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Kočan L, Rapčan R, Griger M, Rapčanová S, Kantárová D, Török P, Vašková J. Deciphering the enigmatic symptoms of Pancoast tumors: Navigating the complex landscape of pain management-A case report. Radiol Case Rep 2024; 19:1810-1814. [PMID: 38406318 PMCID: PMC10891279 DOI: 10.1016/j.radcr.2024.01.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/27/2024] Open
Abstract
Pancoast tumors, also known as superior sulcus tumors, encompass a diverse spectrum of neoplasms that infiltrate the apex of the chest wall, yielding distinctive clinical presentations. One of the earliest signs of tumor growth is pain radiating to the upper limb, stemming from peripheral nerve involvement, which can mimic joint pain or spinal radicular irritation. In this case report, we present the clinical history of a 64-year-old female smoker who had previously been recommended for orthopedic elbow surgery due to epicondylitis. Subsequent to the development of additional symptoms and rigorous investigation, a Pancoast tumor was diagnosed. Furthermore, we discuss the characteristic treatment modalities available for Pancoast tumors, including pharmacological pain management and interventional strategies such as spinal cordotomy and spinal alcoholysis. This case underscores the significance of recognizing atypical presentations and emphasizes the importance of comprehensive evaluation in the diagnosis and management of Pancoast tumors.
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Affiliation(s)
- Ladislav Kočan
- Clinic of Anaesthesiology and Intensive Care Medicine, East Slovak Institute of Cardiovascular Disease, Ondavská 8, 040 11 Košice, Slovak Republic
| | - Róbert Rapčan
- Europainclinics, Kominárska 21/5, 831 04 Bratislava, Slovak Republic
| | - Martin Griger
- Europainclinics, Kominárska 21/5, 831 04 Bratislava, Slovak Republic
| | - Simona Rapčanová
- Europainclinics, Kominárska 21/5, 831 04 Bratislava, Slovak Republic
| | - Daniela Kantárová
- Outpatient clinic for adults, Imunology centre in Martin, Mudroňova 12, 036 01 Martin, Slovak Republic
| | - Pavol Török
- Clinic of Anaesthesiology and Intensive Care Medicine, East Slovak Institute of Cardiovascular Disease, Ondavská 8, 040 11 Košice, Slovak Republic
| | - Janka Vašková
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Trieda SNP 1, Košice, Slovak Republic
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Castelluccia A, Sardaro A, Niccoli Asabella A, Pisani AR, Rubini D, Portaluri M, Tramacere F. Durable complete response to PET-CT driven stereotactic radiation therapy plus pembrolizumab for pleomorphic Pancoast cancer: Case report and literature review. Clin Case Rep 2024; 12:e8633. [PMID: 38585585 PMCID: PMC10996042 DOI: 10.1002/ccr3.8633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
PET-driven SBRT plus pembrolizumab as first-line therapy against pleomorphic Pancoast cancer appears beneficial, probably due to high equivalent doses of SBRT on photopenic necrotic core and synergic immune system stimulation of immunoradiotherapy.
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Affiliation(s)
| | - Angela Sardaro
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of MedicineUniversity of Bari “Aldo Moro”BariItaly
| | - Artor Niccoli Asabella
- Section of Nuclear Medicine, Interdisciplinary Department of MedicineUniversity of Bari Aldo MoroBariItaly
| | - Antonio Rosario Pisani
- Section of Nuclear Medicine, Interdisciplinary Department of MedicineUniversity of Bari Aldo MoroBariItaly
| | - Dino Rubini
- Department of Precision MedicineUniversità degli Studi della Campania Luigi VanvitelliNapoliCampaniaItaly
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Mandishona T, Asemota N, Alqudah O, Saad H, Fuentes-Warr J, Rhodes L, Kouritas V. Chest wall resection with robotic-assisted thoracoscopic surgery for a Pancoast tumour: a case report. Multimed Man Cardiothorac Surg 2024; 2024. [PMID: 38526520 DOI: 10.1510/mmcts.2023.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
We describe a rare procedure involving near-total robotic-assisted thoracoscopic surgery resection of a right posterior Pancoast tumour. Four ports and an assistant port were used. The DaVinci X system was used. The lobectomy was performed first to allow for adequate exposure to the apex and spine. The lateral aspect of ribs 1 to 4 was resected next, and the extrathoracic space was entered. Dissection proceeded through this space superiorly up to the level of the scapula and then posteriorly towards the spine. The second to the fifth ribs were dissected off the chest wall and resected medially off the spine at the rib heads. Further postero-superior exploration revealed the tumour to be invading the transverse process of the second rib, with ill-defined margins. Because of this development, and with the support of the spinal surgeons, a small high posterior thoracotomy was performed to complete the procedure and remove the specimen en bloc. The postoperative recovery was uneventful, and the patient was discharged on post-operative day 5. The final histological report confirmed a squamous non-small-cell lung cancer (pT3N0M0) with negative margins (R0). Asymptomatic recurrence was noted near the margin of the second rib resection posteriorly 1 year postoperatively and was successfully treated with radiotherapy.
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Affiliation(s)
- Tarisai Mandishona
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Nicole Asemota
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Obadah Alqudah
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Haisam Saad
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Joanna Fuentes-Warr
- Department of Thoracic Surgery, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Lydia Rhodes
- Department of Anaesthetics, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Vasileios Kouritas
- Department of Thoracic Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK
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Ünal S, Heineman DJ, van Dorp M, Winkelman T, Braun J, Dahele M, Dickhoff C. Chest wall resections for sulcus superior tumors. J Thorac Dis 2024; 16:1715-1723. [PMID: 38505012 PMCID: PMC10944789 DOI: 10.21037/jtd-23-828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/04/2024] [Indexed: 03/21/2024]
Abstract
Chemoradiotherapy followed by surgical resection (trimodality therapy) is a guideline recommended treatment for sulcus superior tumors (SST). By definition, SSTs invade the chest wall and therefore require en-bloc chest wall resection with the upper lung lobe or segments. The addition of a chest wall resection, potentially results in higher morbidity and mortality rates when compared to standard anatomical pulmonary resection. This, together with their anatomical location in the thoracic outlet, and varying grades of fibrosis and adhesions resulting from induction chemoradiotherapy in the operation field, make surgery challenging. Depending on the exact location of the tumor and extent to which it invades the surrounding structures, the preferred surgical approach may vary, e.g., anterior, posterolateral, hemi-clamshell, or combined approach; all with their own potential advantages and morbidities. Careful patient selection, adequate staging and discussion in a multidisciplinary tumor board in a center experienced in complex thoracic oncology leads to the best long-term survival outcomes with the least morbidity and mortality. Enhanced recovery guidelines are now available for thoracic surgery, promoting faster recovery and helping to minimize complications and morbidity, including infections and thoracotomy pain. Although minimally invasive surgery can enhance recovery and reduce chest wall morbidity, and is in widespread use in thoracic oncology, its use for SST has been limited. However, this is an evolving area and hybrid surgical approaches (including use of the robot) are being reported. Chest wall reconstruction is rarely necessary, but if so, the prosthetic materials are preferably radiolucent/non-scattering, rigid enough while still being somewhat flexible, and inert, providing structural support, allowing chest wall movement, and closing defects, while inciting a limited inflammatory response. New techniques such as 3D image reconstructions/volume rendering, 3D-printing, and virtual reality modules may help pre-operative planning and informed patient consent.
