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Indian Journal of Nuclear Medicine :... 2023We present the case of a 52-year-old male who was recently diagnosed case of a Pancoast tumor and presented to the pulmonary outpatient department with a complaint of...
We present the case of a 52-year-old male who was recently diagnosed case of a Pancoast tumor and presented to the pulmonary outpatient department with a complaint of pain in the shoulder and chest region which was burning type, associated with shoulder abduction weakness and poor hand grip. Subsequently, he was referred for a -Tc bone scan for metastatic workup, which showed increased uptake in all the joints and long bones of the ipsilateral upper limb. This case highlights the importance of considering nontraumatic cause of pattern similar to complex regional pain syndrome.
PubMed: 38390551
DOI: 10.4103/ijnm.ijnm_38_23 -
The Journal of Thoracic and... May 2023Superior sulcus tumors are a challenging subset of non-small cell lung carcinomas invading the thoracic inlet. In this study, we determined whether the location of the... (Review)
Review
OBJECTIVE
Superior sulcus tumors are a challenging subset of non-small cell lung carcinomas invading the thoracic inlet. In this study, we determined whether the location of the tumor along the first rib had an influence on survival.
METHODS
We performed a review of 92 consecutive patients undergoing surgery for non-small cell lung carcinomas invading the thoracic inlet between January 1996 and June 2021. Tumor location was categorized into anterior and posterior based on predefined zones.
RESULTS
In total, 21 tumors were located anteriorly (23%) and 71 posteriorly (77%). The rate of R0 resection (81% vs 87%; P = .4) and pathological complete response to induction therapy (33% vs 37%; P = .8) were similar between locations. After a median follow-up of 5.8 years (range, 0.8-24 years), 49 patients died for an overall survival of 48% (95% CI, 38%-59%) at 5 years. The 5-year survival was favorably influenced by R0 (vs R1) resection (51% vs 29%; P = .02), pathological complete response (vs no pathological complete response) (69% vs 31%; P = .03), posterior (vs anterior) location (56% vs 22%; P = .01), and ≤60 (vs >60) years of age (61% vs 37%; P = .007). Compared with posterior tumors, anterior tumors were associated with higher risk of systemic recurrence and significantly greater survival benefit from pathological complete response. Anterior tumors remained an independent predictor of worse survival in multivariate analysis (hazard ratio, 2.3; 95% CI, 1.2-4.5; P = .01).
CONCLUSIONS
The anatomical location of the tumor affects survival after resection of non-small cell lung carcinomas invading the thoracic inlet. Anterior tumors have greater propensity to metastasize and may derive greater benefit from optimal systemic therapy than posterior tumors.
Topics: Humans; Pancoast Syndrome; Bays; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Carcinoma
PubMed: 36481062
DOI: 10.1016/j.jtcvs.2022.10.033 -
Journal of Brachial Plexus and... Dec 2015The Pancoast syndrome (PS) has been termed after Henry Pancoast. Its neurologic core symptoms include pain, radicular sensory and motor syndromes, and Horner...
INTRODUCTION
The Pancoast syndrome (PS) has been termed after Henry Pancoast. Its neurologic core symptoms include pain, radicular sensory and motor syndromes, and Horner syndrome. A PS is often the presenting sign of lung cancer and bears a grim prognosis.
METHODS
This case report describes an atypical onset of a lung tumor causing a PS. Electrophysiological examination was not conclusive. The diagnosis was confirmed by MRI, CT scan, and biopsy. The intervention consisted of preoperative chemo- and radiotherapy and was followed by an extensive surgical approach with histologically confirmed perineural invasion of the brachial plexus.
RESULTS
The postoperative period was dominated by neuropathic pain. Despite considerable loss of distal sensorimotor function of the right hand, the patient uses the extremity and has returned to professional life.
DISCUSSION
This observation triggered by the advances in general oncology and surgery also demonstrates the management of a lesion of the peripheral nervous system caused by cancer.
PubMed: 27917240
DOI: 10.1055/s-0035-1551654 -
Chinese Clinical Oncology Dec 2015To update the long-term outcomes after subclavian artery (SA) resection and reconstruction during surgery for thoracic inlet (TI) cancer through the anterior...
BACKGROUND
To update the long-term outcomes after subclavian artery (SA) resection and reconstruction during surgery for thoracic inlet (TI) cancer through the anterior transclavicular approach.
