Description

Pancoast Tumour is a primary bronchogenic carcinoma which arises in the apex of the lung at the superior pulmonary sulcus.

Pancoast tumours most commonly demonstrate histology of non-small cell lung cancer (NSCLC) – historically usually squamous cell carcinoma, but now more commonly adenocarcinoma. Pancoast tumours account for 3-5% of all bronchogenic carcinomas. The neoplasm invades the surrounding soft tissues and 25% of tumours present with Pancoast syndrome

Typically treated with radiotherapy to downstage the tumor followed by local resection (complicated by proximity of brachial plexus and subclavian vessels). 5 year survival rate varies from 45% with complete resection to 0% with incomplete resection

Example Cases: CXR Case 064CXR Case 069Befuddler 025


History of Pancoast Tumour

Pancoast was not the first to describe the neoplasm or the associated syndrome associated with local invasion.

1838 – British surgeon Edward Selleck Hare (1812-1838) described the case of a man who had died of a tumour on his neck. He had for some time before death exhibited marked constriction of the left pupil and drooping of the Levator palpebrae sutperioris. The clinical case author Hare, died on September 28, 1838, a day before the communication was published. So far as is known, he was the first clinical observer who recorded the existence of what is now termed “Horner syndrome” in association with a cervical lesion.

1912 – Publio Ciuffini, published a case of primary cancer of the apex of the right lung. He drew the clinicians’ attention to a complex of symptoms which he believed to be characteristic. Symptoms consisted of paresis, paraesthesia, and pain in the ipsilateral arm due to compression of the brachial plexus; ipsilateral ptosis, enophthalmos and miosis; and finally compression of the subclavian artery and vein.

Imponenti furono anche in questo paziente i fenomeni di compressione , esercitati sugli organi vicini: primo a risentire gli effetti di essa fu il plesso brachiale dello stesso lato, a cui seguì, dopo molto tempo, la paralisi unilaterale del ricorrente, la quale in seguito divenne bilaterale, rendendo completamente afono il malato. Ad essa si unirono, un mese prima della fine, gli effetti della lesione della 8th radice cervicale e della l” dorsale, la quale ebbe la sua espressione in quel ristringimento della rima palpebrale destra, in quel l’enoftalmo, nella miosi della pupilla, nella mancanza del riflesso al dolore.

Ciuffini P. Sul cancro primitivo del polmone. 1912

The compression phenomena exerted on nearby organs was impressive in this patient: the first to show the effects was the brachial plexus of the same side, followed, after a long time, by the unilateral paralysis of the recurrent laryngeal nerve, which later became bilateral, making the patient completely mute. It was joined, a month before the end, by the effects of the lesion of the 8th cervical root and of the 1st dorsal, clinically manifest with right eye ptosis, enophthalmos, miosis, and lack of pain reflex.

Ciuffini P. Sul cancro primitivo del polmone. 1912

1924Henry Khunrath Pancoast (1875-1939) described three cases of localised apical lung tumors with neurological findings

Case 1: A man, aged 52, was admitted to the University Hospital early in September, 1921. His chief complaint was intense burning pain, high in the left axilla and extending down the arm, worse at night and keeping him awake. It was then of eleven months’ duration, at first intermittent and later continuous; limited to the shoulder girdle at first, but later referred down the arm to the elbow, and for the last two months to the wrist, during which time there was an associated muscular twitching, increasing weakness of the grip and muscular wasting of the hand.

On admission, there was noted a contracted left pupil, enophthalmos and narrowing of the palpebral fissure.

Pancoast 1924
Pancoast 1924 case 1
Case 1: “…we discovered a shadow in the extreme left apex and destruction of the posterior portions of the left second and third ribs and adjacent corresponding transverse processes” Pancoast 1924

1932 – Pancoast described 7 cases (three previous and 4 new cases). He discarded the term ‘apical chest tumor’ in favour of ‘superior pulmonary sulcus tumor‘, and incorrectly proposed the tumors as arsing from epitheleal rests of the 5th brachial cleft. “It occurred to me that this tumor as a distinct entity might take its origin in an embryonal epithelial rest.

Pancoast 1932 Case 7

Fig. 3 (case 7).—Roentgenogram of the chest, showing the circumscribed apical shadow. Note the upper arrows pointing to the second rib and to the head and neck of the first rib, both of which are intact. Pancoast 1932

1932 – J. W. Tobías correctly surmised the tumor site of origin as bronchopulmonary tissue


Associated Persons

Alternative names
  • Superior Sulcus Tumour; Pulmonary Sulcus Tumor
  • Pancoast’s Tumour; Pancoast’s disease
  • Hare syndrome; Tobías syndrome
  • Ciuffini-Pancoast-Tobías syndrome; Ciuffini-Pancoast syndrome

References

Original articles

Review articles


Cite this article as: Thomas Morey and Mike Cadogan, "Pancoast Tumour," In: LITFL - Life in the FastLane, Accessed on August 11, 2022, https://litfl.com/pancoast-tumour/.

eponym

the person behind the name

Emergency medicine RMO at Sir Charles Gairdner Hospital with a keen interest in cardiorespiratory medicine, intensive care and anaesthetics. MBBS, GKT School of medicine. BSc in Biomedical engineering and material science, Barts & The London.

Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |

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