-
Case Reports in Pulmonology 2014Malignant tumours in the apices of the lungs, especially bronchogenic carcinoma (Pancoast tumours), are the most common cause of Pancoast' syndrome which presents with...
Malignant tumours in the apices of the lungs, especially bronchogenic carcinoma (Pancoast tumours), are the most common cause of Pancoast' syndrome which presents with shoulder or arm pain radiating along the medial aspect of forearm and weakness of small muscles of hand with wasting of hypothenar eminence due to neoplastic involvement of C8 and T1 and T2 nerve roots of brachial plexus. There are a number of benign conditions which may lead to Pancoast's syndrome; fungal abscess located in the apex of lung is one of them. Oral or intravenous antifungals are the treatment of choice in this case and complete recovery is usual, whereas, surgical resection followed by chemoradiotherapy is the treatment of choice in case of Pancoast's syndrome due to lung cancers. Hence, tissue diagnosis is mandatory. Here, we report a case of apical fungal abscess causing Pancoast's syndrome in an immunocompetent individual of 35 years of age to raise the awareness among the clinicians regarding this rare clinical entity.
PubMed: 25302130
DOI: 10.1155/2014/581876 -
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 -
Cancer Control : Journal of the Moffitt... Apr 2014The preferred treatment for locally aggressive lung cancers is triple modality therapy with concurrent and induction chemotherapy with radiation therapy followed by... (Review)
Review
BACKGROUND
The preferred treatment for locally aggressive lung cancers is triple modality therapy with concurrent and induction chemotherapy with radiation therapy followed by surgery. Patients with locally advanced T4 Pancoast tumors with spine involvement, without mediastinal N2 lymph node involvement and without distant metastases, are appropriate candidates for complete resection with subsequent spine reconstruction. This review addresses the questions of whether triple modality therapy with complete en bloc resection of locally advanced Pancoast tumors offers an advantage in terms of overall survival and complication rates compared with other therapeutic modalities or therapies with incomplete resection.
METHODS
A comprehensive literature search was conducted using common medical databases. Inclusion and exclusion criteria for the articles were prospectively defined. The articles were independently reviewed and a consensus decision was made about each article. Selected papers were graded by level of evidence.
RESULTS
A total of 1,001 abstracts and 93 articles fulfilled the criteria; from these studies, 14 were included in this systematic review. No level 1 study was found in this search. Four level 2 studies and 10 level 3 retrospective case series were found. The overall 5-year survival rate reported in these studies ranged from 37% to 59% and the mortality rate ranged from 0% to 6.9%.
CONCLUSIONS
Evidence suggests that triple modality therapy with complete resection of locally advanced Pancoast tumors with involvement of the spine offers an advantage over other therapeutic modalities or therapies with incomplete resections.
Topics: Combined Modality Therapy; Humans; Lymphatic Metastasis; Pancoast Syndrome; Prognosis; Prospective Studies; Spinal Neoplasms; Survival Rate
PubMed: 24667403
DOI: 10.1177/107327481402100209 -
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 Medical Case Reports Aug 2011Pancoast syndrome is characterized by Horner syndrome, shoulder pain radiating down the arm, compression of the brachial blood vessels, and, in long-standing cases,...
INTRODUCTION
Pancoast syndrome is characterized by Horner syndrome, shoulder pain radiating down the arm, compression of the brachial blood vessels, and, in long-standing cases, atrophy of the arm and hand muscles. It is most commonly associated with lung carcinoma but rarely is seen with certain infections.
CASE PRESENTATION
We present the case of a 51-year-old Caucasian man who had acute myeloid leukemia and who developed a rapidly fulminating pneumonia along with signs and symptoms of acute brachial plexopathy and left Horner syndrome. Also, a purpuric plaque developed over his left chest wall and progressed to skin necrosis. The skin biopsy and bronchoalveolar lavage showed a Rhizopus species, leading to a diagnosis of mucormycosis. This is a rare case of pneumonia due to mucormycosis associated with acute Pancoast syndrome.
CONCLUSIONS
According to our review of the literature, only a few infectious agents have been reported to be associated with Pancoast syndrome. We found only three case reports of mucormycosis associated with acute Pancoast syndrome. Clinicians should consider mucormycosis in their differential diagnosis in a patient with pulmonary lesions and chest wall invasion with or without neurological symptoms, especially in the setting of neutropenia or other immunosuppressed conditions. It is important to recognize this condition early in order to target therapy and interventions.
PubMed: 21849070
DOI: 10.1186/1752-1947-5-388 -
Cureus Jan 2024[This retracts the article DOI: 10.7759/cureus.19418.].
[This retracts the article DOI: 10.7759/cureus.19418.].
PubMed: 38274616
DOI: 10.7759/cureus.r94 -
Journal of Investigative Medicine High... 2023Pancoast tumor is a rare and aggressive form of lung cancer; cardiac metastasis is very uncommon. We present a case of advanced Pancoast tumor, with extensive cardiac...
