Pancoast Tumor Presenting as Neck Pain in the Chiropractic Office: A Case Report and Literature Review.

BACKGROUND Pancoast tumors, also called superior sulcus tumors, are a rare type of cancer affecting the lung apex. These tumors can spread to the brachial plexus and spine and present with symptoms that appear to be of musculoskeletal origin. CASE REPORT A 59-year-old Asian man presented to a chiropractor in Hong Kong with a 1-month history of neck and shoulder pain and numbness that had been treated unsuccessfully with exercise, medications, and acupuncture. He had an active history of tuberculosis, which was currently treated with antibiotics, and a 50-pack-year history of smoking. Cervical magnetic resonance imaging (MRI) was performed urgently, revealing a small cervical disc herniation thought to correspond with radicular symptoms. However, as the patient did not respond to a brief trial of care, a thoracic MRI was urgently ordered, revealing a large superior sulcus tumor invading the upper to mid-thoracic spine. The patient was referred for medical care and received radiotherapy and chemotherapy with a positive outcome. A literature review identified 6 previously published cases in which a patient presented to a chiropractor with an undiagnosed Pancoast tumor. All patients had shoulder, spine, and/or upper extremity pain. CONCLUSIONS Patients with a previously undiagnosed Pancoast tumor can present to chiropractors given that these tumors may invade the brachial plexus and spine, causing shoulder, spine, and/or upper extremity pain. Chiropractors should be aware of the clinical features and risk factors of Pancoast tumors to readily identify them and refer such patients for medical care.

Small Cell Lung Carcinoma with Pancoast Syndrome: A Case Report.

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.

Primary pulmonary angiosarcoma presenting as Pancoast tumor.

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.

Pancoast Tumor: The Overlooked Etiology of Shoulder Pain in Smokers.

BACKGROUND Shoulder pain is a common complaint in general practice and typically has an orthopedic or rheumatological etiology. However, it may be the presenting symptom of a serious underlying condition, such as lung cancer. CASE REPORT A 60-year-old man with a 30 pack-year history of smoking presented with worsening right shoulder pain over the last 6 months. He had no respiratory symptoms or weight change. He was seen at several general practice clinics and treated for a rotator cuff injury. However, his pain became severe, to the point that it affected his activities of daily living. A shoulder X-ray revealed opacity in the right apical zone. After a thorough investigation, the patient was found to have lung cancer with local invasion and intracranial metastases. However, in light of the advanced stage of the disease, a palliative approach was taken. The patient remained on multiple oral analgesics for the control of his pain. CONCLUSIONS The present case shows that common symptoms such as shoulder pain can be indicative of serious underlying pathology. Physicians should remain alert and maintain a high index of suspicion for Pancoast tumor in patients who are heavy smokers. Furthermore, a chest X-ray needs to be performed in elderly patients and smokers with shoulder pain.

Recurrent Diffuse Large B-Cell Lymphoma Presenting with Pancoast Syndrome: A Rare Cause of Radicular Neck Pain in the Emergency Department.

BACKGROUND: Pancoast syndrome is an uncommon complication of apical lung tumors. Symptoms include pain, brachial plexopathy, and Horner's syndrome, and are the result of extrinsic compression of tissues within the thoracic inlet. Lymphoma is a very rare etiology. CASE REPORT: We describe the presentation of a 59-year-old male with recurrent diffuse large B-cell lymphoma presenting with Pancoast syndrome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Cancer is an uncommon cause of radicular neck pain but should be considered in the differential, particularly when constitutional complaints are also present. Symptoms and physical examination findings associated with Pancoast syndrome are the consequence of compression of the C7-T2 vertebral roots and sympathetic chain. Computed tomography is usually required to definitively visualize the mass.

Primary Lung Signet Ring Cell Carcinoma Presenting as a Cavitary Pancoast Tumor in a 32-Year-Old Man.

