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Journal of Chiropractic Medicine Dec 2023The purpose of this report was to describe a patient with a Pancoast tumor who presented for chiropractic care with neck and arm pain.
OBJECTIVE
The purpose of this report was to describe a patient with a Pancoast tumor who presented for chiropractic care with neck and arm pain.
CLINICAL FEATURES
A 52-year-old male patient with right-sided cervicothoracic pain and numbness in the right upper extremity presented to a chiropractic office for care. The patient reported an occupational history of repetitive lifting motions and overuse injuries. The patient denied history of smoking at the time of presentation.
INTERVENTION AND OUTCOME
Radiographic imaging revealed tracheal deviation. A chest computed tomography image demonstrated a large lesion in the apex of the right lung, suggestive of bronchogenic carcinoma. The patient was referred to an oncology clinic, where he admitted to having a 20-year history of smoking. The diagnosis of adenocarcinoma was made via biopsy, and the oncologist's evaluation confirmed the cancer to be stage IIIC. The patient received palliative care treatments, as the advanced state of his condition determined that he was not a candidate for surgical intervention.
CONCLUSION
Chiropractors and other first-contact health care providers must keep in mind unusual presentations masquerading as common conditions. This case demonstrates the importance of including apical lung tumors in the differential diagnosis of unilateral arm and neck pain and neurologic deficits of the upper extremity. This case demonstrates the importance of thorough follow-up on images ordered, including the ordering clinicians viewing the images themselves.
PubMed: 38205223
DOI: 10.1016/j.jcm.2023.07.003 -
Laeknabladid Jul 2015Pancoast tumors are lung carcinomas that invade the apical chest wall and surrounding structures. Treatment is complex and often involves surgery together with radio-...
OBJECTIVE
Pancoast tumors are lung carcinomas that invade the apical chest wall and surrounding structures. Treatment is complex and often involves surgery together with radio- and chemotherapy. We studied the outcome of surgical resection for Pancoast tumors in Iceland.
MATERIALS AND METHODS
A retrospective study including all patients that underwent resection of a Pancoast tumor with curative intent in Iceland in the years 1991-2010. Data on symptoms, complications, TNM-stage, relapse and survival were analyzed.
RESULTS
Twelve patients were operated on; 7 on the right lung. Shoulder pain (n=5) and/or chest pain (n=3), cough (n=6) and weight loss (n=5) were the most common presenting symptoms. Adenocarcinoma (n=5) and squamous cell carcinoma (n=4) were the most frequent histological types. Average tumor size was 5,9 cm (range: 2,8-15). Five cases were stage IIB and 7 stage IIIA according to operative staging. In 10 cases (83%) the surgical margins were free of tumor. All patients survived surgery and only one patient suffered a major operative complication, an intraoperative bleeding. In one case induction chemo-radiation prior to surgery was administrated, and 8 patients received postoperative radiotherapy. Recurrent disease was diagnosed in 9 patients; four had local or regional recurrence, four had distant metastases and one patient was diagnosed with both local and distant recurrences simultaneously. Survival at 5 years was 33% and median survival was 27,5 months (range: 4-181).
CONCLUSIONS
Operative and short-term outcomes for patients with Pancoast tumors in Iceland are excellent. However, long-term outcomes are not as favorable and recurrence rate is high compared to other studies, possibly due to incomplete preoperative staging and less use of chemo-radiation therapy prior to surgery among these patients.
Topics: Adenocarcinoma; Adenocarcinoma of Lung; Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; Chemoradiotherapy, Adjuvant; Female; Humans; Iceland; Lung Neoplasms; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Pancoast Syndrome; Pneumonectomy; Radiotherapy, Adjuvant; Retrospective Studies; Risk Factors; Survival Analysis; Time Factors; Treatment Outcome; Tumor Burden
PubMed: 26158627
DOI: 10.17992/lbl.2015.0708.35 -
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 -
Methodist DeBakey Cardiovascular Journal 2015"Pancoast" tumors frequently require a multidisciplinary approach to therapy and are still associated with high morbidity and mortality. Due to their sensitive anatomic...