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Affiliation(s)
- Semih Ünal
- Department of Cardiothoracic Surgery, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - David Jonathan Heineman
- Department of Cardiothoracic Surgery, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Martijn van Dorp
- Department of Cardiothoracic Surgery, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Toon Winkelman
- Department of Cardiothoracic Surgery, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Max Dahele
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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Unal S, Feller R, Stadhouder A, Heineman D, Jiya TU, van Dorp M, Bahce I, Braun J, Senan S, Dahele M, Dickhoff C. Superior Sulcus Tumors Invading the Spine: Multimodal Treatment Outcomes From the Preimmunotherapy Era. JTO Clin Res Rep 2023; 4:100582. [PMID: 38046379 PMCID: PMC10689281 DOI: 10.1016/j.jtocrr.2023.100582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Curative-intent treatment of superior sulcus tumors (SSTs) of the lung invading the spine presents considerable challenges. We retrospectively studied outcomes in a single center, uniformly staged patient cohort treated with induction concurrent chemoradiotherapy followed by surgical resection (trimodality therapy). Methods An institutional surgical database from the period between 2002 and 2021 was accessed to identify SSTs in which the resection included removal of at least part of the vertebral body. All patients were staged using fluorodeoxyglucose positron emission tomography (/computed tomography), computed tomography scan of the chest/upper abdomen, and brain imaging. Surgical morbidity was assessed using the Clavien-Dindo classification. Overall and disease-free survival were calculated using the Kaplan-Meier method. Results A total of 18 patients were included: 8 complete and 10 partial vertebrectomies were performed, with six of the eight complete vertebrectomies involving two vertebral levels, resulting in Complete surgical resection (R0) in 94%. Nine patients had a 1-day procedure, and nine were staged over 2 days. The median follow-up was 30 months (interquartile range 11-57). The 90-day postoperative morbidity was 44% (grade III/IV), with no 90-day surgery-related mortality. There were 83% who had a major pathologic response, associated with improved survival (p = 0.044). The 5-year overall and disease-free survival were 55% and 40%, respectively. Disease progression occurred in 10 patients, comprising locoregional recurrences in two and distant metastases in eight patients. Conclusions Multimodality treatment in selected patients with a superior sulcus tumor invading the spine is safe and results in good survival. Such patients should be referred to expert centers. Future research should focus on improving distant control (e.g. [neo]adjuvant immunotherapy).
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Affiliation(s)
- Semih Unal
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ricardo Feller
- Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Agnita Stadhouder
- Department of Orthopedic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David.J. Heineman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | | | - Martijn van Dorp
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
| | - Idris Bahce
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Suresh Senan
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Max Dahele
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Chris Dickhoff
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands
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Kocher G, Deckarm S, Flury D. Completely portal robotic Pancoast tumour resection with en bloc resection of the left upper lobe and chest wall. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 37970683 DOI: 10.1510/mmcts.2023.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
The current gold standard for the treatment of Pancoast tumours is considered to be neoadjuvant chemoradiation followed by radical resection of the affected upper lobe en bloc with resection of the chest wall. Shaw and Paulson first described the most commonly used approach in 1961 via an extended posterolateral thoracotomy. However, because this approach comes with significant soft tissue damage and occasionally provides only suboptimal exposure, especially for anterior superior sulcus tumours, other approaches have been published in recent years, including open anterior approaches (Dartevelle and Gruenenwald) in addition to rare case reports of minimally invasive assisted hybrid procedures. Because we routinely perform robotic anatomical lung resections as well as three-port robotic first rib resections for thoracic inlet/outlet syndrome in our department, combining both techniques with our accumulated experience seemed to be the next logical step. We describe step-by-step what is (to our knowledge) one of the first reported cases of a fully portal robotic-assisted Pancoast tumour resection consisting of a left upper lobe resection en bloc with the first rib after neoadjuvant chemoradiation therapy. This approach proved to be safe and allowed for excellent exposure, especially of the thoracic outlet.
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Affiliation(s)
- Gregor Kocher
- Department of Thoracic Surgery, Hirslanden Clinic Beau-Site (Hirslanden Group), Bern, Switzerland
| | - Sarah Deckarm
- Department of Thoracic Surgery, Hirslanden Clinic Beau-Site (Hirslanden Group), Bern, Switzerland
| | - Dominik Flury
- Department of Thoracic Surgery, Hirslanden Clinic Beau-Site (Hirslanden Group), Bern, Switzerland
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Bishnoi K, Parida GK, Patro PSS, Agrawal K, Singh P. Complex Regional Pain Syndrome-like Pattern in a Case of Pancoast Tumor. Indian J Nucl Med 2023; 38:384-386. [PMID: 38390551 PMCID: PMC10880852 DOI: 10.4103/ijnm.ijnm_38_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/06/2023] [Accepted: 08/09/2023] [Indexed: 02/24/2024] Open
Abstract
We present the case of a 52-year-old male who was recently diagnosed case of a Pancoast tumor and presented to the pulmonary outpatient department with a complaint of pain in the shoulder and chest region which was burning type, associated with shoulder abduction weakness and poor hand grip. Subsequently, he was referred for a 99m-Tc bone scan for metastatic workup, which showed increased uptake in all the joints and long bones of the ipsilateral upper limb. This case highlights the importance of considering nontraumatic cause of pattern similar to complex regional pain syndrome.
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Affiliation(s)
- Komal Bishnoi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Girish Kumar Parida
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - P Sai Sradha Patro
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Kanhaiyalal Agrawal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Parneet Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Bergman DT, Zaki L, Pettus JR, Zaki BI, Amin M. Genomic profile of Pancoast syndrome due to hepatocellular carcinoma: A case report. Thorac Cancer 2023. [PMID: 37160416 DOI: 10.1111/1759-7714.14923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a common cancer and is frequently diagnosed at a late and unresectable stage with limited effective treatment options. Here, we present the fifth reported case of a 77 year-old male with metastatic HCC presenting as a symptomatic superior sulcus lung tumor and discuss the genomic profile of this rare presentation of HCC for the first time, which included multiple classic mutations in HCC such as TERT, TP53, and WNT/β-catenin signaling as well as in the DNA repair gene ATM. The patient was treated with palliative radiotherapy to the Pancoast tumor followed by atezolizumab plus bevacizumab and passed away 6 months after diagnosis. This rare case highlights the need for effective treatment in aggressive and unresectable HCC and the utility of early genomic studies to allow for targeted therapy such as poly (ADP-ribose) polymerase (PARP)-inhibitors.
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Affiliation(s)
- Drew T Bergman
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Jason R Pettus
- Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Bassem I Zaki
- Radiation Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Manik Amin
- Hematology/Oncology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Nugroho MI, Sensusiati AD. Pancoast tumor mimicking lung tuberculosis, a case report. Radiol Case Rep 2023; 18:1758-62. [PMID: 36926539 DOI: 10.1016/j.radcr.2023.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 03/06/2023] Open
Abstract
It is well-recognized that tuberculosis (TB) can mimic several clinical diseases, particularly cancer. On several occasions, lung TB can be misdiagnosed as cancer, particularly in developed countries with a rare case of TB and high incidence of lung cancer, and vice versa- in which Indonesia, with a high incidence of TB, lung cancer may be mistakenly identified as TB, delaying the initiation of definitive therapy and causing unnecessary diagnostic and treatment procedures. We reported a 59-year-old male who complained of right upper chest pain, accompanied by chronic cough and weight loss, with a history of 6-month treatment with a TB regimen without resolution of his symptoms. Core biopsy CT guiding pathology anatomy revealed atypical adenocarcinoma. All patients seeking medical attention must be treated carefully, avoiding diagnostic procedures that can result in a delay in definitive therapy.
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Hutchings HE, Cox J, Westra J, Kuo YF, Okereke IC. Treatment patterns and outcomes in patients with Pancoast tumors: a national cancer database analysis. J Thorac Dis 2023; 15:33-41. [PMID: 36794135 PMCID: PMC9922605 DOI: 10.21037/jtd-22-1077] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022]
Abstract
Background Pancoast tumors represent 5% of non-small cell lung cancers. Complete surgical resection and no lymph node involvement are important positive prognostic factors. Previous literature has identified neoadjuvant chemoradiation treatment, followed by surgical resection, as the standard of care. But many institutions choose upfront surgery. Our goal was to identify the treatment patterns and outcomes in patients with node-negative Pancoast tumors using the National Cancer Database (NCDB). Methods The NCDB was queried from 2004 through 2017 to identify all patients who had undergone surgery for a Pancoast tumor. Treatment patterns, including the percentage of patients who received neoadjuvant treatment, were recorded. Logistic regression and survival analyses were used to determine outcomes based on different treatment patterns. Secondary analyses were performed on the cohort who received upfront surgery. Results A total of 2,910 patients were included in the study. Overall 30- and 90-day mortality were 3% and 7% respectively. Only 25% (717/2,910) of the group received neoadjuvant chemoradiation treatment prior to surgery. Patients who received neoadjuvant chemoradiation treatment experienced significantly improved 90-day survival (P<0.01) and overall survival (P<0.01). When analyzing the cohort who received upfront surgery, there was a statistically significant difference in survival based on adjuvant treatment pattern (P<0.01). Patients in this group who received adjuvant chemoradiation had the best survival, whereas patients who received adjuvant radiation only or no treatment had the worst outcomes. Conclusions Patients with Pancoast tumors receive neoadjuvant chemoradiation treatment in only a quarter of cases nationally. Patients who received neoadjuvant chemoradiation treatment had improved survival compared to patients who had upfront surgery. Similarly, when surgery is performed first, adjuvant chemoradiation treatment improved survival compared to other adjuvant strategies. These results suggest underutilization of neoadjuvant treatment for patients with node-negative Pancoast tumors. Future studies with a more clearly defined cohort are needed to assess the treatment patterns being utilized on patients with node-negative Pancoast tumors. It will be beneficial to see whether neoadjuvant treatment for Pancoast tumors has increased in recent years.
