Pancoast Syndrome

Pancoast Syndrome occurs secondary to local compression of brachial plexus and sympathetic chain by superior (pulmonary) sulcus tumors.

Associated tumors are usually non-small cell lung cancer (NSCLC) and interchangeably referred to as Pancoast Tumours.

Syndrome consists of:

Shoulder pain: initially localised to shoulder and vertebral border of scapula)
Radicular pain C8-T2: Progressive ulna nerve distribution pain and muscular atrophy
Horners syndrome: present in 25% of presentations of Superior sulcus tumors. Extension of neoplastic invasion/compression to involve sympathetic chain and stellate ganglion

Pancoast was not the first to describe the neoplasm or the associated syndrome associated with local invasion. British surgeon Edward Selleck Hare (1812-1838) first described in 1838 Publio Ciuffini described lung apical tumor with local invasion in 1911.
Pancoast described three cases in 1924 and in 1932 described the tumor as a “superior pulmonary sulcus tumor“. Pancoast incorrectly described the tumors as ‘arsing from epitheleal rests of the 5th brachial cleft‘.
J. W. Tobías correctly surmised the tumor site of origin as bronchopulmonary tissue in his 1932 publication

Pancoast HK. Importance of careful roentgen-ray investigation of apical chest tumors. Journal of the American Medical Association, Chicago, 1924, 83: 1407. [JAMA text]
Pancoast HK. Superior pulmonary sulcus tumor. Tumor characterised by pain, Horner’s syndrome, destruction of bone and atrophy of hand muscles. Journal of the American Medical Association,1932, 99: 1391-1396. [JAMA text]
Hare, ES. Tumor involving certain nerves. London Medical Gazette, 2nd series, 1838/39, 1: 16-18.
Tobías, JW. Sindrome ápico-costo-vertebral doloroso por tumor apexiano. Su valor diagnóstico en el cáncer primitivo pulmonare. Revista medica Latino-americana, Buenos Aires, 1932, 17: 1522-1557.
The Pancoast Era – University of Pennsylvania [PDF Full text]
Arcasoy, SM. Jett, JR. Superior Pulmonary Sulcus Tumors and Pancoast’s Syndrome N Engl J Med 1997; 337:1370-1376 [Full Text] [PMID 9358132]