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.

Cases presenting to orthopedists with manifestations of lung cancer on skeletal radiographs.

The value of cervical spine or shoulder radiography has been established for the detection of Pancoast tumors. However, for the detection of lung cancers other than Pancoast tumors, the value of these skeletal radiographies has not been assessed. The aim of our study was to determine how many patients first presented to orthopedists with manifestations of lung cancer on skeletal radiographs and to present several cases for illustration. From the registry of the pathology department of our hospital, we identified 345 lung cancer patients diagnosed histologically over 10 years. From these patients, we selected 310 who had no previous history of malignancies at histological diagnosis of lung cancer. The study population consisted of individuals from the selected patients who had presented once or more to orthopedists at our hospital for any reason, at up to 2 years prior to histological diagnosis of lung cancer. For the study population, all radiological examinations performed by the orthopedists were reviewed by radiologists. The study population included 46 patients constituting 14.8 % (46/310) of the selected patients. Of these 46 patients, 37 (80.4 %) received 97 skeletal radiographies. Reviewing these skeletal radiographies disclosed lung tumors on 13 in 11 (11/46, 23.9 %) of the patients. We found that more than 10 % of lung cancer patients with no previous history of malignancies had presented to orthopedists on one or more occasions, at up to 2 years before histological diagnosis, and that approximately 25 % of these patients had manifestations of lung cancer on skeletal radiographs.

Pancoast tumor presenting with multiple joint pains: a case report.

BACKGROUND: Pancoast tumors represent a unique subset of lung cancers wherein a primary neoplasm arises in the lung's apex and invades the surrounding soft tissues. One of the main challenges in the diagnosis and treatment of these apical lung cancers is that they are usually not visualized on initial chest x-ray and, by the time the patient presents with symptoms, the tumor has almost always invaded nearby structures. CASE PRESENTATION: Herein we report a case of a 58-year-old nonsmoking African American male who presented to the neurology clinic with a history of multiple chronic joint pains. The patient complained of shoulder pain that traveled into his right arm and right finger and had worsened over the past 9 months. The patient also reported decreased right proximal strength and swelling of his right hand. Magnetic resonance imaging of the shoulder and cervical region showed mild cervical spondylosis and a questionable right apical mass. A subsequent high-resolution computed tomography scan of the chest revealed a large right apical lung mass, with chest wall invasion and erosion of the adjacent ribs. Biopsy of the mass confirmed poorly differentiated non-small cell lung cancer. Radiation therapy was initiated, and the patient's pain improved significantly. Given the size of the tumor, chemotherapy was recommended by the oncology team. The patient decided against chemotherapy. CONCLUSION: This case highlights the importance of early diagnosis by expanding the differential diagnosis in patients presenting with weakness, sensory loss, and shoulder pain beyond radiculopathy or joint-related diseases. A comprehensive history and careful examination may lead to an earlier diagnosis, more appropriate treatment, and better outcome in cases of Pancoast tumor presenting with neuropathic or musculoskeletal pain.

PANCOAST TUMOUR WITH SPINE RESECTION - CASE REPORT.

Pancoast tumours are defined as tumours arising from the upper lobe and invading the thoracic inlet,representing less than 5% of all lung cancers. Clinical features depend on the involved structures. For many years invasion of the spine was considered unresectable and fatal. Due to the progress in spine surgery, en bloc resection including the spine is nowadays possible. We report the first case of a successful en bloc vertebral resection of a Pancoast tumour in a 66 year-old male, with a squamous cell carcinoma, treated at our department in a multidisciplinary setting, after induction chemoradiotherapy. An en bloc resection including the left upper lobe, the first three ribs and the vertebral body of D2, was performed through a Paulson incision after posterior cervico-dorsal arthrodesis. A complete R0 resection was confirmed on the pathology specimen. Currently, one year after surgery, although no local recurrence has occurred, the patient is being treated with immunotherapy due to disease progression in the right acetabulum which was irradiated (20Gy) and then submitted to iliac resection and prothesis reconstruction.

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.

[Do we inspecting the patient face who has shoulder pain?] / Omuz agrisi olan hastanin yüzünü de muayene ediyor muyuz?