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Affiliation(s)
| | - Jessica Cox
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan Westra
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA;,Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
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11
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Rao SJ, Iqbal SB, Sagheer U. Pancoast Tumor With Cardiac Metastases and Intracardiac Thrombosis. J Investig Med High Impact Case Rep 2023; 11:23247096231154642. [PMID: 36772879 PMCID: PMC9926002 DOI: 10.1177/23247096231154642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Pancoast tumor is a rare and aggressive form of lung cancer; cardiac metastasis is very uncommon. We present a case of advanced Pancoast tumor, with extensive cardiac metastases and intracardiac thrombosis in a woman presenting with dyspnea, shoulder pain, and weight loss. A contrast-enhanced chest computed tomographic scan revealed an apical mass, metastatic thoracic nodes, and filling defects within both ventricles. Further imaging with cardiac magnetic resonance imaging revealed 2 left ventricular masses infiltrating into the myocardium suggestive of metastatic disease, and a multilobulated mass within the right ventricle suggestive of intracardiac thrombus. She was initiated on anticoagulation for intracardiac thrombosis. Surgical pathology of biopsied tissue samples was consistent with advanced metastatic lung adenocarcinoma. She was a poor candidate for surgical intervention. Given the patient's goals of care, she was ultimately transitioned to comfort care.
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Affiliation(s)
- Shiavax J Rao
- MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA
| | - Shaikh B Iqbal
- MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA
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12
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Mohamud S, Oyawusi M, Weir RL, Halbert EO, Millis RM, Gebremedhin T, Dehkordi O. Pancoast tumor presenting with multiple joint pains: a case report. J Med Case Rep 2022; 16:109. [PMID: 35292093 PMCID: PMC8922877 DOI: 10.1186/s13256-022-03328-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Pancoast tumors represent a unique subset of lung cancers wherein a primary neoplasm arises in the lung’s apex and invades the surrounding soft tissues. One of the main challenges in the diagnosis and treatment of these apical lung cancers is that they are usually not visualized on initial chest x-ray and, by the time the patient presents with symptoms, the tumor has almost always invaded nearby structures. Case presentation Herein we report a case of a 58-year-old nonsmoking African American male who presented to the neurology clinic with a history of multiple chronic joint pains. The patient complained of shoulder pain that traveled into his right arm and right finger and had worsened over the past 9 months. The patient also reported decreased right proximal strength and swelling of his right hand. Magnetic resonance imaging of the shoulder and cervical region showed mild cervical spondylosis and a questionable right apical mass. A subsequent high-resolution computed tomography scan of the chest revealed a large right apical lung mass, with chest wall invasion and erosion of the adjacent ribs. Biopsy of the mass confirmed poorly differentiated non-small cell lung cancer. Radiation therapy was initiated, and the patient’s pain improved significantly. Given the size of the tumor, chemotherapy was recommended by the oncology team. The patient decided against chemotherapy. Conclusion This case highlights the importance of early diagnosis by expanding the differential diagnosis in patients presenting with weakness, sensory loss, and shoulder pain beyond radiculopathy or joint-related diseases. A comprehensive history and careful examination may lead to an earlier diagnosis, more appropriate treatment, and better outcome in cases of Pancoast tumor presenting with neuropathic or musculoskeletal pain.
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Affiliation(s)
- Safia Mohamud
- Department of Neurology, George Washington University Hospital, Washington, DC, 20037, USA.
| | - Mosunmola Oyawusi
- Department of Neurology, Howard University Hospital, Washington, DC, USA
| | - Roger L Weir
- Department of Neurology, Howard University Hospital, Washington, DC, USA
| | - Etuajie O Halbert
- Department of Psychiatry, Howard University Hospital, Washington, DC, USA
| | - Richard M Millis
- Department of Pathophysiology, College of Medicine, American University of Antigua, Coolidge, Antigua, Antigua and Barbuda
| | - Teddy Gebremedhin
- Department of Neurology, Howard University Hospital, Washington, DC, USA
| | - Ozra Dehkordi
- Department of Neurology, Howard University Hospital, Washington, DC, USA
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Bao F, Yu F, Hao X, Gu Z, Park SY, Grossi F, Fang W. Surgical resection of superior pulmonary sulcus tumor after neoadjuvant chemoradiation via the anterior transmanubrial approach: a case report. Ann Transl Med 2021; 9:1603. [PMID: 34790809 PMCID: PMC8576648 DOI: 10.21037/atm-21-4698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
Superior pulmonary sulcus tumor is a cancer arising in the apex of the lung that with potential invasion of the brachial plexus, upper ribs, vertebrae, subclavian vessels, and stellate ganglion. Induction concurrent chemoradiotherapy followed by radical surgical resection with lobectomy combined with any structures in the thoracic inlet invaded by tumor and thorough mediastinal lymph node dissection is the preferred treatment. Both anterior and posterior approaches are applied for resection. Here, we report a 61-year-old man with an 8.6 cm × 5.1 cm mass arising from the right upper lobe invading the apex of the chest wall. Brachial plexus magnetic resonance imaging suggested tumor invasion of the inferior trunk of the brachial plexus, anterior portion of the first 2 ribs, and suspicious involvement of the subclavian artery. Biopsy of the mass showed stage cT4N2M0, IIIB, poorly differentiated adenocarcinoma. The patient was treated by induction concurrent chemoradiotherapy, which was followed by surgical resection of the right upper lobe and the affected chest wall via the transmanubrial approach. The patient suffered prolonged postoperative air leak and empyema. After continuous chest tube drainage and intrapleural fibrinolytic therapy, he recovered well and was discharged safely. Final pathology showed no viable residue tumor, pathologic complete response of the tumor to induction treatment, a tumor size of 4.1 cm, and no lymph nodes; therefore, the final stage was ypT0N0M0. The transmanubrial approach is feasible for resection of tumor invading the branches of the subclavian artery; however, postoperative empyema which might have resulted from prolonged air leak should be carefully treated by meticulous air leak management.
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Affiliation(s)
- Feichao Bao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fenghao Yu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiuxiu Hao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Francesco Grossi
- Medical Oncology Unit, Department of Medicine and Surgery, University of Insubria, ASST dei Sette Laghi, Varese, Italy
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Marzban-Rad S, Sattari P, Marzban-Rad M, Azimi G. Cardiopulmonary bypass for resection of pancoast tumor with mediastinal extension and involvement of right bronchial branch: A case report. Ann Med Surg (Lond) 2021; 71:102910. [PMID: 34691445 PMCID: PMC8515239 DOI: 10.1016/j.amsu.2021.102910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 10/27/2022] Open
Abstract
Introduction and importance: Pneumonectomy is commonly associated with cardiopulmonary complications. Pneumonectomy in Pancoast tumor with mediastinal extension and no metastasis could be successful and efficient. Case presentation Herein, we report a successful pneumonectomy of a 54-year-old man with pancoast tumor along with the involvement of mediastinal space including right hilum of the lung, right bronchial, inferior vena cava vein and pericardium. Clinical discussion Based on the bronchoscopy and biopsy, the complete involvement of right bronchial tree was reported and non-small cell carcinoma was diagnosed in pathology. Conclusion To reduce the complications of the surgery, the cardiopulmonary pump machine was used during the operation.
