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Agri 2020 Apr;32(2):109-112

Division of Algology, Department of Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.

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. Read More

Curr Probl Cancer 2020 Apr 1;44(2):100506. Epub 2019 Nov 1.

Division of Hematology and Medical Oncology, Department of Medicine, University of Louisville, Louisville, Kentucky. Electronic address:

Kyobu Geka 2019 Sep;72(10):840-844

Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan.

The apical invading lung cancer is the tumor infiltrating to the thoracic inlet, in other words, the 1st rib or the higher chest wall. Tumor arising in the posterior apex is invasive to the vertebral body, the sympathetic trunk, and the brachial plexus. Pancoast tumor is well known with typical triads, which is invasive to the sympathetic trunk and the brachial plexus in the posterior apex of the lung. Read More

Clin Ter 2019 Jul-Aug;170(4):e291-e294

Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo.

Background: Pancoast's syndrome is caused by malignant neoplasm of superior sulcus of the lung which produces destructive lesions of thoracic inlet and comes along with the involvement of brachial plexus and stellate ganglion. Computed tomography (CT) or magnetic resonance imaging (MRI) scans can detect early lesions otherwise missed by routine radiographs and can also define the local extent or metastatic progression of the disease. Protocols involving combinations of irradiation, chemotherapy, and surgery are currently being under investigation to determine the best management. Read More

Tidsskr Nor Laegeforen 2019 03 11;139(5). Epub 2019 Mar 11.

Front Neurol 2019 22;10. Epub 2019 Jan 22.

Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, United States.

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. Read More

BMJ Case Rep 2019 Jan 24;12(1). Epub 2019 Jan 24.

Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.

A 54-year-old man presented to the emergency department with a 4-week history of right shoulder pain radiating down his arm, with some associated sensory loss. Further questioning and examination in the department revealed a classical Horner's syndrome; miosis, partial ptosis and hemifacial anhidrosis. An initial chest X-ray was deemed to be unremarkable; however, further review by a radiologist noted asymmetrical right apical thickening. Read More

BMJ Case Rep 2018 Nov 28;11(1). Epub 2018 Nov 28.

Department of Medical, Oral and Biotechnological Sciences, "G. d'Annunzio" University, Chieti, Italy.

Pancoast's syndrome may be the result of neoplastic, inflammatory or infectious disease. We report an unusual case of Pancoast's syndrome in a patient with metastatic breast cancer. A 54-year-old woman, affected by metastatic breast cancer, presented for severe shoulder pain, paraesthesia and numbness in the right arm. Read More

J Mycol Med 2019 Apr 12;29(1):80-83. Epub 2018 Dec 12.

Department of Radiology, Zhejiang Hospital, 12, Lingyin road, 310013 Hangzhou, China. Electronic address:

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. Read More

Exp Oncol 2018 Oct;40(3):239-242

National Cancer Institute, Kyiv 03022, Ukraine.

Aim: To study the nature of different variants of paraneoplastic syndrome (PNPS) in lung cancer, taking into account the features of the tumorous process and the complications of radiochemotherapy.

Patients And Methods: We performed an analysis of the data of 1,669 patients with lung cancer aged between 24 and 87 years, among whom there were 89% of men and 11% of women. The ratio of small cell and non-small-cell histological variants of the lung cancer was 1: 4, IB, IIA, IIB, IIIA, IIIB and IV stages of cancer - 1:2:6:58:43:57. Read More

J Emerg Med 2018 09 23;55(3):399-401. Epub 2018 Jul 23.

Department of Emergency Medicine, University of California, San Diego, California.

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. Read More

Eur J Intern Med 2019 02 10;60:e7-e8. Epub 2018 Jul 10.

Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, CA, USA. Electronic address:

Cir Esp 2018 Dec 20;96(10):655. Epub 2018 Jun 20.

Departamento de Cirugía Torácica, Universidad de Ataturk, Erzurum, Turquía.

Zentralbl Chir 2018 Jun 22;143(3):316-330. Epub 2018 Jun 22.

Pancoast or superior pulmonary sulcus tumour is a subset of lung carcinoma that invades the structures of the thoracic inlet - first ribs, distal roots of the brachial plexus, stellate ganglion, vertebrae, and subclavian vessels. The first symptom is usually shoulder pain; consequently, most patients are initially treated for osteoarthritis. Late diagnosis is common. Read More

Eur J Cardiothorac Surg 2019 02;55(2):377-379

Department of Thoracic Surgery, Kyoto University Hospital, Sakyo-ku, Kyoto, Japan.