METHODS
Between 1985 and 2014, 85 patients (60 men and 25 women; mean age, 52 years) underwent en bloc resection of thoracic-inlet non-small cell lung cancer (NSCLC) (n=69), sarcoma (n=11), breast carcinoma (n=3) or thyroid carcinoma (n=2) involving the SA. L-shaped transclavicular cervicothoracotomy was performed, with posterolateral thoracotomy in 18 patients or a posterior midline approach in 15 patients. Resection extended to the chest wall (>2 ribs, n=60), lung (n=76), and spine (n=15). Revascularization was by end-to-end anastomosis (n=48), polytetrafluoroethylene (PTFE) graft interposition (n=28), subclavian-to-common carotid artery transposition (n=8), or grafting of the autologous superficial femoral artery in an anterolateral thigh free flap (n=1). Complete R0 resection was achieved in 75 patients and microscopic R1 resection in 10 patients. Postoperative radiation therapy was given to 51 patients.
RESULTS
There were no cases of postoperative death, neurological sequelae, graft infection or occlusion, or limb ischemia. Postoperative morbidity consisted of pneumonia (n=16), phrenic nerve palsy (n=2), recurrent nerve palsy (n=4), bleeding (n=4), acute pulmonary embolism (n=1), cerebrospinal fluid leakage (n=1), chylothorax (n=1), and wound infection (n=2). Five-year survival and disease-free survival rates were 32% and 22%, respectively. Long-term survival was not observed after R1 resection.
CONCLUSIONS
Subclavian arteries invaded by TI malignancies can be safely resected and reconstructed through the anterior transclavicular approach, with good long-term survival provided complete R0 resection is achieved.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Blood Vessel Prosthesis Implantation; Breast Neoplasms; Carcinoma, Non-Small-Cell Lung; Carotid Artery, Common; Disease-Free Survival; Female; Femoral Artery; Humans; Kaplan-Meier Estimate; Lung Neoplasms; Male; Middle Aged; Neoplasm Invasiveness; Pancoast Syndrome; Postoperative Complications; Proportional Hazards Models; Plastic Surgery Procedures; Retrospective Studies; Sarcoma; Subclavian Artery; Thoracotomy; Thyroid Neoplasms; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Young Adult
PubMed: 26730753
DOI: 10.3978/j.issn.2304-3865.2015.12.08 -
Asian Cardiovascular & Thoracic Annals Jun 2021A primary pulmonary angiosarcoma is an extremely rare entity with fewer than 30 cases reported in the literature. We found no reports of primary pulmonary angiosarcoma...
A primary pulmonary angiosarcoma is an extremely rare entity with fewer than 30 cases reported in the literature. We found no reports of primary pulmonary angiosarcoma presenting as a Pancoast tumor. We describe a case of pulmonary angiosarcoma located in the right superior sulcus that was treated by surgery.
Topics: Hemangiosarcoma; Humans; Pancoast Syndrome
PubMed: 33435693
DOI: 10.1177/0218492320988456 -
Journal de Mycologie Medicale Apr 2019Pulmonary mucormycosis is a rare opportunistic infection caused by Mucormycosis. This fungal infection is uncommon in immunocompetent individuals. Because of its various...
Pulmonary mucormycosis is a rare opportunistic infection caused by Mucormycosis. This fungal infection is uncommon in immunocompetent individuals. Because of its various clinical and imaging manifestations, it is a diagnostic challenge to distinguish pulmonary mucormycosis from other pulmonary diseases, such as carcinoma. Herein, we report a case of pulmonary mucormycosis presenting as Pancoast syndrome and bone destruction of ribs. A 46-year-old Chinese woman was admitted due to pain in chest, right neck and arm for four months and hoarseness for one week. The pre-admission diagnosis via chest CT was pulmonary carcinoma. The subsequent bronchoalveolar lavage fluid analysis and bronchoscopic biopsy were negative for malignant cells, except chronic inflammation. Imaging-guided percutaneous biopsies were carried out after admission and the final pathological diagnosis was pulmonary mucormycosis. Although the patient was started on oral posaconazole of 400mg bid, the disease condition continued to deteriorate. She finally died of respiratory failure.