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Affiliation(s)
- Saeid Marzban-Rad
- Department of Thoracic Surgery, Imam-Reza Hospital, Aja University of Medical Sciences, Tehran, Iran
| | - Parastesh Sattari
- Institute of Health Education and Research, Chamran Hospital, Tehran, Iran
| | - Maryam Marzban-Rad
- Department of Food Science and Technology, School of Nutrition Science and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghasem Azimi
- Department of Internal Medicine, School of Medicine, Shahed University, Tehran, Iran
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Sobash PT, Vedala K, Alfano D, Pinckard-Dover H, Muesse JL, Desikan R. A rare case of chordoma presenting as a Pancoast tumor. Rare Tumors 2021; 13:20363613211029493. [PMID: 34276922 PMCID: PMC8255556 DOI: 10.1177/20363613211029493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
The notochord is the defining structure of all chordate embryos. It is a midline structure ventral to the ectoderm, neural plates, and neural arch. Remnants of the notochord ultimately give rise to the nucleus pulposus. The function of the notochord is to organize the surrounding structures. Chordoma is a rare malignant bone tumor arising from remnants of the notochord. These tumors are indolent and can present as incidental or locally advanced involving adjacent structures. These tumors typically present at the skull base and sacral spine but more rarely can be seen on the cervical and thoracic spine. Rare cases of chordoma invading the brachial plexus have been recorded. Surgical resection is the mainstay of treatment for chordomas. We would like to discuss a novel presentation of a chordoma as a Pancoast tumor, and aim to highlight the clinical importance of accurate diagnosis and planning therapy along with poor prognosis of incomplete surgical resection.
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Affiliation(s)
- Philip T Sobash
- Department of Internal Medicine, White River Health System, Batesville, AR, USA
| | - Krishna Vedala
- Department of Internal Medicine, White River Health System, Batesville, AR, USA
| | - Daniel Alfano
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Heather Pinckard-Dover
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jason L Muesse
- Department of Thoracic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Raman Desikan
- Department of Hematology/Oncology, White River Health System, Batesville, AR, USA
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Tang WF, Xu W, Huang WZ, Lin GN, Zeng YM, Lin JS, Wu M, Bao H, Peng JW, Jiang HM, Wang HQ, Wu YM, Ye HY, Liang Y. Pathologic complete response after neoadjuvant tislelizumab and chemotherapy for Pancoast tumor: A case report. Thorac Cancer 2021; 12:1256-1259. [PMID: 33656285 PMCID: PMC8046127 DOI: 10.1111/1759-7714.13910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
A 60‐year‐old man was hospitalized because of numbness and weakness in the right upper limb. Magnetic resonance imaging revealed a large mass in the right upper lobe invading the right eighth cervical and first thoracic nerve root. Biopsy pathology confirmed primary lung adenocarcinoma with a clinical stage of cT4N0M0 IIIA, negative for anaplastic lymphoma kinase fusion gene and epidermal growth factor receptor mutations but positive for programmed death ligand 1 (3%). Neoadjuvant tislelizumab and chemotherapy were offered to this patient with Pancoast tumor, and tumor shrinkage of 71% was achieved. After the operation, surgical pathology indicated pathologic complete response (pCR). Circulating tumor cells testing was negative after the first adjuvant treatment. In this case, we provide real‐world evidence of encouraging pCR with neoadjuvant tislelizumab and chemotherapy for a patient with Pancoast tumor.
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Affiliation(s)
- Wen-Fang Tang
- Department of Cardiothoracic Surgery, Zhongshan People's Hospital, Zhongshan, China
| | - Wei Xu
- Department of Cardiothoracic Surgery, Zhongshan People's Hospital, Zhongshan, China
| | - Wei-Zhao Huang
- Department of Cardiothoracic Surgery, Zhongshan People's Hospital, Zhongshan, China
| | - Gui-Nan Lin
- Department of Oncology, Zhongshan People's Hospital, Zhongshan, China
| | - Yu-Mei Zeng
- Department of Pathology, Zhongshan People's Hospital, Zhongshan, China
| | - Jie-Shan Lin
- Department of Nephrology, Blood Purifiction Center, Zhongshan People's Hospital, Zhongshan, China
| | - Min Wu
- Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Hua Bao
- Nanjing Geneseeq Technology Inc., Nanjing, China
| | - Jie-Wen Peng
- Department of Oncology, Zhongshan People's Hospital, Zhongshan, China
| | - Hai-Ming Jiang
- Department of Cardiothoracic Surgery, Zhongshan People's Hospital, Zhongshan, China
| | - Heng-Qiang Wang
- Department of Cardiothoracic Surgery, Zhongshan People's Hospital, Zhongshan, China
| | - Ying-Meng Wu
- Department of Cardiothoracic Surgery, Zhongshan People's Hospital, Zhongshan, China
| | - Hong-Yu Ye
- Department of Cardiothoracic Surgery, Zhongshan People's Hospital, Zhongshan, China
| | - Yi Liang
- Department of Cardiothoracic Surgery, Zhongshan People's Hospital, Zhongshan, China
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Oka S, Ono K, Kajiyam K, Yoshimatsu K. A minimally invasive and safe surgical approach to resect anterior superior sulcus tumors. Int J Surg Case Rep 2020; 68:148-50. [PMID: 32145568 DOI: 10.1016/j.ijscr.2020.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Superior sulcus tumors (SSTs) are a wide range of tumors invading a section of the apical chest wall called the thoracic inlet. The unique characteristics of SSTs lie in the anatomy of the region where these tumors occur. For this reason, a surgical approach to treating these tumors is technically demanding, and complete resection may be difficult to accomplish. CASE PRESENTATION A 71-year-old Japanese man presented at our hospital due to left anterior chest pain and an abnormal chest CT scan showing a 40 × 33 × 30-mm tumor located in the left anterior apex of the thoracic inlet. This tumor had invaded the first and second rib and was located near the subclavian vein. There was no significant distant metastasis. Therefore, we performed surgical resection. The surgical procedure included three steps. First, we performed VATS observation via the left thoracic cavity. Second, via the transmanubrial approach, we obtained tumor-free margins of the anterior cervical structures. Third, through VATS in the left lateral decubitus position, we performed left upper lobectomy and mediastinal lymph node dissection. This surgery was successful, with no postoperative complications. DISUCUSSION This surgical approach was effective and safe for treating a superior sulcus tumor located the anterior apex of the thoracic inlet. Next, VATS lobectomy is minimally invasive and safe after the transmanubrial approach for managing anterior superior sulcus tumor. CONCLUSION We experienced a case of locally advanced superior sulcus tumor located at the anterior apex of the thoracic inlet and performed complete resection.
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Shimada Y, Kudo Y, Maehara S, Hagiwara M, Tanaka T, Shigefuku S, Kakihana M, Kajiwara N, Ohira T, Ikeda N. Significant prognostic determinants in lung cancers of the superior sulcus: comparable analysis of resected and unresected cases. Gen Thorac Cardiovasc Surg 2020; 68:801-11. [PMID: 32125634 DOI: 10.1007/s11748-020-01322-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In this study, we aimed to identify prognostic determinants and to comparably analyze clinical features of patients with both resected and unresected superior sulcus tumors (SSTs). METHODS The data of 56 patients who underwent any treatment for an SST from 2004 through 2016 in our hospital were reviewed. Overall survival (OS) rates were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to determine independent prognostic factors for patients with resected and unresected SST separately. RESULTS The number of patients with resected and unresected SSTs was 24 (43%) and 32 (57%), respectively. Of the 24 patients who underwent surgery, 20 received induction therapy, with 32% achieving pathological complete response. Complete resection (R0) was performed in 22 patients (92%). On multivariate survival analysis, preoperative serum carcinoembryonic antigen (CEA) level (median 8.3 ng/ml, p = 0.021) was identified as the independent determinant of OS in surgical patients; whereas, initial treatment response (complete response or partial response, p = 0.032) was the independent OS indicator in non-surgical patients. The 5-year OS of the patient with resected and unresected SST was 68.8% and 29.1% (p = 0.008), respectively. CONCLUSION Significant prognostic factors differ among patients stratified by the presence of surgical resection for SSTs. Preoperative CEA level in surgical candidates and initial treatment response in non-surgical patients were the independent factors associated with OS. Surgical candidates are expected to have more favorable survival than patients with unresectable SSTs.