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. Read More

J Am Osteopath Assoc 2018 Jun;118(6):416-419

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. Read More

Ann Thorac Surg 2018 09 12;106(3):e115-e116. Epub 2018 Apr 12.

Division of Thoracic Surgery, European Institute of Oncology, University of Milan, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.

Several different surgical approaches to anterior Pancoast tumors have been proposed. The osteomuscular-sparing transmanubrial approach allows optimal exposure and control of apical chest wall structures, but it requires an additional thoracotomy to perform the lobectomy with radical lymph node resection. The presented technique combines the osteomuscular-sparing transmanubrial approach with robotic-assisted upper lobectomy in a severely obese patient, thereby reducing the invasiveness of the surgical approach and the postoperative complications. Read More

A A Pract 2018 Jul;11(2):29-31

From the Departments of Chronic Pain Medicine.

Pancoast-Tobias syndrome characterizes the signs and symptoms of a superior pulmonary sulcus tumor, and includes arm and shoulder pain, atrophy of intrinsic hand muscles, and ipsilateral Horner syndrome. The rarity and overall poor prognosis of patients with superior pulmonary sulcus tumors associated with Pancoast-Tobias syndrome has led to few reports detailing pain management strategies with adjunctive therapies, such as continuous infusions of ketamine and lidocaine, chemotherapy, radiation, and multimodal oral medication regimens. This case highlights the diagnosis and treatment of pain in a patient with Pancoast-Tobias syndrome. Read More

Infection 2018 Oct 25;46(5):735-736. Epub 2018 Jan 25.

Department of Emergency Room and General Medicine, Ageo Central General Hospital, Ageo, Japan.

BMJ Case Rep 2017 Dec 7;2017. Epub 2017 Dec 7.

Department of Pulmonary, Critical Care and Sleep Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

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. Read More

Semin Thorac Cardiovasc Surg 2017 27;29(1):89-90. Epub 2017 Mar 27.

Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.

Semin Thorac Cardiovasc Surg 2017 Spring;29(1):79-88. Epub 2017 Feb 22.

Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy; Department of Oncology and Hematology, DIPO, University of Milan, Italy.

This paper reports on the characteristics, treatment modalities, and outcomes of patients with superior sulcus tumors who underwent surgery over a period of 15 years in 1 institution. Clinical records of 94 consecutive patients operated on by the same surgical team for non-small cell lung cancer between July 1998 and December 2013 were retrospectively reviewed. All patients received lung and chest wall en bloc resection. Read More

BMJ Case Rep 2017 Jun 13;2017. Epub 2017 Jun 13.

Department of Internal Medicine, King Abdullah Medical City, Mecca, Saudi Arabia.

Ann Thorac Cardiovasc Surg 2017 Jun 9;23(3):161-163. Epub 2017 May 9.

Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Nara, Japan.

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. Read More

J Surg Oncol 2017 Aug 13;116(2):227-235. Epub 2017 Apr 13.

Division of Thoracic Surgery, Department of Surgery, Comprehensive Cancer Center, Medical University of Vienna, Austria.

Objective: This study aims to evaluate the impact of T stage and extended surgery on the outcome of patients with Pancoast tumors after induction chemoradiation therapy.

Methods: Forty-six consecutive patients who underwent chemoradiation therapy (platin-based, 45-66 Gy) followed by surgery between 1998 and 2013 were retrospectively reviewed and analyzed.

Results: In 28 (61%) patients with T4 tumors, extended procedures (more than rib resection) were performed. Read More

Thorac Surg Clin 2017 May;27(2):149-157

Department of Thoracic Surgery, University of California, San Francisco, 1600 Divisadero Street, Room A-743, San Francisco, CA 94143-1724, USA.

Superior sulcus tumors have posed a formidable therapeutic challenge since their original description by Pancoast and Tobias in the early twentieth century. Initial therapeutic efforts with radiotherapy were associated with high rates of relapse and mortality. Bimodality therapy with complete surgical resection in the 1960s paved the way for trimodality therapy as the current standard of care in the treatment of superior sulcus tumors. Read More

BMJ Case Rep 2017 Mar 24;2017. Epub 2017 Mar 24.

Department of Family Medicine, Apple Valley Medical Clinic, Apple Valley, Minnesota, USA.

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). Read More

J Med Case Rep 2017 Mar 7;11(1):61. Epub 2017 Mar 7.

Department of Surgery, Weiss Memorial Hospital, Chicago, IL, USA.

