and it can result from intrinsic disorders of the shoulder or referred pain. We present the case of a 24-year-old woman who presented to the family medicine clinic complaining of left shoulder pain for three months duration. The pain was not associated with numbness or weakness. There was no history of preceding trauma. The initial diagnosis was supraspinatus tendinosis. The patient was prescribed oral analgesics and was advised to undergo multiple physiotherapy sessions. Later, the patient presented to the clinic again and reported she did not have any improvement in her symptoms. The patient was referred to the orthopedic clinic for further evaluation and management. The patient underwent a frontal radiograph of the chest which demonstrated a well-defined opacity located in the apex of the left lung. A computed tomography scan of the chest demonstrated the presence of erosion to the vertebral body raising the suspicion for a neurogenic tumor as was later supported by magnetic resonance imaging. The patient underwent video-assisted thoracotomy with brachial plexus exploration. Complete resection of the tumor was achieved with no complications. The present case highlights those common musculoskeletal complaints, such as shoulder pain, which could indicate underlying non-orthopedic pathology.
PubMed: 34909333
DOI: 10.7759/cureus.19418 -
Journal of Cancer Research and... 2020Lung cancer is the most common malignant disease and is the topmost cause of cancer deaths in the world across all age groups and in both sexes. It is the most common...
INTRODUCTION
Lung cancer is the most common malignant disease and is the topmost cause of cancer deaths in the world across all age groups and in both sexes. It is the most common cause of cancer deaths in developed countries and is also rising at an alarming rate in the developing countries.
OBJECTIVE
The present study was undertaken to explore the clinicopathological and molecular profile of bronchogenic carcinoma in northwestern population of India.
MATERIALS AND METHODS
A total of 136 consecutive patients with histologically proven bronchogenic carcinoma, registered between May 2014 and April 2016 at a tertiary care hospital in New Delhi, India, were analyzed.
RESULTS
Out of a total of 136 diagnosed cases, 6% were in the third to fourth decade of life, 49% in the fifth to sixth decade, and 45% in the seventh decade and above. Seventy-one percent of patients were male. Smoking was the major risk factor in 65.40% of patients. About 33% of female patients were smokers with a significant overlap in the use of smoking objects. Twenty-one percent of patients had been initially empirically treated with antitubercular therapy. Most common symptoms at presentation were cough, dyspnea, weight loss, and chest pain. Pleural effusion, paraneoplastic phenomenon, clubbing, peripheral lymphadenopathy, and Pancoast syndrome were the major signs at presentation. Twenty-one percent of nonsmokers and 40% of smoker patients presented with ECOG Performance Status 3 or 4. Ninety-three percent of patients presented in stage III or IV. Metastases to skeleton, brain, liver, pleura, adrenals, lung, and distant lymph nodes were present in 30.8%, 16.9%, 15.4%, 15.4%, 14.7%, 13.2%, and 11.8%, respectively. Fiberoptic bronchoscopy was found to be the most efficient diagnostic procedure as compared to transthoracic and thoracoscopic methods. Histologically, squamous cell carcinoma, adenocarcinoma, and small cell carcinoma and its variants were seen in 35.30%, 44.9%, and 15.40% cases, respectively. Nearly 4.4% of patients were diagnosed as poorly differentiated carcinoma. Driver mutations (epidermal growth factor receptor or anaplastic lymphoma kinase) were detected in 48% (25 of 52 tested) of adenocarcinomas and 55.55% (5 of 9 tested) of young, nonsmoker, female squamous cell carcinoma patients.
CONCLUSION
This study highlights that the adenocarcinoma incidence is surpassing squamous cell carcinoma in Indian lung cancer patients also, as observed in Western population. Mean age at diagnosis is about one decade earlier than in the Western population. Driver mutations are more common in India than in the West as also reported in other Asian studies.
Topics: Adult; Aged; Aged, 80 and over; Anaplastic Lymphoma Kinase; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Carcinoma, Squamous Cell; ErbB Receptors; Female; Humans; Incidence; India; Lung Neoplasms; Male; Middle Aged; Risk Factors; Smokers; Young Adult
PubMed: 32930117
DOI: 10.4103/jcrt.JCRT_473_17