"Pancoast" tumors frequently require a multidisciplinary approach to therapy and are still associated with high morbidity and mortality. Due to their sensitive anatomic location, complex resections and chemoradiation regimens are typically required for treatment. Those with signs of aortic invasion pose an even greater challenge, given the added risks of cardiopulmonary bypass for aortic resection and interposition. Placement of an aortic endograft can facilitate resection if the tumor is in close proximity to or is invading the aorta. Prophylactic endografting to prevent radiation-associated aortic rupture has also been described. This case describes a 60-year-old female who presented with a stage IIIa left upper lobe undifferentiated non-small-cell carcinoma encasing the subclavian artery with thoracic aorta and bony invasion. Following carotid-subclavian bypass with Dacron, en bloc resection of the affected lung, ribs, and vertebral bodies was performed. The aorta was prophylactically reinforced with a Gore TAG thoracic endograft prior to adjuvant chemoradiation. The patient remains disease-free at more than 5 years follow-up after completing her treatment course. Endovascular stenting with subsequent chemoradiation may prove to be a viable alternative to palliation or open operative management and prevention of aortic injury during tumor resection and/or adjuvant therapy in select patients with aortic involvement.
Topics: Aorta, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Carcinoma, Non-Small-Cell Lung; Chemoradiotherapy, Adjuvant; Endovascular Procedures; Female; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Middle Aged; Neoplasm Staging; Pancoast Syndrome; Pneumonectomy; Polyethylene Terephthalates; Prosthesis Design; Treatment Outcome
PubMed: 26306134
DOI: 10.14797/mdcj-11-2-140 -
Caspian Journal of Internal Medicine 2019Metastatic carcinomas to the upper jaw region are very rare and unfortunately occur in advanced stages of malignancies. Pancoast tumor is a challenging subset of lung...
BACKGROUND
Metastatic carcinomas to the upper jaw region are very rare and unfortunately occur in advanced stages of malignancies. Pancoast tumor is a challenging subset of lung carcinoma commonly followed by distant metastasis. Since the metastatic lesion of our patient was very huge and unusual, we decided to report the case.
CASE PRESENTATION
Our patient was a middle-aged heavy smoker male with a history of unresectable pancoast tumor. He was referred to the dental clinic with an expanded maxillary metastasis involving the bone and sinus region as well as oral soft tissues. To confirm the primary site of his malignancy, immunohistochemical staining was performed.
CONCLUSION
Distant metastases of a pancoast tumor are more frequent when the primary tumor is unoperable and bone involvement is one of the early manifestations of disease.
PubMed: 31559001
DOI: 10.22088/cjim.10.3.351 -
Zhongguo Fei Ai Za Zhi = Chinese... Nov 2015The surgical resection for pancoast tumors remains challenging. There are only few reports explaining the use of VATS in the treatment of Pancoast tumors. The aim of...
BACKGROUND AND OBJECTIVE
The surgical resection for pancoast tumors remains challenging. There are only few reports explaining the use of VATS in the treatment of Pancoast tumors. The aim of this study is to assess whether the use of video-assisted thoracoscopic surgery (VATS) for the surgical treatment of Pancoast tumors was feasible and safe.
METHODS
Between Janunary 2010 and June 2013, ten patients who were diagnosed as Pancoast tumors were recruited. Six patients were accepted for surgical treatment either through an anterior (n=3) or a posterior approach (n=3) combined with VATS. The observation index of this study included: Operation safety and mortality; The integrity of the tumor resection; General data of operation and postoperative complications; Tumor recurrence and metastasis at twelve months after operation.
RESULTS
There were no perioperative deaths. The average time of operation time was 242 min. The radical en bloc resection of the involved chest wall were done in each patients. The average amount of blood loss was 308 mL and the average time of hospital stay was 14 d. Only one patient had postoperative pneumonia and recovered after use of antibiotics. There was none of severe postoperative complications. No patient developed a local recurrence or distant metastasis within twelve months.
CONCLUSIONS
The use of VATS has practical value in the management of Pancoast tumors. It is useful to make an accurate extent of the resection of chest-wall and provides a better exposure. Anterior or posterior approach with VATS surgery can facilitate the safety management of Pancoast tumors.
Topics: Female; Humans; Lung Neoplasms; Male; Middle Aged; Pneumonectomy; Thoracic Surgery, Video-Assisted
PubMed: 26582226
DOI: 10.3779/j.issn.1009-3419.2015.11.07 -
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 -
Chinese Clinical Oncology Dec 2015A retrospective monocentric study of consecutive patients with superior sulcus tumor non-small cell lung cancer (SS-NSCLC), treated by induction concurrent...
BACKGROUND
A retrospective monocentric study of consecutive patients with superior sulcus tumor non-small cell lung cancer (SS-NSCLC), treated by induction concurrent chemoradiotherapy (CRT), article management.