Signet ring cell carcinoma, a subtype of adenocarcinoma, is a rare cause of primary lung cancer. The authors report a case of primary lung signet ring cell carcinoma presenting as a cavitary Pancoast tumor in a 32-year-old male smoker. Beyond the rarity of primary lung signet ring cell carcinoma itself, the youth of the patient, his smoking status, the presence of cavitation, and the location of the tumor in the superior sulcus make it especially atypical.

A rare presentation of myxofibrosarcoma as a Pancoast tumor: a case report.

BACKGROUND: Myxofibrosarcoma is an aggressive soft tissue neoplasm, classified as a variant of malignant fibrous histiocytoma. Most often, it occurs in middle to late adult life peaking in the seventh decade and involving the lower extremities (77%), trunk (12%), and retroperitoneum or mediastinum (8%). We report the first case of thoracic myxofibrosarcoma presenting as a Pancoast tumor. CASE PRESENTATION: A 48-year-old non-tobacco smoking African-American man presented with a slow-growing mass in his neck along with 11 kg weight loss over 9 months. A review of his systems was positive for hoarseness and lowgrade intermittent fever without any shortness of breath or cough. A physical examination revealed a mass on the left side of his neck superior to his sternoclavicular joint measuring 3 × 3 × 1 cm. He had ptosis and miosis of his left eye. His breath sounds were decreased and coarse at the left apex. A neurological examination revealed 3/5 strength in his left upper arm. The remainder of the physical examination was unremarkable. Ultrasound of his neck showed an ill-defined heterogeneous mass lateral to his left thyroid lobe. A computed tomography scan of his chest showed a large multiloculated pleural-based mass in his left lung surrounding the adjacent neurovascular structures. A percutaneous biopsy was non-diagnostic. Subsequently, he underwent a left thoracotomy with biopsy. The mass extended from his anterior mediastinum medially at the level of the pulmonary trunk, superiorly into the superior sulcus and posteriorly into his chest wall. Surgical pathology confirmed the diagnosis of myxofibrosarcoma. CONCLUSIONS: Here we present a case of Pancoast tumor with myxofibrosarcoma as the underlying etiology. Pancoast syndrome generally entails an infiltrating lesion in the superior sulcus presenting with upper extremity pain, atrophy of the hand muscles, and Horner's syndrome. The differential diagnosis of Pancoast syndrome includes inflammatory and infectious etiologies, as well as neoplasms of benign and malignant nature. Of the neoplasms implicated, the most common are non-small cell lung carcinomas; myxofibrosarcoma presenting as a Pancoast tumor has not been reported in the literature.

Spindle Cell Sarcoma Presenting as Pancoast Syndrome.

This report describes a patient who presented with pancoast syndrome, secondary to spindle cell sarcoma of the lung. A 56-year man presented with dyspnea, engorged neck veins and bilateral upper limb pitting edema. The patient also had ptosis and miosis in the right eye. Right ulnar nerve palsy with atrophy of hand muscles was seen. His chest X-ray showed bilateral pleural effusion with an opacity involving the apex of the right lung along with mediastinal widening. Echocardiography revealed a pericardial effusion which was drained. The patient's CTscan of chest strongly suspected a malignant mass in right upper lobe with extensive mediastinal lymphadenopathy, pleural metastases and pericardial involvement. He was started on oxygen inhalation, dexamethasone, and clopidogrel. Bronchoscopic biopsy confirmed the diagnosis of spindle cell sarcoma. Meanwhile, he was advised radiotherapy. The tumour was not amenable to surgery. Spindle cell sarcoma is a rare connective tissue tumor that replicates rapidly. To the best of the authors' knowledge, it is hereby reported the first case of spindle cell sarcoma of the lung presenting as Pancoast syndrome.