A Pancoast or superior sulcus tumor is a rare, bronchogenic carcinoma. In the early period, shoulder pain is the most common symptom. In this case, the patient had presented with complaints of shoulder and arm pain at other outpatient clinics and was examined primarily for musculoskeletal causes and radiculopathy. The patient had no complaints of facial symptoms and Horner's syndrome signs, such as anhidrosis of the face and neck region, were not noticed. Advanced imaging of a patient with preganglionic Horner's syndrome is important. Fewer than 50% of patients with a Pancoast tumor have a resectable lesion at the first diagnosis. Diagnosis is often delayed or there may be a misdiagnosis because musculoskeletal disorders are the focus and there are few lung-related complaints. A detailed examination and anamnesis is very important in patients with arm and shoulder pain.

[A case of lung adenocarcinoma of pancoast type successfully treated with concurrent chemoradiotherapy].

We reported a case of lung adenocarcinoma of Pancoast type that was successfully treated with chemoradiotherapy. A 66-year-old man was admitted to our hospital because of back pain. Chest computed tomography (CT) showed a Pancoast tumor on the left side. Using transbronchial needle aspiration, we diagnosed lung adenocarcinoma (cT3N0M0). The patient received chemoradiotherapy simultaneously(carboplatin AUC5 and irinotecan 60 mg/m2). There are no findings of tumor recurrence 8 years after chemoradiotherapy. This patient was successfully treated with concurrent chemoradiotherapy, which is suggested to be a useful therapy for Pancoast tumor.

Reconstruction of a dominant vertebral artery during resection of a superior sulcus tumour with an incomplete circle of Willis.

A 74-year-old man presented with a left superior sulcus tumour invading the subclavian artery. After induction chemoradiotherapy, he underwent a vertebral artery reconstruction in addition to the subclavian artery reconstruction via a transmanubrial approach and video-assisted thoracoscopic left upper lobectomy. The final pathology was ypT4N0M0 adenocarcinoma. The technical aspects and indication for a vertebral artery reconstruction are discussed in this article.

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 with rheumatic symptoms without Pancost's syndrome--case report]. / Guz Pancoasta z objawami reumatologicznymi bez zespolu Pancoasta--opis przypadku.

About 5% of pulmonary lesions are the apical lung tumors, which can be divided in tumors producing and non-producing Pancoast's syndrome. The authors present a case of a 45-year-old male with ambulatory non-diagnosed Pancoast tumor demonstrating with rheumatic symptoms without typical signs of Pancoast's syndrome. Performing a routine chest X-ray after complete treatment of pulmonary inflammatory diseases, as well as in rheumatic disorders was proved fundamental.

Less Invasive Approach to Pancoast Tumor in a Partitioned Incision.

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.

Pleural lipoma clinically mimicking the presentation of superior sulcus tumour upon initial evaluation.

Here we present a case of a large pleural lipoma which presented with paresthesias of the hand. This is an unusual presentation of an uncommon tumour.

Delay by patients and doctors in treatment of Pancoast tumor.

PURPOSE: Long delays in diagnosis and treatment of Pancoast tumor have been reported but the reasons for these delays have yet to be fully considered. The aim of this study was to assess recent delays in diagnosis and treatment of Pancoast tumor and to determine the reasons for the delays. PATIENTS AND METHODS: We identified Pancoast tumors in patients with lung cancer referred to the radiation department of a city hospital between September 1999 and August 2004. From interviews conducted by a radiation oncologist and review of the medical records, delay due to a patient was calculated as the interval between the onset of symptoms and presentation to a physician, and delay due to a doctor as the interval between the presentation and the definitive treatment. The overall treatment delay was calculated as the sum of those delays. Radiological workups were also reviewed for errors, and the effect of any errors on the delays was estimated. RESULTS: The study population included 42 men and six women with a median age of 65.5 years at presentation. Treatment delay ranged widely from 38 to 400 days (mean 164.0): delay due to patients ranged from 0 to 371 days (mean 55.8), accounting for 34% of the mean treatment delay; delay due to doctors ranged from 14 to 349 days (mean 108.2), and accounted for the remaining (66%) mean treatment delay. In 166 radiological studies reviewed, 98 radiological errors (59%) were identified in 28 patients (58%). These patients waited an additional mean of 88.4 days for correct radiological interpretation, accounting for 48% of the mean doctors' delay. Thus, the mean doctors' delay with radiological errors was significantly longer than that without radiological errors (p < 0.05). CONCLUSIONS: Treatment delay for Pancoast tumor was relatively long, and approximately two-thirds of the delay was due to doctors, mainly because of errors in radiology.