METHODS
From 1994 to 2005, 36 patients (15 T3, 21 T4 tumors, including N2-N3 node involvement) received induction CRT with cisplatin/vinorelbine/fluorouracil combined with 44 Gy radiotherapy (5 daily 2 Gy fractions/week). After CRT completion, RECIST evaluation and operability were assessed. In resectable patients, surgery was performed one month after CRT. Patients with unresectable disease followed CRT up to 66 Gy. The median of follow-up period was 38.6 months [2-206].
RESULTS
Induction CRT was completed for 94.4% with 71% radiological objective response (OR). Sixteen patients (44%) underwent surgical resection, and pathologic complete resection was performed in 93.8%. There were 7 patients (44%) with pathologic complete response. The median disease-free survival (DFS) time was 12.9 months with DFS rates at 1 and 2 years 53.6% and 39.1% respectively. The median overall survival (OS) was 46.4 months. The OS rates at 2 and 5 years were 68.8% and 37.5% respectively with no difference between T3 and T4 tumors. In unresectable disease, the median DFS time was 8.1 months. The DFS rate at 1 year was 25.2%. The median OS was 9.1 months. The OS rates at 1 and 2 years were 45% and 16.9% respectively. Recurrences were found in 72% of patients. Brain metastasis was the most common site of recurrence. Prognostic factors for OS were the response to induction treatment, the possibility of surgery, and pathologic complete response.
CONCLUSIONS
This trimodality treatment regimen confers a survival outcome in agreement with previous studies. Patients with pretreatment N3 lymph node should be included in trimodality treatment.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Carcinoma, Non-Small-Cell Lung; Chemoradiotherapy, Adjuvant; Cisplatin; Disease Progression; Disease-Free Survival; Dose Fractionation, Radiation; Female; Fluorouracil; France; Humans; Kaplan-Meier Estimate; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Pancoast Syndrome; Pneumonectomy; Proportional Hazards Models; Retrospective Studies; Time Factors; Treatment Outcome; Vinblastine; Vinorelbine
PubMed: 26730751
DOI: 10.3978/j.issn.2304-3865.2015.12.01 -
Clinical and Translational Radiation... Feb 2019Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a...
INTRODUCTION
Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee's multi-institutional quality assurance study in patients with Pancoast tumors as a "dry run" for trial implementation.
METHODS
CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG PET-CT while two patients had 3D-CT and FDG-FDG PET-CT. Seventeen SWOG-affiliated physicians independently delineated target volumes defined as gross primary and nodal tumor volumes (GTV_P & GTV_N), clinical target volume (CTV), and planning target volume (PTV).Six board-certified thoracic radiation oncologists were designated as the 'Experts' for this study. Their delineations were used to create a simultaneous truth and performance level estimation (STAPLE) contours using ADMIRE software (Elekta AB, Sweden 2017). Individual participants' contours were then compared with Experts' STAPLE contours.
RESULTS
When compared to the Experts' STAPLE, GTV_P had the best agreement among all participants, while GTV_N showed the lowest agreement among all participants. There were no statistically significant differences in all studied parameters for all TVs for cases with 4D-CT versus cases with 3D-CT simulation scans.
CONCLUSIONS
High degree of inter-observer variation was noted for all target volume except for GTV_P, unveiling potentials for protocol modification for subsequent clinically meaningful improvement in target definition. Various similarity indices exist that can be used to guide multi-institutional radiotherapy delineation QA credentialing.
PubMed: 30775563
DOI: 10.1016/j.ctro.2019.01.001 -
Annals of Thoracic and Cardiovascular... Jun 2017We describe our approach to resect a Pancoast tumor with thoracoscopic assistance in a partitioned incision. We used the LigaSure vessel-sealing system under...
We describe our approach to resect a Pancoast tumor with thoracoscopic assistance in a partitioned incision. We used the LigaSure vessel-sealing system under thoracoscopy in chest wall resection for Pancoast tumor. This approach is of great utility: easy-to use and less invasive for Pancoast tumor resection.
Topics: Carcinoma, Squamous Cell; Chemoradiotherapy, Adjuvant; Humans; Male; Middle Aged; Neoadjuvant Therapy; Pancoast Syndrome; Pneumonectomy; Thoracic Surgery, Video-Assisted; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 28484150
DOI: 10.5761/atcs.nm.17-00019