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Multimedia Manual of Cardiothoracic... Mar 2024We describe a rare procedure involving near-total robotic-assisted thoracoscopic surgery resection of a right posterior Pancoast tumour. Four ports and an assistant port...
We describe a rare procedure involving near-total robotic-assisted thoracoscopic surgery resection of a right posterior Pancoast tumour. Four ports and an assistant port were used. The DaVinci X system was used. The lobectomy was performed first to allow for adequate exposure to the apex and spine. The lateral aspect of ribs 1 to 4 was resected next, and the extrathoracic space was entered. Dissection proceeded through this space superiorly up to the level of the scapula and then posteriorly towards the spine. The second to the fifth ribs were dissected off the chest wall and resected medially off the spine at the rib heads. Further postero-superior exploration revealed the tumour to be invading the transverse process of the second rib, with ill-defined margins. Because of this development, and with the support of the spinal surgeons, a small high posterior thoracotomy was performed to complete the procedure and remove the specimen en bloc. The postoperative recovery was uneventful, and the patient was discharged on post-operative day 5. The final histological report confirmed a squamous non-small-cell lung cancer (pT3N0M0) with negative margins (R0). Asymptomatic recurrence was noted near the margin of the second rib resection posteriorly 1 year postoperatively and was successfully treated with radiotherapy.
Topics: Humans; Robotic Surgical Procedures; Thoracic Wall; Carcinoma, Non-Small-Cell Lung; Pancoast Syndrome; Lung Neoplasms; Thoracoscopy
PubMed: 38526520
DOI: 10.1510/mmcts.2023.063 -
Frontiers in Neurology 2019Horner's syndrome is an established clinical finding unique to neoplastic brachial plexopathy. We present the case of a patient who developed Horner's syndrome as the...
Horner's syndrome is an established clinical finding unique to neoplastic brachial plexopathy. We present the case of a patient who developed Horner's syndrome as the first manifestation of neurolymphomatosis (NL) of the brachial plexus that did not have the usually associated bulky adenopathy/Pancoast syndrome phenotype. We discuss the clinical utility of Horner's syndrome with regards to brachial plexopathy of indeterminate etiology, as well as the utility of other diagnostic modalities in NL. NL, particularly of the brachial plexus, is particularly challenging to diagnose. MRI and CSF studies are often inconclusive. FDG-PET imaging can be difficult to get insurance to approve. The presence of Horner's syndrome in brachial plexopathy of indeterminate etiology, even in the absence of bulky adenopathy, should raise clinical suspicion of NL, possibly prompting such interventions as fascicular nerve biopsy.
PubMed: 30723449
DOI: 10.3389/fneur.2019.00004 -
Thoracic Cancer Nov 2022Surgical treatment of superior sulcus tumors (SSTs) is clinically challenging. Definitive chemoradiotherapy (CRT) is a standard treatment for SST. In operable cases,...
Surgical treatment of superior sulcus tumors (SSTs) is clinically challenging. Definitive chemoradiotherapy (CRT) is a standard treatment for SST. In operable cases, multimodal therapy (CRT followed by surgery) is another option, at least for experienced institutions. Immune checkpoint inhibitors (ICIs) have recently been developed, and several clinical trials have investigated definitive CRT followed by ICIs for consolidation or maintenance therapy of unresectable local advanced non-small cell lung cancer (NSCLC), including SSTs. Clinical studies of salvage surgery after CRT followed by ICIs are also ongoing. However, the clinical outcomes of salvage surgery after multimodal therapies and histopathological analyses of surgical specimens after such treatments remain unclear. Here, we report the case of a patient with SST comprising squamous cell carcinoma with invasion of the second to third rib and vertebrae who underwent salvage surgery after concurrent definitive CRT followed by the ICI durvalumab, and show the results of clinicopathological analyses of the resected specimen.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Chemoradiotherapy; Salvage Therapy; Pancoast Syndrome; Neoplasm Staging
PubMed: 36193676
DOI: 10.1111/1759-7714.14681 -
Respiratory Medicine Case Reports 2019A 45-year old man, chronic smoker with a pancoast tumor due to squamous cell carcinoma has been described. The initial diagnosis of lung carcinoma was based on a scant...
A 45-year old man, chronic smoker with a pancoast tumor due to squamous cell carcinoma has been described. The initial diagnosis of lung carcinoma was based on a scant tissue so the exact cell typing was not possible. The initial treatment consisted of platinum based chemotherapy and radiotherapy. He developed a left adrenal lesion on treatment. There was a possibility of metachronous primary. Also, a large tissue sample was required for tumor markers. The lung mass was difficult to access and was static on treatment. A left adrenal biopsy was considered to be more appropriate. A novel approach for left adrenal lesion with esophageal ultrasound using ultrasound bronchoscope (EUS-B) was successfully performed. This article is aimed at describing the use of EUS-B for transdiaphragmatic structures.
PubMed: 30603608
DOI: 10.1016/j.rmcr.2018.12.012 -
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 -
Reports of Practical Oncology and... 2016A dosimetric study comparing intensity modulated radiotherapy (IMRT) by TomoTherapy to conformational 3D radiotherapy (3D-RT) in patients with superior sulcus non-small...
AIM
A dosimetric study comparing intensity modulated radiotherapy (IMRT) by TomoTherapy to conformational 3D radiotherapy (3D-RT) in patients with superior sulcus non-small cell lung cancer (NSCLC).
BACKGROUND
IMRT became the main technique in modern radiotherapy. However it was not currently used for lung cancers. Because of the need to increase the dose to control lung cancers but because of the critical organs surrounding the tumors, the gains obtainable with IMRT is not still demonstrated.
