Left apical opacity seen on single-view anteroposterior chest radiograph in a 32-year-old male smoker with primary lung signet ring cell carcinoma presenting as a cavitary Pancoast tumor. Figure 1. [jaoa.org]

Drooping of right shoulder and hollowing of right supra and infraclavicular region present. Chest movements and expansion decreased on right side. Scoliosis with concavity to right side present. 6. [slideshare.net]

Pancoast presented two papers in 1924 and 1932 and the tumour became known as Pancoast Tumour. In his papers, Pancoast describes the clinical presentation of three cases. [raynersmale.com]

The left 2nd and 3rd ribs (black arrow) are destroyed and therefore missing, whereas they are normally present on the right (white arrows). [learningradiology.com]

The reported 5-year survival rate is 0-29% in these patients, which is likely a result of extensive disease involvement at initial presentation. [emedicine.medscape.com]

• Fever

  Pancoast tumors are named for Henry Pancoast, a US radiologist, who described them in 1924 and 1932. [1] Signs and symptoms [ edit ] Aside from cancer general symptoms such as malaise, fever, weight loss and fatigue, Pancoast tumor can include a complete [en.wikipedia.org]

  A review of his systems was positive for hoarseness and lowgrade intermittent fever without any shortness of breath or cough. [jmedicalcasereports.biomedcentral.com]

  There was no history of fever, weight loss, and anorexia. She was normotensive and non-diabetic. There was no past history of the tuberculosis. [lungindia.com]

• Pseudotumor

  Inflammatory pseudotumor (plasma cell granuloma), mycotic subclavian artery aneurysm, and carotid pseudoaneurysm in a child (caused by a hydatid cyst) have been reported. [aboutcancer.com]

• Cough

  These tumors are less likely than other lung cancers, due to their unique location, to cause the symptoms of cough and chest pain commonly associated with lung cancer. [emedicinehealth.com]

  The tumor can also compress the recurrent laryngeal nerve and from this a hoarse voice and "bovine" (non-explosive) cough may occur. [en.wikipedia.org]

  When to see a doctor It is important for people to see a doctor if they develop any of the symptoms of Pancoast syndrome, or any other symptoms associated with lung cancer, such as coughing or shortness of breath. [medicalnewstoday.com]

  Less commonly, unilateral recurrent laryngeal nerve palsy producing unilateral vocal cord paralysis (hoarse voice ± bovine cough), and/or phrenic nerve involvement. Arm oedema secondary to the compression of blood vessels. [patient.info]

  The patient is immobilized the first post op day with attention to chest Physiotherapy and bronchoscopic suctioning may be necessary to clear secretions in patients with ineffective cough [6]. [physio-pedia.com]

• Tracheal Deviation

  A chest x-ray and right shoulder x-ray revealed extensive pleural and parenchymal mass in the right apex and tracheal deviation to the left (Figures 1 and 2). [swjpcc.com]

  Figure 1 Chest radiograph with slight right tracheal deviation and subtle non-homogenous opacity in left upper zone (black arrows). [casereports.bmj.com]

• Jugular Venous Distention

  Physical examination revealed ptosis and jugular venous distention with normal neurological findings and normal shoulder movements. His back was not painful with palpation either. [academic.oup.com]

• Palpitations

  No left sided chest pain, palpitation or giddiness. PAST HISTORY : Pulmonary TB 5 years back. completed treatment. Not a known case of DM, SHT, CAD or BA. 4. CASE SUMMARY PERSONAL HISTORY : Chronic smoker and alcoholic. [slideshare.net]

• Anisocoria

  On physical exam, anisocoria was noted with the right pupil being smaller than the left pupil. [swjpcc.com]

• Hand Muscle Weakness

  Muscle weakness, atrophy and parasthesia Horner’s syndrome in up to 50% due to invasion of the superior cervical sympathetic chain and stellate ganglion Ptosis Miosis Anhidrosis Superior vena caval obstruction Phrenic and recurrent laryngeal nerve involvement [learningradiology.com]

  Neurological complications (I) Intrinsic hand muscle weakness (Klumpke-Déjérine syndrome) can be caused by C8 root division; while the division of T1 root affects the neural system less significantly. [ncbi.nlm.nih.gov]

• Decreased Sweating

  sweating) (Arcasoy & jett, 1997; Manenti, et al., 2013). [raynersmale.com]

• Distractibility

  The head of the rib is disarticulated from the transverse process by dividing the costotransverse ligaments and, with gentle pressure, using a periosteal elevator to distract the rib anteriorly away from its transverse process attachments. ( Figure 9 [ctsnet.org]

• Absent Triceps Reflex

  Wasting of the hand muscles, absent triceps reflex. Symptoms of spinal canal tumor or cervical disc disease if the spinal cord is invaded or compressed. [slideshare.net]

• Giddiness

  No left sided chest pain, palpitation or giddiness. PAST HISTORY : Pulmonary TB 5 years back. completed treatment. Not a known case of DM, SHT, CAD or BA. 4. CASE SUMMARY PERSONAL HISTORY : Chronic smoker and alcoholic. [slideshare.net]

[…] artery), or MRI  Additional MRI is mandatory if the workup suggests tumor encroachment into the intervertebral foramina to rule out invasion of the extradural space. 10. [de.slideshare.net]

WORKUP LABORATORY STUDIES : CBC BUN/ creatinine levels. WBC count Urine analysis. Coagulation profile(PT, aPTT and platelet count). Cross matching. [slideshare.net]