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Kumar R, Bhandari S, Kloecker GH. Harlequin sign in Pancoast tumor. Curr Probl Cancer 2020; 44:100506. [PMID: 31732238 DOI: 10.1016/j.currproblcancer.2019.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/10/2019] [Accepted: 09/30/2019] [Indexed: 11/20/2022]
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Rizkalla J, Dauglas S, Nimmons S, El-Feky W, Syed I. Superior sulcus tumor disguised as cervical radiculopathy with metastasis to brachial plexus. Proc (Bayl Univ Med Cent) 2019; 32:582-583. [PMID: 31656428 DOI: 10.1080/08998280.2019.1647737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/18/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022] Open
Abstract
A 74-year-old man presented to an orthopedic spine surgeon with signs and symptoms consistent with cervical radiculopathy. Investigation revealed metastasis of a Pancoast tumor to the patient's brachial plexus. A year after initial diagnosis, the patient achieved full neurological function of his left arm. Pancoast tumors are rare in the orthopedic population. Thorough physical examination, imaging, and nerve conduction studies ultimately led to the patient's diagnosis.
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Affiliation(s)
- James Rizkalla
- Department of Orthopedic Surgery, Baylor University Medical CenterDallasTexas
| | - Seagal Dauglas
- School of Medicine, Texas A&M Health Science CenterDallasTexas
| | - Scott Nimmons
- Department of Orthopedic Surgery, Baylor University Medical CenterDallasTexas
| | | | - Ishaq Syed
- Department of Orthopedic Surgery, Baylor University Medical CenterDallasTexas
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21
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Forooghi R, Ranaei M, Bijani F, Seifi S, Moslemi D, Mohammadi M, Nikafshar N. Huge maxillary metastasis of an aggressive Pancoast tumor -A case report. Caspian J Intern Med 2019; 10:351-355. [PMID: 31559001 PMCID: PMC6729146 DOI: 10.22088/cjim.10.3.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Background Metastatic carcinomas to the upper jaw region are very rare and unfortunately occur in advanced stages of malignancies. Pancoast tumor is a challenging subset of lung carcinoma commonly followed by distant metastasis. Since the metastatic lesion of our patient was very huge and unusual, we decided to report the case. Case Presentation Our patient was a middle-aged heavy smoker male with a history of unresectable pancoast tumor. He was referred to the dental clinic with an expanded maxillary metastasis involving the bone and sinus region as well as oral soft tissues. To confirm the primary site of his malignancy, immunohistochemical staining was performed. Conclusion Distant metastases of a pancoast tumor are more frequent when the primary tumor is unoperable and bone involvement is one of the early manifestations of disease.
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Affiliation(s)
- Ramin Forooghi
- Oral Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Ranaei
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Fatima Bijani
- Student. Research Committee, Babol University of Medical Science, Babol, Iran
| | - Safoura Seifi
- Oral Health Research Center, Institute of Health, Babol University of Medical Sciences, Babol, Iran
| | - Daryoosh Moslemi
- Cancer Research Center, Health Research Institute. Babol University of Medical Sciences, Babol, Iran
| | | | - Nima Nikafshar
- Student. Research Committee, Babol University of Medical Science, Babol, Iran
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Elhalawani H, Elgohari B, Lin TA, Mohamed ASR, Fitzgerald TJ, Laurie F, Ulin K, Kalpathy-Cramer J, Guerrero T, Holliday EB, Russo G, Patel A, Jones W, Walker GV, Awan M, Choi M, Dagan R, Mahmoud O, Shapiro A, Kong FMS, Gomez D, Zeng J, Decker R, Spoelstra FOB, Gaspar LE, Kachnic LA, Thomas CR, Okunieff P, Fuller CD. An in-silico quality assurance study of contouring target volumes in thoracic tumors within a cooperative group setting. Clin Transl Radiat Oncol 2019; 15:83-92. [PMID: 30775563 PMCID: PMC6365802 DOI: 10.1016/j.ctro.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/03/2019] [Accepted: 01/04/2019] [Indexed: 12/25/2022] Open
Abstract
We aimed at quantifying inter-observer Pancoast tumors delineation variability. Experts’ delineations were used to define ground truth. Other observers’ delineations were compared against ground truth. High degree of variability was noted for most target volumes except GTV_P. This unveils potentials for protocol modification for future IMRT studies.
Introduction Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee’s multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a “dry run” for trial implementation. Methods CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG PET-CT while two patients had 3D-CT and FDG-FDG PET-CT. Seventeen SWOG-affiliated physicians independently delineated target volumes defined as gross primary and nodal tumor volumes (GTV_P & GTV_N), clinical target volume (CTV), and planning target volume (PTV). Six board-certified thoracic radiation oncologists were designated as the ‘Experts’ for this study. Their delineations were used to create a simultaneous truth and performance level estimation (STAPLE) contours using ADMIRE software (Elekta AB, Sweden 2017). Individual participants’ contours were then compared with Experts’ STAPLE contours. Results When compared to the Experts’ STAPLE, GTV_P had the best agreement among all participants, while GTV_N showed the lowest agreement among all participants. There were no statistically significant differences in all studied parameters for all TVs for cases with 4D-CT versus cases with 3D-CT simulation scans. Conclusions High degree of inter-observer variation was noted for all target volume except for GTV_P, unveiling potentials for protocol modification for subsequent clinically meaningful improvement in target definition. Various similarity indices exist that can be used to guide multi-institutional radiotherapy delineation QA credentialing.
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Affiliation(s)
- Hesham Elhalawani
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Baher Elgohari
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Timothy A Lin
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA.,Baylor College of Medicine, TX 77030, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA.,Department of Clinical Oncology and Nuclear Medicine, Alexandria University, Alexandria, Egypt
| | - Thomas J Fitzgerald
- Imaging and Radiation Oncology Core QA Center Rhode Island, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Fran Laurie
- Imaging and Radiation Oncology Core QA Center Rhode Island, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kenneth Ulin
- Imaging and Radiation Oncology Core QA Center Rhode Island, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Massachusetts, USA
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Emma B Holliday
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Gregory Russo
- Department of Radiation Oncology, Boston Medical Center, Massachusetts, USA
| | - Abhilasha Patel
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, TX, USA
| | - William Jones
- Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, TX, USA
| | - Gary V Walker
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA.,Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - Musaddiq Awan
- Department of Radiation Oncology, Case Western Reserve University, OH, USA
| | - Mehee Choi
- Department of Radiation Oncology, Northwestern University, IL, USA
| | - Roi Dagan
- University of Florida Health Proton Therapy Institute, FL, USA
| | - Omar Mahmoud
- Department of Radiation Oncology, University of Miami, FL, USA
| | - Anna Shapiro
- Department of Radiation Oncology, Upstate Cancer Center, SUNY Upstate Medical University, NY, USA
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, OH, USA
| | - Daniel Gomez
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington Medical Center, WA, USA
| | - Roy Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, Connecticut, USA
| | - Femke O B Spoelstra
- Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Laurie E Gaspar
- Department of Radiation Oncology, Vanderbilt University, TN, USA
| | - Lisa A Kachnic
- Department of Radiation Oncology, Vanderbilt University Medical Center, Tennessee, USA
| | - Charles R Thomas
- Department of Radiation Medicine, Oregon Health & Science University, Oregon, USA
| | - Paul Okunieff
- SWOG, Department of Radiation Oncology, University of Florida College of Medicine, Florida, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, TX 77030, USA
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Hellman JB, Lin LK. Right eyelid droop. Eur J Intern Med 2019; 60:e7-e8. [PMID: 30001867 DOI: 10.1016/j.ejim.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Justin B Hellman
- Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, CA, USA
| | - Lily Koo Lin
- Department of Ophthalmology and Vision Science, University of California Davis Health, Sacramento, CA, USA.
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Correia MS, Clark RF. Recurrent Diffuse Large B-Cell Lymphoma Presenting with Pancoast Syndrome: A Rare Cause of Radicular Neck Pain in the Emergency Department. J Emerg Med 2018; 55:399-401. [PMID: 30049430 DOI: 10.1016/j.jemermed.2018.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/21/2018] [Accepted: 06/10/2018] [Indexed: 11/24/2022]
Abstract
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. CASE REPORT We describe the presentation of a 59-year-old male with recurrent diffuse large B-cell lymphoma presenting with Pancoast syndrome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Cancer is an uncommon cause of radicular neck pain but should be considered in the differential, particularly when constitutional complaints are also present. Symptoms and physical examination findings associated with Pancoast syndrome are the consequence of compression of the C7-T2 vertebral roots and sympathetic chain. Computed tomography is usually required to definitively visualize the mass.