Topics: Antifungal Agents; Bone and Bones; Diagnosis, Differential; Female; Humans; Immunocompetence; Lung; Lung Diseases, Fungal; Lung Neoplasms; Middle Aged; Mucormycosis; Opportunistic Infections; Pancoast Syndrome; Tomography, X-Ray Computed
PubMed: 30553628
DOI: 10.1016/j.mycmed.2018.10.005 -
Chest Dec 2015
Topics: Carcinoma, Non-Small-Cell Lung; Combined Modality Therapy; Humans; Neoplasm Staging; Outcome Assessment, Health Care; Pain Management; Pain, Postoperative; Pancoast Syndrome; Pneumonectomy; Prognosis; Reoperation
PubMed: 26110487
DOI: 10.1378/chest.15-1196 -
Chest Dec 2015
Topics: Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Non-Small-Cell Lung; Humans; Neoplasm Staging; Outcome Assessment, Health Care; Pancoast Syndrome; Patient Selection; Pneumonectomy; Survival Analysis
PubMed: 26110373
DOI: 10.1378/chest.15-1194 -
Asian Spine Journal Dec 2016Monocentric prospective study.
STUDY DESIGN
Monocentric prospective study.
PURPOSE
To assess the safety and effectiveness of the posterior approach for resection of advanced Pancoast tumors.
OVERVIEW OF LITERATURE
In patients with advanced Pancoast tumors invading the spine, most surgical teams consider the combined approach to be necessary for "" resection to control visceral, vascular, and neurological structures. We report our preliminary experience with a single-stage posterior approach.
METHODS
We included all patients who underwent posterior resection of advanced Pancoast tumors invading the spine in our institution between January 2014 and May 2015. All patients had locally advanced tumors without N2 nodes or distant metastases. All patients, except 1, benefited from induction treatment consisting of a combination of concomitant chemotherapy (cisplatin-VP16) and radiation.
RESULTS
Five patients were included in this study. There were 2 men and 3 women with a mean age of 55 years (range, 46-61 years). The tumor involved 2 adjacent levels in 1 patient, 3 levels in 1 patient, and 4 levels in 3 patients. There were no intraoperative complications. The mean operative time was 9 hours (range, 8-12 hours), and the mean estimated blood loss was 3.2 L (range, 1.5-7 L). No patient had a worsened neurological condition at discharge. Four complications occurred in 4 patients. Three complications required reoperation and none was lethal. The mean follow-up was 15.5 months (range, 9-24 months). Four patients harbored microscopically negative margins (R0 resection) and remained disease free. One patient harbored a microscopically positive margin (R1 resection) and exhibited local recurrence at 8 months following radiation treatment.
CONCLUSIONS
The posterior approach was a valuable option that avoided the need for a second-stage operation. Induction chemoradiation is highly suitable for limiting the risk of local recurrence.
PubMed: 27994780
DOI: 10.4184/asj.2016.10.6.1047 -
Cancer Biotherapy & Radiopharmaceuticals Oct 2015To evaluate any potential value of 2-deoxy-2-[18F] fluoro-D-glucose with positron emission tomography/computerized tomography (FDG PET/CT) in staging of patients with...
PURPOSE
To evaluate any potential value of 2-deoxy-2-[18F] fluoro-D-glucose with positron emission tomography/computerized tomography (FDG PET/CT) in staging of patients with Pancoast tumors and to investigate the relationship between volume-based quantitative PET parameters and prognosis.
MATERIALS AND METHODS
The authors retrospectively reviewed data of the 47 patients with Pancoast tumors who underwent initial staging by conventional imaging methods and FDG PET/CT. FDG-PET images were visually and quantitatively evaluated, and metabolic tumor volume (MTV), total lesion glycolysis, and maximum standardized uptake values of primary tumors were calculated. The correlations between quantitative PET parameters and tumor stages, as well as overall survival, were analyzed.
RESULTS
By detecting unknown distant metastasis, PET/CT upstaged 21% of patients. The sensitivity and specificity for detection of lymphatic involvement were 100% and 83.75%, respectively. Having surgery (p = 0.01) and being at an early stage (p = 0.004) were the most predictive factors for overall survival. Although there was no significant correlation between quantitative PET parameters and overall survival, MTV was the most powerful discriminator for operability and preoperative staging (p < 0.05).
CONCLUSIONS
FDG-PET imaging was found to be a valuable method for an accurate staging in the management of patients with Pancoast tumor. Having surgery and being at an early stage at presentation were found to be significant predictors for survival. Quantitative metabolic parameters may contribute to clarification of operable patient subgroups having an early disease stage with low MTV.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Female; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Humans; Kaplan-Meier Estimate; Lymphatic Metastasis; Male; Middle Aged; Multimodal Imaging; Pancoast Syndrome; Positron-Emission Tomography; ROC Curve; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed; Tumor Burden
PubMed: 26367245
DOI: 10.1089/cbr.2014.1809