Tumor del vértice pulmonar superior como causa del síndrome de Pancoast / Upper lung apex tumor as a cause of Pancoast syndrome

El cáncer bronquial es una de las neoplasias malignas de mayor trascendencia por su creciente incidencia, alta mortalidad y en gran medida evitable mediante el control del tabaquismo. El síndrome de Pancoast se produce por la presencia de un tumor en el vértice pulmonar con extensión local hacia el plexo braquial, cadena simpática cervical inferior y primeros cuerpos vertebrales y costillas. Su causa principal es el cáncer de pulmón no microcítico, y cursa con dolor de hombro y síndrome de Horner. La mejor técnica diagnóstica es la punción transtorácica por su localización periférica, y la mejor opción terapéutica es la quimiorradioterapia neoadyuvante seguida de cirugía en los casos resecables.

[Tumour of the right lung vertex that produced a Pancoast syndrome: description of a case]. / Tumor del vértice pulmonar derecho que produce un síndrome de Pancoast. Descripción de un caso clínico.

We describe a clinical case of an 80 year-old woman, with a history of Alzheimer's disease, who presented with right shoulder pain, numbness and decreased strength in the right arm, with right eye ptosis, cough and dysphagia. The chest X-Ray and thoracic-abdominal computed tomography scan showed a large mass in the upper lobe and apex of the right lung, supraclavicular metastatic lymph nodes. In the fine needle aspiration biopsy: poorly differentiated non-small cell carcinoma. She was referred to Oncology to start chemotherapy treatment.

Pancoast's syndrome secondary to infectious etiologies: a not so uncommon occurrence.

Pancoast's syndrome includes Horner's syndrome, atrophy of the hand muscles and shoulder, axilla or arm pain. This syndrome is caused by an apical thoracic lesion, most commonly a bronchogenic carcinoma, which invades the brachial plexus roots and the cervicothoracic sympathetic chain. Several nonmalignant causes are documented in the literature with infection being one. After a case of Pancoast syndrome caused by a methicillin-sensitive Staphylococcus aureus empyema, we began a systematic search of the literature to identify case reports/series of Pancoast syndrome secondary to infection. Our search was limited to the English language and performed using MEDLINE. Thirty-one cases of Pancoast's syndrome secondary to infectious causes were found in our review of the literature. The infectious causes identified were bacterial, fungal and parasitic organisms; however, no single organism could be identified as the most prevalent. Our review represents the most complete summation of individual case reports on this subject and highlights clinical characteristics of each presentation and the organisms that were encountered. This number of cases of Pancoast's syndrome secondary to infectious causes indicates that this association may be more common than previously reported.

[A case of rapidly progressing lung spindle cell carcinoma presenting as Pancoast syndrome].

We report a case of rapidly progressing spindle cell carcinoma presenting as Pancoast syndrome. The patient was a 59-year-old woman with a chief complaint of right forearm paresthesia. A chest computed tomography revealed a huge tumor in S1 and S2 in the right lung, invading the upper mediastinum and the first rib. A CT-guided lung biopsy was performed. H-E stain of the tissue revealed spindle-shaped tumor cells proliferating diffusely in a streaming pattern without definitive squamous or glandular differentiation. Immunohistochemical stains with CAM 5.2 and vimentin were positive for tumor cells. Based on a pathological diagnosis of spindle cell carcinoma (cT4N3M1, stage IV) she was treated with chemoradiotherapy. Despite treatment, the patient died 6 months after presenting.

Small cell carcinoma in Pancoast syndrome.

Pancoast syndrome consists of signs and symptoms resulting from a tumor affecting the pulmonary apex and adjacent structures. The process is typically caused by a neoplasm. The majority of cases of Pancoast syndrome are caused by bronchogenic carcinoma. The most commonly found histologic subtypes are adenocarcinoma and epidermoid carcinoma. There have been very few reports of small cell lung carcinoma in the genesis of Pancoast syndrome. We describe the case of a patient with Pancoast syndrome caused by small cell lung carcinoma and discuss the aspects related to the diagnosis and treatment.