Treatment o Workup: · Typical NSCLC workup: · CT chest and abdomen · CBC, LFTs, electrolytes · Bone scan · [FDG]-PET imaging or mediastinoscopy to evaluate for mediastinal node involvement for triaging patients to operative versus non-operative treatment [vcuthoracicimaging.com]

No alterations were observed in the results of the blood workup, biochemical blood tests or urinalysis. His PPD was nonreactor and testing for acid-fast bacilli in sputum was negative. [scielo.br]

Laboratory Studies The blood workup for patients with Pancoast tumors is not specific, and results are not diagnostic. Lung cancers produce various substances. [emedicine.medscape.com]

• Periostal Elevation

  The head of the rib is disarticulated from the transverse process by dividing the costotransverse ligaments and, with gentle pressure, using a periosteal elevator to distract the rib anteriorly away from its transverse process attachments. ( Figure 9 [ctsnet.org]

Treatment and survival The particular growth features of the Pancoast tumor have affected the treatment regimen since its disclosure. [ncbi.nlm.nih.gov]

Careful patient selection for trimodality treatment, on the basis of staging and comorbidity, is of vital importance in the treatment of Pancoast tumours. [cardiothoracicsurgery.biomedcentral.com]

As a result, and depending on the stage of the cancer, treatment may involve radiation and chemotherapy given prior to surgery ( neoadjuvant treatment). [en.wikipedia.org]

Not only can we recommend the most appropriate treatments for each patient’s unique situation, but we can also deliver these treatments with an unparalleled level of expertise. [moffitt.org]

Discussion and conclusion Patient with Pancoast tumor usually present in advanced stage of the disease which requires chemotherapy and radiotherapy as options of treatment. Histologic confirmation is a key for further treatment of these patients. [docksci.com]

Despite advances in management, prognosis remains poor with an overall 5-year survival of only 36%. [radiopaedia.org]

Diagnosis of Pancoast tumor is often late, and misdiagnosis is a common problem that can affect the prognosis. Therefore, Pancoast tumor should always be considered in differential diagnosis of radicular pain of the upper extremity. [jsurgery.bums.ac.ir]

[…] metastases are contraindications for surgery Preoperative radiation therapy followed by surgical resection is the most common form of treatment Complications Surgical complications include Atelectasis Chest pain Spinal fluid leaks Horner’s syndrome Prognosis [learningradiology.com]

Prognosis A significant improvement in survival from Pancoast tumors has been achieved in the past few decades. [verywellhealth.com]

While malignancy is the most common cause, infectious etiologies are an important consideration as well. [swjpcc.com]

Conclusions Here we present a case of Pancoast tumor with myxofibrosarcoma as the underlying etiology. [jmedicalcasereports.biomedcentral.com]

Etiology and Pathophysiology They most frequently present as non–small cell lung cancer (NSCLC). The most common histologic subtype is adenocarcinoma (50–66% of cases), followed by squamous cell and large cell carcinomas. [unboundmedicine.com]

In 1932, Henry Pancoast first described the clinic-radiological features of the thoracic inlet tumors, but he mistakenly thought that it originates from embryonal epithelial rests of fifth brachial cleft. [2] Among malignant etiologies other than lung [lungindia.com]

Etiology Non small cell lung carcinoma (NSCLC) is the most common cell type of Pancoast tumor. Squamous cell is usually the most frequent cell type, followed closely by adenocarcinoma, and less frequently, large cell carcinoma. [vcuthoracicimaging.com]

Epidemiology These tumors represent 3–5% of all lung cancers. The tumor demonstrates a male preponderance and an average age of presentation during the 6th decade of life. [unboundmedicine.com]

Pathophysiology Pancoast tumor is the type of lung cancer that is associated with invasion of the apical chest wall. [wikidoc.org]

Etiology and Pathophysiology They most frequently present as non–small cell lung cancer (NSCLC). The most common histologic subtype is adenocarcinoma (50–66% of cases), followed by squamous cell and large cell carcinomas. [unboundmedicine.com]

PATHOPHYSIOLOGY The mass is an extension of lung cancer. Mostly squamous cell carcinomas or adeno carcinomas. 3-5% are small cell carcinomas. [slideshare.net]

Given the complexity of the pain pathophysiology seen in Pancoast tumors, and the positive results found in a small body of older and more recent research, surgical therapies such as cordotomy should be considered more often and earlier in the illness [oncnursingnews.com]

Prevention The most important preventive measure that can be taken to reduce the risk of developing any lung cancer is to quit smoking. Avoiding exposure to secondhand smoke and materials, such as asbestos and radon also reduces risk. [medicalnewstoday.com]

Preventing Pancoast Tumor The most important preventive step is to avoid using tobacco products. Quitting tobacco also reduces the risk of lung cancer. [webmd.com]

Risk Factors Tobacco use Secondhand smoke Radiation exposure Occupational exposures including asbestos, chromium, nickel, beryllium, arsenic, soot, or tar Industrial air pollution Family history of lung cancer HIV infection General Prevention Avoidance [unboundmedicine.com]

Is It Possible to Prevent Pancoast Tumors? The most important preventive step is to avoid using tobacco products. Quitting tobacco can reduce the risk of lung cancer. For more information, see Cigarette Smoking. [emedicinehealth.com]

[…] of 40-60 [7] Male > Female [7] Associated Co-morbidities Muscle atrophy [2] Cervical radiculopathy [2] Horner's Syndrome [6] COPD Vertebrae compression [6] Bone cancer Medications Pharmacotherapy goals are to induce remission, reduce morbidity, and prevent [physio-pedia.com]