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25
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Puma F, Vannucci J, Scarnecchia E, Vinci D, Daddi N. Original "double-step" technique for large superior sulcus tumors invading the anterior chest wall without subclavian vessels involvement. J Thorac Dis 2018; 10:S1850-S1854. [PMID: 30026971 DOI: 10.21037/jtd.2018.05.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background In some patients with complex Superior Sulcus tumors, a combination of surgical accesses may be required. For patients with very large tumors which invade the first ribs anteriorly and without subclavian vessels involvement, we developed a "double-step" technique to facilitate resection and reduce surgical trauma. Methods The technique was performed on five patients with a bulky non-small cell lung cancer (NSCLC), four of whom had a Superior Sulcus tumor. All patients received a radical wide thoracectomy en-bloc with an upper lobectomy. Neither significant flail chest nor postoperative respiratory complications were observed. The method is based on the possibility of interrupting the medial extremity of the first rib beneath the clavicle through a limited, preliminary parasternal incision. The remaining ribs involved in the resection are also interrupted at the costo-chondral junction, leaving the sternum and clavicle intact. Once the medial limit of the involved ribs has been sectioned, multiple stitches are placed through the peristernal tissues and temporarily left inside the chest. Through a second posterior incision, the en-bloc chest wall and lung resection is easily completed. The previously placed peristernal stitches are collected and used for the medial fixation of the prosthesis. Results Using this technique the resection was radical in all cases. No major postoperative complications were registered. Conclusions The technique has several advantages: trauma related to double access is negligible; radical resection is facilitated, anterior chest wall resection is accomplished without sternal or clavicular injury, en-bloc chest wall and lung resection is made straightforward despite the extended area of resected ribs attached to the tumor, released within the chest cavity; chest wall stabilization is simple and reliable. The only disadvantage is that the patient's surgical position needs to be changed.
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Affiliation(s)
- Francesco Puma
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Jacopo Vannucci
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Elisa Scarnecchia
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Damiano Vinci
- Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy
| | - Niccolò Daddi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Sant' Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
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Yuan L, Mao Y. [Advance of Treatment for Superior Sulcus Tumor of the Lung]. Zhongguo Fei Ai Za Zhi 2018; 21:493-497. [PMID: 29945709 PMCID: PMC6022026 DOI: 10.3779/j.issn.1009-3419.2018.06.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
肺上沟瘤是指发生在肺上沟区的的支气管源性肿瘤, 是非小细胞肺癌(non-small cell lung cancer, NSCLC)的一个独特的临床亚型, 占肺癌总数不足5%。它常侵犯第1肋、臂丛、锁骨下动静脉、交感神经链、星状神经节和(或)椎体等胸廓入口结构。近几十年, 肺上沟瘤的治疗取得了不断的进展, 最新发布的几个临床试验证实了同期放化疗加手术切除能够改善肿瘤的完整切除率、局部控制率和病理缓解率, 延长患者的总生存时间。已经成为肺上沟瘤的治疗最为有效的方式, 并成为美国国立综合癌症网络(National Comprehensive Cancer Network, NCCN)和美国胸科医师协会(American College of Chest Physicians, ACCP)指南推荐的肺上沟瘤治疗方案。本文回顾国内外相关文献, 简要介绍肺上沟瘤手术治疗及综合治疗的进展情况。
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Affiliation(s)
- Ligong Yuan
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China
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Robinson LA, Tanvetyanon T, Grubbs D, Antonia S, Creelan B, Fontaine J, Toloza E, Keenan R, Dilling T, Stevens CW, Sommers KE, Vrionis F. Induction chemoradiotherapy versus chemotherapy alone for superior sulcus lung cancer. Lung Cancer 2018; 122:206-213. [PMID: 30032833 DOI: 10.1016/j.lungcan.2018.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/31/2018] [Accepted: 06/17/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Although treatment of superior sulcus tumors with induction chemoradiotherapy (CRT) followed by surgery employed in the Intergroup INT-0160 trial is widely adopted as a standard of care, there may be significant associated morbidity and mortality. We describe our experience using standard and alternative induction regimens to assess survival rates and treatment toxicity in these patients. MATERIALS AND METHODS Electronic medical records of all patients who underwent multimodality treatment including resection of lung cancer invading the superior pulmonary sulcus between 1994 and 2016 were retrospectively reviewed. Multivariable Cox Proportional Hazards model was constructed. RESULTS Of 102 consecutive patients, 53 (52%) underwent induction CRT, 34 (33%) underwent induction chemotherapy only (Ch) followed by adjuvant radiotherapy, and 15 (15%) underwent no induction therapy followed by adjuvant therapy. There were 2 postoperative deaths (1.9%). To date, 42 patients are alive with a median follow-up 72.5 months. Overall 5-year survival rate was 45.4%. Survival was significantly influenced by age, FEV1, positive resection margins, surgical complications, but not the induction regimen. CRT resulted in higher complete pathological response rate than Ch: 38% vs. 3% (p < 0.001). CRT was associated with higher post-operative re-intubation rate: 13% vs. 0% (p = 0.03). CONCLUSIONS Our single-institutional experience indicated that while induction CRT produced greater complete pathological response than Ch, it also increased the risk of post-operative complications. With careful patient selection, induction Ch followed by adjuvant radiotherapy may provide comparable survival outcomes to induction CRT. Since induction Ch is associated with lower risk of complications, it may be a particularly desirable choice for patients with impaired performance status.
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Affiliation(s)
- Lary A Robinson
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA.
| | - Tawee Tanvetyanon
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Deanna Grubbs
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Scott Antonia
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Ben Creelan
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jacques Fontaine
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Eric Toloza
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Robert Keenan
- Division of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Thomas Dilling
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Craig W Stevens
- Department of Radiation Oncology, Beaumont Hospital, Royal Oak, MI, USA
| | | | - Frank Vrionis
- Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL, USA
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Chepelev L, Souza C, Althobaity W, Miguel O, Krishna S, Akyuz E, Hodgdon T, Torres C, Wake N, Alexander A, George E, Tang A, Liacouras P, Matsumoto J, Morris J, Christensen A, Mitsouras D, Rybicki F, Sheikh A. Preoperative planning and tracheal stent design in thoracic surgery: a primer for the 2017 Radiological Society of North America (RSNA) hands-on course in 3D printing. 3D Print Med 2017; 3:14. [PMID: 29782619 PMCID: PMC5954793 DOI: 10.1186/s41205-017-0022-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022] Open
Abstract
In this work, we provide specific clinical examples to demonstrate basic practical techniques involved in image segmentation, computer-aided design, and 3D printing. A step-by-step approach using United States Food and Drug Administration cleared software is provided to enhance surgical intervention in a patient with a complex superior sulcus tumor. Furthermore, patient-specific device creation is demonstrated using dedicated computer-aided design software. Relevant anatomy for these tasks is obtained from CT Digital Imaging and Communications in Medicine images, leading to the generation of 3D printable files and delivery of these files to a 3D printer.
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Affiliation(s)
- Leonid Chepelev
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
| | - Carolina Souza
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
| | - Waleed Althobaity
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
| | - Olivier Miguel
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
| | - Satheesh Krishna
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
| | - Ekin Akyuz
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
| | - Taryn Hodgdon
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
| | - Carlos Torres
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
| | - Nicole Wake
- 2Department of Radiology, New York University, New York, NY USA
| | - Amy Alexander
- 3Department of Radiology, Mayo Clinic, Rochester, MN USA
| | - Elizabeth George
- 4Department of Radiology, Brigham and Women's Hospital, Boston, MA USA
| | - Anji Tang
- 4Department of Radiology, Brigham and Women's Hospital, Boston, MA USA
| | - Peter Liacouras
- 5Department of Radiology, Walter Reed National Military Medical Center, Bethesda, MD USA
| | - Jane Matsumoto
- 3Department of Radiology, Mayo Clinic, Rochester, MN USA
| | | | | | - Dimitrios Mitsouras
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
| | - Frank Rybicki
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
| | - Adnan Sheikh
- 1Department of Medical Imaging, The Ottawa Hospital, University of Ottawa School of Medicine, Ottawa, ON Canada
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Abstract
Patient with Pancoast Tumor usually present in advanced stage of the disease which requires chemotherapy and radiotherapy as options of treatment. Histologic confirmation is a key for further treatment of these patients. Normally in bronchoscopy the lesion can't be visualised and in result making biopsy difficult to perform. Transthoracic biopsy through computed tomography poses anatomic difficulties and not always the pulmonary lesion can be reached. We report a case of pancoast tumor in a 68 year old male who presented with left arm pain and upper lobe increased density mass in chest x ray. Computed tomography confirmed an upper lobe mass of the left lung with invasion of the chest wall. It was successfully diagnosed with biopsy taken through the oesophagus of intrapulmonary mass with the EBUS bronchoscope (EUS- B FNA). No complication were observed during and after the procedure. To our knowledge this is the first case of making the diagnosis of lung carcinoma Pancoast tumor using EBUS bronchoscope with approach through oesophagus (EUS-B FNA). There may be a role in using EBUS specifically to diagnose a pancoast tumor in the right patient population.