MATERIAL AND METHODS
A dosimetric comparison of the planned target and organs at risk parameters between IMRT and 3D-RT in eight patients who received preoperative or curative intent irradiation.
RESULTS
In the patients who received at least 66 Gy, the mean V95% was significantly better with IMRT than 3D-RT (p = 0.043). IMRT delivered a lower D2% compared to 3D-RT (p = 0.043). The IH was significantly better with IMRT (p = 0.043). The lung V 5 Gy and V 13 Gy were significantly higher in IMRT than 3D-RT (p = 0.043), while the maximal dose (D max) to the spinal cord was significantly lower in IMRT (p = 0.043). The brachial plexus D max was significantly lower in IMRT than 3D-RT (p = 0.048). For patients treated with 46 Gy, no significant differences were found.
CONCLUSION
Our study showed that IMRT is relevant for SS-NSCLC. In patients treated with a curative dose, it led to a reduction of the exposure of critical organs, allowing a better dose distribution in the tumor. For the patients treated with a preoperative schedule, our results provide a basis for future controlled trials to improve the histological complete response by increasing the radiation dose.
PubMed: 27489512
DOI: 10.1016/j.rpor.2016.03.006 -
Journal of Hand and Microsurgery Dec 2015
PubMed: 26578844
DOI: 10.1007/s12593-015-0195-1 -
Journal of Cardiothoracic Surgery Sep 2014Since 2001 we have utilized a novel surgical approach for Pancoast tumors in which lobectomy and mediastinal lymph node dissection are performed directly though the...
BACKGROUND
Since 2001 we have utilized a novel surgical approach for Pancoast tumors in which lobectomy and mediastinal lymph node dissection are performed directly though the chest wall defect. The defect is then patched at the completion of the procedure ("cut-in patch-out") thereby avoiding a separate thoracotomy with rib spreading. We undertook a study to compare outcomes of this novel "cut-in patch-out" technique with traditional thoracotomy for patients with Pancoast tumors.
METHODS
We retrospectively identified 41 patients undergoing surgical resection of Pancoast tumors requiring en-bloc removal of at least 3 ribs at our institution from 1999 to 2012. Surgery was accomplished by either a "cut-in patch-out" technique (n = 25) or traditional posterolateral thoracotomy and separate chest wall resection (n = 16). Multiple variables including patient demographics, neoadjuvant therapy, extent of resection, and pathology were analyzed with respect to outcomes from morbidity, narcotic use, and oncologic perspectives.
RESULTS
Baseline demographics, neoadjuvant therapy, and perioperative factors including extent of surgery, complete resections (R0), nodal status and lymph node number, morbidity, and mortality were similar between the two groups. The mean duration of out-patient narcotic use was significantly lower in the "cut-in patch-out" group compared to the thoracotomy group (80.6 days ± 62.4 vs. 158.2 days ± 119.2, p < 0.01). Using multivariate regression analysis, the traditional thoracotomy technique (OR 7.72; p = 0.01) was independently associated with prolonged oral narcotic requirements (>100 days). Additionally, five year survival for the "cut-in patch-out" group was 48% versus the traditional group at 12.5% (p = 0.04).
CONCLUSIONS
Compared with a traditional thoracotomy and separate chest wall resection approach for P-NSCLC, a "cut-in patch-out" technique offers an alternative approach that appears to have at least oncologic equivalence while decreasing pain. We have more recently adapted this technique to select patients with pulmonary neoplasms involving chest wall invasion and believe further investigation is warranted.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Case-Control Studies; Female; Humans; Lymph Node Excision; Male; Mediastinum; Middle Aged; Pain, Postoperative; Pancoast Syndrome; Pneumonectomy; Retrospective Studies; Thoracic Wall; Thoracotomy; Treatment Outcome
PubMed: 25265907
DOI: 10.1186/s13019-014-0163-z -
BMJ Case Reports Mar 2017We present an interesting case where a patient is presented with a droopy left eyelid (as part of Horner syndrome) and Cushingoid features which were a result of a...
We present an interesting case where a patient is presented with a droopy left eyelid (as part of Horner syndrome) and Cushingoid features which were a result of a Pancoast tumour (apical lung tumour in superior pulmonary sulcus) involving the left lung. This tumour was secreting ectopic adrenocorticotropic hormone (ACTH), a paraneoplastic endocrine phenomenon, which resulted in Cushing syndrome symptomatology. Though most ectopic ACTH-producing lung cancers are either small cell or carcinoid tumours, this was in fact a large cell neuroendocrine cancer (LCNEC). Patient underwent surgical resection and adjuvant/neoadjuvant chemotherapy with radiation; however, he succumbed to LCNEC given aggressive nature of the disease.
Topics: ACTH Syndrome, Ectopic; Adrenocorticotropic Hormone; Carcinoid Tumor; Carcinoma, Large Cell; Fatigue; Horner Syndrome; Humans; Lung Neoplasms; Male; Neoadjuvant Therapy; Pancoast Syndrome
PubMed: 28343156
DOI: 10.1136/bcr-2016-219156 -
Tidsskrift For Den Norske Laegeforening... Mar 2019
Topics: Aged; Arm; Brachial Plexus Neuritis; Carcinoma, Non-Small-Cell Lung; Fatal Outcome; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Muscular Atrophy; Pain; Pancoast Syndrome; Paresis; Tomography, X-Ray Computed
PubMed: 30872839
DOI: 10.4045/tidsskr.18.0497