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. Read More

Clin Exp Obstet Gynecol 2017 ;44(3):337-340

Homer's syndrome (HS) is based on dysfunction of symphathetic nervous system at the cervical canal. The signs of the syndrome occur on the same side as the lesion of the sympathetic trunk and include: a constricted pupil, a weak-droopy eyelid, apparent decreased sweating, and with or without inset eyeball. HS has been observed as a rare complication of epidural anaesthesia in obstetrics during labour or cesarean section. Read More

Pain Med 2016 12 1;17(12):2437-2438. Epub 2016 Jun 1.

Department of Radiology, Elbistan State Hospital, Kahramanmaraş, Turkey.

Asian Spine J 2016 Dec 8;10(6):1047-1057. Epub 2016 Dec 8.

Division of Neurosurgery, Hôpital Notre-Dame, University of Montreal, Montreal, QC, Canada.

Study Design: Monocentric prospective study.

Purpose: To assess the safety and effectiveness of the posterior approach for resection of advanced Pancoast tumors.

Overview Of Literature: In patients with advanced Pancoast tumors invading the spine, most surgical teams consider the combined approach to be necessary for "" resection to control visceral, vascular, and neurological structures. Read More

Tumori 2016 Nov 11;102(Suppl. 2). Epub 2016 Nov 11.

Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan - Italy.

Purpose: Several techniques have been proposed for the challenging surgical resection of Pancoast tumors. We describe a hybrid approach that combines video-assisted thoracic surgery (VATS) lobectomy and limited Shaw-Paulson thoracotomy.

Methods: We report a case of Pancoast tumor in a 57-year-old man, staged as cT3N0M0, that was treated with induction chemoradiotherapy prior to the hybrid surgical approach. Read More

Expert Rev Respir Med 2016 12 27;10(12):1255-1258. Epub 2016 Oct 27.

a Pulmonary Oncology Unit, "G. Papanikolaou" General Hospital , Aristotle University of Thessaloniki , Thessaloniki , Greece.

Introduction: According to the American College of Chest Physician definition, a Pancoast tumor is a tumor which invades any of the structures of the apex of the chest including the first thoracic ribs or periosteum, the lower nerve roots of the bronchial plexus, the sympathetic chain and stellate gaglion near the apex of the chest or the subclavian vessels. Pancoast tumors account for less than 3-5 % of lung tumors. Areas covered: We searched the libraries scopus and pub med and found 124 related manuscripts. Read More

Rev Mal Respir 2016 Nov 29;33(9):808-811. Epub 2016 Aug 29.

Service de pneumologie, hôpitaux de Brabois, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France.

Introduction: Rhabdoid tumours usually develop in brain and spinal cord or kidney; they are highly malignant neoplasms that typically arise in infancy and early childhood. However, rare cases of pulmonary localization have been described, particularly among young adults.

Case Report: A 26-year-old man, smoker, had a right apical lung mass associated with a Pancoast syndrome leading to haemoptysis. Read More

Cancer Control 2016 Jul;23(3):295-301

Imland Klinik, 24768 Rendsburg, Germany.

Background: Surgical outcomes for Pancoast (superior sulcus) tumors of the lung have significantly changed during the last few decades and have improved with use of curative-intent surgery by utilizing en bloc complete resections.

Methods: A retrospective analysis was conducted of 11 selected patients treated at Moffitt Cancer Center from 2007 to 2016. Data from patient records were collected and analyzed. Read More

J Clin Anesth 2016 Sep 29;33:166-7. Epub 2016 Apr 29.

Department of Anesthesiology, Osaka Medical College.

J Coll Physicians Surg Pak 2016 Jul;26(7):623-5

Department of Medicine, Khyber Teaching Hospital, Peshawar.

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. Read More

Ann Transl Med 2016 Jun;4(12):239

Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy.

Superior Sulcus Tumors, frequently termed as Pancoast tumors, are a wide range of tumors invading the apical chest wall. Due to its localization in the apex of the lung, with the potential invasion of the lower part of the brachial plexus, first ribs, vertebrae, subclavian vessels or stellate ganglion, the superior sulcus tumors cause characteristic symptoms, like arm or shoulder pain or Horner's syndrome. The management of superior sulcus tumors has dramatically evolved over the past 50 years. Read More

Interact Cardiovasc Thorac Surg 2016 11 29;23(5):821-825. Epub 2016 Jun 29.

Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether induction (neoadjuvant) chemoradiotherapy (iCRT) compared with other therapeutic strategies improves survival in patients with Pancoast tumours. Altogether 248 papers were identified using the below-mentioned search. Read More

Ann Thorac Surg 2016 Jul;102(1):e7-9

Center for Advanced Heart Failure and Department of Cardiovascular Surgery, University of Texas-Houston and Memorial Hermann Hospital-Texas Medical Center, Houston, Texas. Electronic address:

Venovenous (V-V) extracorporeal membrane oxygenation (ECMO) is used for respiratory failure that is suspected to be reversible (bridge to recovery), or as a bridge to lung transplantation. Patients with proximal airway obstruction due to endobronchial malignancy can develop acute respiratory failure, and may benefit from V-V ECMO as a bridge to airway intervention, further treatment, and eventual recovery. We describe a case of a superior sulcus tumor with tracheobronchial and superior vena cava invasion causing both respiratory failure and superior vena cava syndrome. Read More

Mayo Clin Proc 2016 05;91(5):e69-70

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.

J Cardiothorac Surg 2016 Apr 14;11(1):65. Epub 2016 Apr 14.

Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS (Scientific Institute for Research Hospitalization and Health Care) "Ca' Granda" General Hospital University of Milan, Via Francesco Sforza, 35, Milan, 20122, Italy.

Background: The mini-ivasive approach to superior sulcus tumors is an uncommon procedure that is still far from standardization. We describe a hybrid surgical technique to approach "en block" chest resection and pulmonary lobectomy for anterior superior sulcus tumors.

Case Presentation: A patient affected by right anterior Pancoast tumor surgically staged as cT4N0M0 (suspected anonymous vein invasion) underwent chemo-radiation induction therapy with satisfactory tumor reduction. Read More

J Emerg Med 2016 May 15;50(5):e215-8. Epub 2016 Feb 15.

Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

Background: Horner's syndrome refers to the clinical triad of ptosis, miosis, and anhidrosis resulting from disruption of the ocular and facial sympathetic pathways. A myriad of etiologies can lead to Horner's syndrome; awareness of the underlying anatomy can assist physicians in identifying potential causes and initiating appropriate care.

Case Report: Two patients presented to our Nashville-area hospital in 2014. Read More

Chin Clin Oncol 2015 Dec;4(4):41

Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Thoracic Oncology Institute Marie Lannelongue Hospital, Le Plessis Robinson, France.

Background: To update the long-term outcomes after subclavian artery (SA) resection and reconstruction during surgery for thoracic inlet (TI) cancer through the anterior transclavicular approach.

Methods: Between 1985 and 2014, 85 patients (60 men and 25 women; mean age, 52 years) underwent en bloc resection of thoracic-inlet non-small cell lung cancer (NSCLC) (n=69), sarcoma (n=11), breast carcinoma (n=3) or thyroid carcinoma (n=2) involving the SA. L-shaped transclavicular cervicothoracotomy was performed, with posterolateral thoracotomy in 18 patients or a posterior midline approach in 15 patients. Read More

Chin Clin Oncol 2015 Dec;4(4):39

Clermont University, Université d'Auvergne, 63003 Clermont-Ferrand, France; Radiotherapy Department, Jean Perrin Anti-Cancer Center, 63011 Clermont-Ferrand, France.

Background: A retrospective monocentric study of consecutive patients with superior sulcus tumor non-small cell lung cancer (SS-NSCLC), treated by induction concurrent chemoradiotherapy (CRT), article management.

Methods: From 1994 to 2005, 36 patients (15 T3, 21 T4 tumors, including N2-N3 node involvement) received induction CRT with cisplatin/vinorelbine/fluorouracil combined with 44 Gy radiotherapy (5 daily 2 Gy fractions/week). After CRT completion, RECIST evaluation and operability were assessed. Read More

N Z Med J 2015 Oct 16;128(1423):84-5. Epub 2015 Oct 16.

Emergency Department, Nelson Hospital, Nelson.

Neurodiagn J 2015 Sep;55(3):169-79

This case illustrates the benefits of utilizing intraoperative neurophysiological monitoring (IONM) for preventing injury to sensory/motor pathways of the spinal cord during a cordotomy procedure to relieve pain. Cordotomy has been used effectively in the treatment of visceral pain but comes with a high risk of damaging motor and sensory pathways due to close proximity of lesion. The subject is a 47-year-old female with a pancoast tumor of the left lung, left brachialplexopathy, and severe neuropathic pain syndrome, refractory to medical therapy. Read More

QJM 2016 May 15;109(5):337-8. Epub 2015 Oct 15.

From the Department of Thoracic Surgery, University Hospital Hassan II, Fez, Morocco Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.