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Affiliation(s)
| | | | | | - Alma Andoni
- Univeristy Hospital Shefqet Ndroqi, Tirana, Albania
| | - Ilir Peposhi
- Univeristy Hospital Shefqet Ndroqi, Tirana, Albania
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Oka S, Kobayashi K, Matsumiya H, Kanayama M, Shinohara S, Shinohara S, Taira A, Kuwata T, Takenaka M, Chikaishi Y, Hirai A, Tashima Y, Imanishi N, Kuroda K, Ichiki Y, Tanaka F. An effective and safe surgical approach for a superior sulcus tumor: A case report. Int J Surg Case Rep 2017. [PMID: 28648878 PMCID: PMC5484986 DOI: 10.1016/j.ijscr.2017.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Surgical approach for locally advanced superior sulcus tumor is difficult. We experienced a locally advanced superior sulcus tumor located from the anterior to posterior apex thoracic inlet. Our surgical approach was effective and safe for treating a SST located from the anterior to posterior apex of the thoracic inlet.
Introduction Superior sulcus tumors, frequently referred to as Pancoast tumors, are a wide range of tumors invading a section of the apical chest wall called the thoracic inlet. For this reason, a surgical approach and complete resection may be difficult to accomplish. We experienced a locally advanced superior sulcus tumor (SST) located from the anterior to posterior apex thoracic inlet and performed complete resection after definitive chemoradiation. Presentation of case A 71-year-old Japanese male presented at our hospital due to left back pain and an abnormal chest computed tomography (CT) scan showing 80 × 70 × 60-mm tumor located in the left middle apex thoracic inlet. This tumor was located near the subclavian artery, and the subclavian lymph nodes were swollen. The tumor was found to be an adenocarcinoma (clinical-T3N3M0 stage IIIB). Therefore, we performed definitive chemoradiation therapy. Slight reduction in the tumor size was noted after the treatment, and the subclavian lymph nodes were not swollen. We next performed surgical resection for this SST. Regarding the surgical approaches, the anterior approach was a transmanubrial approach, and the posterior approach was a Paulson’s thoracotomy. In this manner, we were able to perform complete en-bloc resection of this tumor. Discussion This surgical approach was effective and safe for treating a SST located from the anterior to posterior apex of the thoracic inlet. The patient remains healthy and recurrence-free at 2.5 years after the operation. Conclusion Surgical approach for SST is difficult. Therefore, this approach is effective and safety.
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Affiliation(s)
- Soichi Oka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Kenichi Kobayashi
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hiroki Matsumiya
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masatoshi Kanayama
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shuichi Shinohara
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shinji Shinohara
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akihiro Taira
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Taiji Kuwata
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masaru Takenaka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yasuhiro Chikaishi
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ayako Hirai
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuko Tashima
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naoko Imanishi
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koji Kuroda
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshinobu Ichiki
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Fumihiro Tanaka
- Second Department of Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
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Abstract
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.
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Affiliation(s)
- Norikazu Kawai
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Takeshi Kawaguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Motoaki Yasukawa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Takashi Watanabe
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Nara, Japan.,Department of Thoracic Surgery, Nara Prefecture General Medical Center, Nara, Nara, Japan
| | - Takashi Tojo
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Kashihara, Nara, Japan
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Thampy E, Cherian SV. An unusual but classic cause of hand numbness: Pancoast tumour. Postgrad Med J 2017; 93:779. [PMID: 28596442 DOI: 10.1136/postgradmedj-2017-134995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Elena Thampy
- Department of Internal Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX, USA
| | - Sujith V Cherian
- Department of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health Science Center at Houston-McGovern Medical School, Houston, TX, USA
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Abstract
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. Originally deemed universally fatal, in 1956, Shaw and Paulson introduced a new treatment paradigm with combined radiotherapy and surgery ensuring 5-year survival of approximately 30%. During the 1990s, following the need to improve systemic as well as local control, a trimodality approach including induction concurrent chemoradiotherapy followed by surgical resection was introduced, reaching 5-year survival rates up to 44% and becoming the standard of care. Many efforts have been persecuted, also, to obtain higher complete resection rates using appropriate surgical approaches and involving multidisciplinary team including spine surgeon or vascular surgeon. Other potential treatment options are under consideration like prophylactic cranial irradiation or the addition of other chemotherapy agents or biologic agents to the trimodality approach.
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Affiliation(s)
- Giuseppe Marulli
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Lucia Battistella
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Francesca Calabrese
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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Truntzer P, Antoni D, Santelmo N, Schumacher C, Falcoz PE, Quoix E, Massard G, Noël G. Superior sulcus non-small cell lung carcinoma: A comparison of IMRT and 3D-RT dosimetry. Rep Pract Oncol Radiother 2016; 21:427-34. [PMID: 27489512 DOI: 10.1016/j.rpor.2016.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/22/2016] [Indexed: 12/25/2022] Open
Abstract
AIM A dosimetric study comparing intensity modulated radiotherapy (IMRT) by TomoTherapy to conformational 3D radiotherapy (3D-RT) in patients with superior sulcus non-small cell lung cancer (NSCLC). BACKGROUND IMRT became the main technique in modern radiotherapy. However it was not currently used for lung cancers. Because of the need to increase the dose to control lung cancers but because of the critical organs surrounding the tumors, the gains obtainable with IMRT is not still demonstrated. MATERIAL AND METHODS A dosimetric comparison of the planned target and organs at risk parameters between IMRT and 3D-RT in eight patients who received preoperative or curative intent irradiation. RESULTS In the patients who received at least 66 Gy, the mean V95% was significantly better with IMRT than 3D-RT (p = 0.043). IMRT delivered a lower D2% compared to 3D-RT (p = 0.043). The IH was significantly better with IMRT (p = 0.043). The lung V 5 Gy and V 13 Gy were significantly higher in IMRT than 3D-RT (p = 0.043), while the maximal dose (D max) to the spinal cord was significantly lower in IMRT (p = 0.043). The brachial plexus D max was significantly lower in IMRT than 3D-RT (p = 0.048). For patients treated with 46 Gy, no significant differences were found. CONCLUSION Our study showed that IMRT is relevant for SS-NSCLC. In patients treated with a curative dose, it led to a reduction of the exposure of critical organs, allowing a better dose distribution in the tumor. For the patients treated with a preoperative schedule, our results provide a basis for future controlled trials to improve the histological complete response by increasing the radiation dose.
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Affiliation(s)
- Pierre Truntzer
- Radiotherapy Department, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 42, 67065 Strasbourg Cedex, France
| | - Delphine Antoni
- Radiotherapy Department, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 42, 67065 Strasbourg Cedex, France; Radiobiology Laboratory EA 3430, Federation of Translational Medicine in Strasbourg (FMTS), Strasbourg University, Strasbourg, France
| | - Nicola Santelmo
- Thoracic Surgery Department, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Catherine Schumacher
- Thoracic Surgery Department, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Pierre-Emmanuel Falcoz
- Thoracic Surgery Department, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Elisabeth Quoix
- Pneumology Department, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Gilbert Massard
- Thoracic Surgery Department, Nouvel Hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg Cedex, France
| | - Georges Noël
- Radiotherapy Department, Centre Paul Strauss, 3, rue de la Porte de l'Hôpital, BP 42, 67065 Strasbourg Cedex, France; Radiobiology Laboratory EA 3430, Federation of Translational Medicine in Strasbourg (FMTS), Strasbourg University, Strasbourg, France
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Kim MP, Ta AH, Ellsworth WA 4th, Marco RA, Gaur P, Miller JS. Three dimensional model for surgical planning in resection of thoracic tumors. Int J Surg Case Rep 2015; 16:127-9. [PMID: 26453940 DOI: 10.1016/j.ijscr.2015.09.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/24/2015] [Indexed: 12/20/2022] Open
Abstract
3D printed model can be made of thoracic malignancy by taking CT image of the patient and creating a 3D surface rendered imaging and printing it on 3D printer. 3D printed model can help counsel the patient about the planned operation. 3D printed model can help in surgical planning of the resection of complex thoracic tumors.