Pancoast tumor is a rare and aggressive form of lung cancer; cardiac metastasis is very uncommon. We present a case of advanced Pancoast tumor, with extensive cardiac metastases and intracardiac thrombosis in a woman presenting with dyspnea, shoulder pain, and weight loss. A contrast-enhanced chest computed tomographic scan revealed an apical mass, metastatic thoracic nodes, and filling defects within both ventricles. Further imaging with cardiac magnetic resonance imaging revealed 2 left ventricular masses infiltrating into the myocardium suggestive of metastatic disease, and a multilobulated mass within the right ventricle suggestive of intracardiac thrombus. She was initiated on anticoagulation for intracardiac thrombosis. Surgical pathology of biopsied tissue samples was consistent with advanced metastatic lung adenocarcinoma. She was a poor candidate for surgical intervention. Given the patient's goals of care, she was ultimately transitioned to comfort care.
Topics: Female; Humans; Pancoast Syndrome; Heart Neoplasms; Lung Neoplasms; Thrombosis; Adenocarcinoma of Lung
PubMed: 36772879
DOI: 10.1177/23247096231154642 -
Cureus Feb 2021A 65-year-old man with 50 pack-year smoking history presented to the emergency department for evaluation of upper back and right shoulder pain secondary to a fall....
A 65-year-old man with 50 pack-year smoking history presented to the emergency department for evaluation of upper back and right shoulder pain secondary to a fall. Physical examination was notable for anisocoria with a constricted left pupil (miosis), mild ptosis of the left eyelid, and bilateral shoulder pain, right more than left, with both passive and active movements. Chest computed tomography identified a soft tissue mass at the left lung apex with extension into the pleural surface, associated with destructive osseous changes of the right scapula, adjacent ribs, and thoracic vertebral bodies. Imaging of the brain revealed multiple masses suspicious of metastatic brain lesions. Biopsy of the right supraclavicular lymph node revealed lung tissue adenocarcinoma and negative Kirsten rat sarcoma viral oncogene homolog (K-Ras), epidermal growth factor receptor (EGFR), B-raf proto-oncogene (BRAF), C-ros oncogene 1 (ROS1), and anaplastic lymphoma kinase (ALK) rearrangement. Recognizing Pancoast syndrome in patients with significant smoking history, anisocoria, and shoulder pain is crucial for identifying the underlying etiology and expediting the treatment.
PubMed: 33728131
DOI: 10.7759/cureus.13112 -
JNMA; Journal of the Nepal Medical... Feb 2022Small cell lung cancer mostly arises centrally in the large bronchi. The literature search revealed very limited cases of small cell lung cancer arising at the upper...
Small cell lung cancer mostly arises centrally in the large bronchi. The literature search revealed very limited cases of small cell lung cancer arising at the upper part of the pulmonary sulcus near the thoracic inlet as superior sulcus tumor and also manifesting with typical Pancoast syndrome. We report a case of a 71 years old male patient, presenting with features of Pancoast syndrome including Horner's syndrome with completed three cycles of chemotherapy resulting in partial response which concludes that small cell lung carcinoma has to be considered despite the clinical findings like pancoast syndrome.
Topics: Aged; Humans; Lung Neoplasms; Male; Pancoast Syndrome; Small Cell Lung Carcinoma
PubMed: 35210644
DOI: 10.31729/jnma.6620 -
Asian Spine Journal Oct 2022Retrospective cohort study.
STUDY DESIGN
Retrospective cohort study.
PURPOSE
This study aimed to evaluate the outcomes of patients who had T4 Pancoast tumors invading the spine and underwent en bloc resection and spinal stabilization through a single-stage posterior approach.
OVERVIEW OF LITERATURE
Surgical resection for Pancoast tumors affecting the spine has been successfully performed in two stages involving spinal reconstruction and tumor resection. However, reports have rarely presented the results of en bloc resection combined with spinal stabilization for T4 Pancoast tumors invading the spine through a single-stage posterior approach.
METHODS
Patients who had T4N0M0 Pancoast tumors invading the spine and underwent a single-stage posterior approach were retrospectively recruited. The following data were obtained and examined: demographics, tumor histology, preoperative and postoperative therapy, complications, spinal reconstruction technique, tumor resection extent, survival time, and disease recurrence.
RESULTS
Eighteen patients were included. The mean population age was 61±17 years, and the most common pathological type was adenocarcinoma (61.1%). Complete resection (R0) was obtained in 15 patients (83.3%), positive surgical margins (R1) were found in three patients (16.7%), and the 90-day mortality rate was 0%. Postoperative major complications were detected in 12 patients (66.7%), who required reoperation. The mean survival time was 67±24 months, but the median survival time was not reached. Among the patients, 10 (55.6%) are still alive at the end of the study. The 2- and 5-year actual survival rates were 59% (95% confidence interval [CI], 35.7%-82.3%) and 52.5% (95% CI, 28.4%-76.6%), respectively.
CONCLUSIONS
En bloc resection and spinal stabilization through a single-stage posterior approach might be effective for T4 Pancoast tumors invading the spine.
PubMed: 35654107
DOI: 10.31616/asj.2021.0202