Carcinoma de pequenas células na síndrome de Pancoast / Small cell carcinoma in Pancoast syndrome

A síndrome de Pancoast consiste de sinais e sintomas decorrentes do acometimento do ápice pulmonar e estruturas adjacentes por um tumor. Na maioria das vezes, o processo causal é uma neoplasia. O carcinoma broncogênico é a principal neoplasia causadora da síndrome. Os subtipos histológicos mais encontrados são o adenocarcinoma e o carcinoma epidermoide. A ocorrência de carcinoma de pequenas células de pulmão como gênese da síndrome de Pancoast é rara, com poucos relatos na literatura. Descrevemos o caso de um doente com síndrome de Pancoast causado por um carcinoma de pequenas células de pulmão, discutindo aspectos referentes ao diagnóstico e à terapêutica.

Pancoast syndrome consists of signs and symptoms resulting from a tumor affecting the pulmonary apex and adjacent structures. The process is typically caused by a neoplasm. The majority of cases of Pancoast syndrome are caused by bronchogenic carcinoma. The most commonly found histologic subtypes are adenocarcinoma and epidermoid carcinoma. There have been very few reports of small cell lung carcinoma in the genesis of Pancoast syndrome. We describe the case of a patient with Pancoast syndrome caused by small cell lung carcinoma and discuss the aspects related to the diagnosis and treatment.

Alleviation of Pancoast's tumor pain by ultrasound-guided percutaneous ablation of cervical nerve roots.

The case report describes use of real-time ultrasound guidance to facilitate percutaneous ablation of cervical nerve roots in a patient with Pancoast's syndrome. Distortion of anatomy by the tumor made it difficult to perform the procedure safely using fluoroscopy. A 64-year-old right-handed male patient with carcinoma of the left lung presented with severe pain in the left shoulder and the arm. A clinical diagnosis of the left brachial plexopathy secondary to tumor involvement of C5 to C8 nerve roots was made. Radiological appearance of the cervical spine revealed distorted anatomy because of severe degeneration of the cervical spine and guarding torticollis. Diagnostic prognostic block of the C4 to C7 exiting nerve roots was done under ultrasound guidance and resulted in more than 75% reduction in pain intensity for 4 hours. Ultrasound-guided percutaneous cervical rhizotomy was performed later. At 3-month follow-up, the patient still had complete pain relief as well as improvement in quality of sleep. Ultrasound-guided cervical nerve roots ablation is a feasible approach for patients with intractable neuropathic pain secondary to Pancoast's tumor. It can be a useful alternative to fluoroscopy in patients in whom a fluoroscopy-guided approach is deemed difficult and hazardous.

[Pancoast tumor-like primary lung lymphoma]. / Pierwotny chloniak oskrzela o klinicznym przebiegu guza Pancoasta.

Apical lung location of lymphomas is extremely rare and may pose diagnostic problems. Here we present a case of advanced primary Pancoast-like left apical lung lymphoma incidentally diagnosed in a 72 year old asymptomatic woman after a routine, prophylactic chest X-ray performed in June 2005. FNB was not diagnostic therefore an open lung biopsy was attempted. Histopathological examination of the excised specimen was consistent with B-cell low-grade marginal zone extranodal NHL (BALTL); CD20+, CD3-. Treatment combined of 9 cycles of chemotherapy followed by radiotherapy of the residual mass allowed to achieve a long-term complete remission.

Pancoast syndrome caused by metastasis to the superior mediastinum of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is common in Taiwan. Recently, extrahepatic metastases have developed more frequently in patients due to prolonged survival rates to which improved diagnostic and treatment methods have contributed. We present here a case of a 46-year-old man with an unusual metastasis to the superior mediastinum causing Pancoast syndrome eight months after a right hepatic lobectomy for HBV-related HCC. Early detection and prompt treatment of paraspinal metastasis are important to relieve symptoms and prevent permanent loss of neurological functions.