Introduction The computed tomography scan provides vital information about the relationship of thoracic malignancies to the surrounding structures and aids in surgical planning. However, it can be difficult to visualize the images in a two-dimensional screen to interpret the full extent of the relationship between important structures in the surgical field. Presentation of case We report two cases where we used a three-dimensional printed model to aid in the surgical resection of thoracic malignancies. Discussion Careful planning is necessary to resect thoracic malignancies. Although two-dimensional images of the thoracic malignancies provide vital information about the tumor and its surrounding structures, the three-dimensional printed model can provide more accurate information about the tumor and assist in surgical planning. Conclusion Three-dimensional printed model provide better visualization of complex thoracic tumors, aid in counseling the patient about the surgical procedure and assisted in surgical resection of thoracic malignancy.
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36
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Lu T, Fischer UM, Marco RA, Naoum JJ, Reardon MJ, Lumsden AB, Blackmon SH, Davies MG. Case Report: En Bloc Resection of Pancoast Tumor with Adjuvant Aortic Endograft and Chemoradiation. Methodist Debakey Cardiovasc J 2015; 11:140-4. [PMID: 26306134 DOI: 10.14797/mdcj-11-2-140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
"Pancoast" tumors frequently require a multidisciplinary approach to therapy and are still associated with high morbidity and mortality. Due to their sensitive anatomic location, complex resections and chemoradiation regimens are typically required for treatment. Those with signs of aortic invasion pose an even greater challenge, given the added risks of cardiopulmonary bypass for aortic resection and interposition. Placement of an aortic endograft can facilitate resection if the tumor is in close proximity to or is invading the aorta. Prophylactic endografting to prevent radiation-associated aortic rupture has also been described. This case describes a 60-year-old female who presented with a stage IIIa left upper lobe undifferentiated non-small-cell carcinoma encasing the subclavian artery with thoracic aorta and bony invasion. Following carotid-subclavian bypass with Dacron, en bloc resection of the affected lung, ribs, and vertebral bodies was performed. The aorta was prophylactically reinforced with a Gore TAG thoracic endograft prior to adjuvant chemoradiation. The patient remains disease-free at more than 5 years follow-up after completing her treatment course. Endovascular stenting with subsequent chemoradiation may prove to be a viable alternative to palliation or open operative management and prevention of aortic injury during tumor resection and/or adjuvant therapy in select patients with aortic involvement.
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Affiliation(s)
- Tony Lu
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Uwe M Fischer
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Rex A Marco
- The University of Texas Medical School at Houston, Houston, Texas
| | - Joseph J Naoum
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Michael J Reardon
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Alan B Lumsden
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
| | | | - Mark G Davies
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
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Calabek B, Meng S, Pollanz S, Klepetko W, Hoetzenecker K, Oberndorfer F, Grisold W. A Case of Pancoast Tumor with Unusual Presentation. J Brachial Plex Peripher Nerve Inj 2015; 10:e53-e56. [PMID: 27917240 DOI: 10.1055/s-0035-1551654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 03/24/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The Pancoast syndrome (PS) has been termed after Henry Pancoast. Its neurologic core symptoms include pain, radicular sensory and motor syndromes, and Horner syndrome. A PS is often the presenting sign of lung cancer and bears a grim prognosis. METHODS This case report describes an atypical onset of a lung tumor causing a PS. Electrophysiological examination was not conclusive. The diagnosis was confirmed by MRI, CT scan, and biopsy. The intervention consisted of preoperative chemo- and radiotherapy and was followed by an extensive surgical approach with histologically confirmed perineural invasion of the brachial plexus. RESULTS The postoperative period was dominated by neuropathic pain. Despite considerable loss of distal sensorimotor function of the right hand, the patient uses the extremity and has returned to professional life. DISCUSSION This observation triggered by the advances in general oncology and surgery also demonstrates the management of a lesion of the peripheral nervous system caused by cancer.
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Affiliation(s)
- Bernadette Calabek
- Department of Neurology, Kaiser Franz Josef-Hospital, Ludwig Boltzmann-Institute of Neurooncology, Vienna, Austria
| | - Stefan Meng
- Department of Radiology, Kaiser Franz Josef-Hospital, Vienna, Austria
| | - Sabine Pollanz
- Department of Neurology, Kaiser Franz Josef-Hospital, Ludwig Boltzmann-Institute of Neurooncology, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, University Hospital of Vienna, Vienna, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, University Hospital of Vienna, Vienna, Austria
| | | | - Wolfgang Grisold
- Department of Neurology, Kaiser Franz Josef-Hospital, Ludwig Boltzmann-Institute of Neurooncology, Vienna, Austria
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38
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Abstract
Bronchogenic carcinomas involving the chest wall include tumors invading the ribs and spine, as well as Pancoast tumors. In the past, such neoplasms were considered to be incurable, but with new multimodality regimens, including induction chemoradiation followed by surgery, they can now be completely resected and patients can benefit from prolonged survival. The most important prognostic factors are the completeness of resection and the pathologic nodal status.
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Affiliation(s)
- Jean Deslauriers
- Division of Thoracic Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Laval University, 2725 chemin Sainte-Foy, L-3540, Quebec City, Quebec G1V 4G5, Canada.
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39
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Abstract
Brachial plexus injury can occur as a result of trauma, inflammation or malignancies, and associated complications. The current topic is concerned with various forms of brachial plexopathy, its clinical features, pathophysiology, imaging findings, and management. Idiopathic brachial neuritis (IBN), often preceded with antecedent events such as infection, commonly present with abruptonset painful asymmetric upper limb weakness with associated wasting around the shoulder girdle and arm muscles. Idiopathic hypertrophic brachial neuritis, a rare condition, is usually painless to begin with, unlike IBN. Hereditary neuralgic amyotrophy is an autosomal-dominant disorder characterized by repeated episodes of paralysis and sensory disturbances in an affected limb, which is preceded by severe pain. While the frequency of the episodes tends to decrease with age, affected individuals suffer from residual deficits. Neurogenic thoracic outlet syndrome affects the lower trunk of the brachial plexus. It is diagnosed on the basis of electrophysiology and is amenable to surgical intervention. Cancer-related brachial plexopathy may occur secondary to metastatic infiltration or radiation therapy. Traumatic brachial plexus injury is commonly encountered in neurology, orthopedic, and plastic surgery set-ups. Trauma may be a direct blow or traction or stretch injury. The prognosis depends on the extent and site of injury as well as the surgical expertise.
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Affiliation(s)
- Satish V Khadilkar
- Department of Neurology, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, Maharashtra, India
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40
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Sokouti M, Halimi M, Golzari SEJ. Squamous cell carcinoma on the remaining sequel of tuberculosis, presented as pancoast tumor 8 years later. Tanaffos 2012; 11:49-51. [PMID: 25191429 PMCID: PMC4153214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/16/2012] [Indexed: 11/18/2022]
Abstract
Herein a 46 year-old man is presented with intolerable severe pain of right shoulder radiating to right arm and fourth and fifth fingers. He had a history of right upper lobectomy due to complicated tuberculosis eight years ago. Based on the findings of clinical examination and computed tomography imaging, diagnosis of Pancoast tumor of the right chest apex was confirmed. However, Fine Needle Aspiration (FNA) under computed tomography (CT) guidance was not conclusive. By performing a limited thoracotomy, multiple biopsy specimens were obtained from the mass and destroyed ribs for histopathologic examination which consequently confirmed the diagnosis of squamous cell carcinoma. Eventually, the patient was referred to the radiotherapy ward for treatment of Pancoast tumor.
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Affiliation(s)
- Mohsen Sokouti
- Department of Cardiothoracic Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Monireh Halimi
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad EJ Golzari
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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