Pancoast syndromeC34.1

From 1838, there is an account by Hare in which the typical symptoms of a Pancoast tumor are described for the first time (Büttner 2004).

In 1932, radiologist Henry Pancoast presented a tumor in the superior pulmonary sulcus to the American Medical Association, which would later be named after him (Harvey 2012).

The Pancoast tumor was considered inoperable until the 1950s. It was not until 1953 that Chardack and MacCallum successfully resected a Pancoast tumor for the first time. In 1961, Shaw and Paulsen were the first to perform preoperative radiotherapy followed by resection (Ewig 2014).

Pancoast syndrome (PS) is a set of symptoms and signs that are due to neoplastic impairment:

- of the brachial plexus

- of the parietal pleura

- the 1st and 2nd thoracic nerves

- of the 1st and 2nd ribs with adjacent vertebral bodies

- of the sympathetic trunk

- of the stellate ganglion (Bhandari 2018)

Pancoast syndrome usually occurs concurrently with Horner syndrome (Kasper 2015).

Pancoast syndrome is usually caused by a lung tumor in the superior sulcus:

• Pancoast tumor (Halls 1970)
• bronchogenic carcinoma
• metastases from laryngeal, urinary bladder, cervical and thyroid carcinomas
• hematological diseases
• infectious diseases
• pulmonary amyloid nodules
• neurogenic thoracic outlet syndrome
• thoracic involvement of hepatocellular carcinoma (very rare)

(Chang 2001)

Often the first symptom is shoulder pain (Nam 2015).

As it progresses, the typical symptoms of Pancoast syndrome - a peripheral pulmonary tumor located near the apex (Harvey 2012):

• Horner's symptom complex due to invasion of the paravertebral sympathetic trunk (Kasper 2015) with
  • Ptosis
  • Miosis
  • Enophthalmos
• Intercostal neuralgia
• Bone destruction of the 1st rib and / or 1st BWK.
• Swelling of the arm due to lymphatic or venous congestion (Herold 2022)
• ipsilateral anhidrosis
• Plexus neuralgia of the affected side with shoulder and arm pain, hypesthesias of the ulnar forearm and 4th and 5th fingers, weakness of the intrinsic hand muscles (Kasper 2015)

see also Pancoast tumor

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2. Büttner J U (2004) Asbestos in pre-modern times- from myth to science. Waxmann Verlag 19, 24 - 26, 262
3. Chang C F et al (2001) Hepatocellular carcinoma with Pancoast's syndrome as an initial symptom: a case report.Japanese Journal of Clinical Oncology 31 (3) 119 - 121.
4. Ewig S et al (2014) Lung cancer: individualized therapy in a certified thoracic center. Georg Thieme Verlag Stuttgart215
5. Harvey I et al (2012) Principles and Practice of Lung Cancer: The Official Reference Text of the International Association for the Study of Lung Cancer (IASLC). Wolters Kluwer Health 479
6. Hecken J et al (2022) Decision of the Federal Joint Committee on an amendment to the drug guideline: cemiplimab (non-small cell lung cancer, first-line). Dtsch Arztebl 119 (6) A 252.
7. Herold G et al (2020) Internal medicine. Herold Publ. 404
8. Kasper D L et al (2015) Harrison's Principles of Internal Medicine. Mc Graw Hill Education 122, 510 - 511, 519
9. Nam S O et al (2015) Pancoast Syndrome Accompanied by Rotator Cuff Tear. Clin Shoulder Elbow 18 (1) 43 - 46.