Pancoast Syndrome

Description

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
• Horner syndrome: present in 25% of presentations of Superior sulcus tumors. Extension of neoplastic invasion/compression to involve sympathetic chain and stellate ganglion

Example Cases: CXR Case 064 – CXR Case 069 – Befuddler 025

Associated Persons

• Henry Khunrath Pancoast (1875-1939)

Alternative names

• Pancoast’s Tumour
• Superior Sulcus Tumour
• Pulmonary Sulcus Tumor
• Pancoast’s disease
• Tobías’ syndrome

Controversies

• 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

References

• 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]