ABSTRACT
STUDY DESIGN: Monocentric prospective study. PURPOSE: To assess the safety and effectiveness of the posterior approach for resection of advanced Pancoast tumors. OVERVIEW OF LITERATURE: In patients with advanced Pancoast tumors invading the spine, most surgical teams consider the combined approach to be necessary for “en-bloc” resection to control visceral, vascular, and neurological structures. We report our preliminary experience with a single-stage posterior approach. METHODS: We included all patients who underwent posterior en-bloc resection of advanced Pancoast tumors invading the spine in our institution between January 2014 and May 2015. All patients had locally advanced tumors without N2 nodes or distant metastases. All patients, except 1, benefited from induction treatment consisting of a combination of concomitant chemotherapy (cisplatin-VP16) and radiation. RESULTS: Five patients were included in this study. There were 2 men and 3 women with a mean age of 55 years (range, 46–61 years). The tumor involved 2 adjacent levels in 1 patient, 3 levels in 1 patient, and 4 levels in 3 patients. There were no intraoperative complications. The mean operative time was 9 hours (range, 8–12 hours), and the mean estimated blood loss was 3.2 L (range, 1.5–7 L). No patient had a worsened neurological condition at discharge. Four complications occurred in 4 patients. Three complications required reoperation and none was lethal. The mean follow-up was 15.5 months (range, 9–24 months). Four patients harbored microscopically negative margins (R0 resection) and remained disease free. One patient harbored a microscopically positive margin (R1 resection) and exhibited local recurrence at 8 months following radiation treatment. CONCLUSIONS: The posterior approach was a valuable option that avoided the need for a second-stage operation. Induction chemoradiation is highly suitable for limiting the risk of local recurrence.
Subject(s)
Female , Humans , Male , Drug Therapy , Follow-Up Studies , Intraoperative Complications , Neoplasm Metastasis , Operative Time , Pancoast Syndrome , Prospective Studies , Recurrence , Reoperation , SpineABSTRACT
É descrito o caso de um paciente de 52 anos, tabagista, que procurou atendimento médico queixando-se de dor em região interescápulo vertebral direita acompanhada de parestesia distal de metacarpos ipsilateral, febre, tosse produtiva e perda ponderal. Ao exame físico, havia presença de murmúrio vesicular diminuído em ápice pulmonar direito. A radiografia de tórax evidenciava opacidade neste mesmo local e na tomografia computadorizada, havia presença de massa encapsulada lobo superior direito, com mediastino superior desviado para esquerda e presença de linfadenomegalias. Com a hipótese de neoplasia pulmonar e síndrome de Pancoast, foi solicitado uma mediastinoscopia com biópsia cujo resultado foi inconclusivo. Logo, optou-se pela toracotomia para retirada da massa e realização de biópsia cujo resultado foi confirmatório para BOOP. Para o tratamento, optou-se por prednisona, cuja resposta foi efetiva.
Subject(s)
Humans , Male , Middle Aged , Pneumonia , Bronchiolitis Obliterans , Pancoast SyndromeABSTRACT
Pancoast syndrome (PS) is characterized by a malignant neoplasm of the superior sulcus of the lung with destructive lesions of the thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves. The most common initial symptom of PS is shoulder pain; however, cough, dyspnea, and hemoptysis, signs often associated with lung cancer, are not as common. Investigation of PS can be difficult even with plain radiographs of the chest because it is surrounded by osseous structures such as the ribs, vertebral bodies, and manubrium. Due to these characteristics, orthopedic surgeons tend to make a misdiagnosis resulting in delay of appropriate treatment. Here we report on a patient who was supposed to undergo rotator cuff repair for his shoulder pain and weakness, and was eventually diagnosed with PS.
Subject(s)
Humans , Bays , Brachial Plexus , Cough , Diagnostic Errors , Dyspnea , Hemoptysis , Lung , Lung Neoplasms , Manubrium , Orthopedics , Pancoast Syndrome , Ribs , Rotator Cuff , Shoulder Pain , Superior Vena Cava Syndrome , ThoraxABSTRACT
Pancoast syndrome (PS) is characterized by a malignant neoplasm of the superior sulcus of the lung with destructive lesions of the thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves. The most common initial symptom of PS is shoulder pain; however, cough, dyspnea, and hemoptysis, signs often associated with lung cancer, are not as common. Investigation of PS can be difficult even with plain radiographs of the chest because it is surrounded by osseous structures such as the ribs, vertebral bodies, and manubrium. Due to these characteristics, orthopedic surgeons tend to make a misdiagnosis resulting in delay of appropriate treatment. Here we report on a patient who was supposed to undergo rotator cuff repair for his shoulder pain and weakness, and was eventually diagnosed with PS.
Subject(s)
Humans , Bays , Brachial Plexus , Cough , Diagnostic Errors , Dyspnea , Hemoptysis , Lung , Lung Neoplasms , Manubrium , Orthopedics , Pancoast Syndrome , Ribs , Rotator Cuff , Shoulder Pain , Superior Vena Cava Syndrome , ThoraxABSTRACT
Os autores descrevem um caso de Síndrome de Pancoastcom desfecho desfavorável por atraso no diagnóstico.Enfatiza-se a necessidade de alto índice de suspeiçãopara esta síndrome, a fim de oportunizar a sua detecçãoprecoce e, consequentemente, a possibilidade de tratamentocurativo ou maior sobrevida.
The authors describe a case of Pancoast Syndrome withunfavorable outcome because of delay on diagnosing.It?s emphasized the need of high suspicion index to thesyndrome, in order to nurture it?s early detection and,consequently, the possibility of curative treatment or increasedsurvival.
ABSTRACT
CONTEXT: Non-small cell lung carcinomas (NSCLCs) of the superior sulcus are considered to be the most challenging type of malignant thoracic disease. In this disease, neoplasms originating mostly from the extreme apex of the lung expand to the chest wall and thoracic inlet structures. Multiple imaging procedures have been applied to identify tumors and to stage and predict tumor resectability in surgical operations. Clinical examinations to localize pain complaints in shoulders and down the arms, and to screen for Horner's syndrome and abnormalities seen in paraclinical assessments, have been applied extensively for differential diagnosis of superior sulcus tumors. Although several types of imaging have been utilized for diagnosing and staging Pancoast tumors, there have been almost no reports on the efficiency of whole-body bone scans (WBBS) for detecting the level of abnormality in cases of superior sulcus tumors. CASE REPORT: We describe a case of Pancoast tumor in which technetium-99m methylene diphosphonate (Tc-99m MDP) bone single-photon emission-computed tomography (SPECT) was able to accurately detect multiple areas of abnormality in the vertebrae and ribs. In describing this case, we stress the clinical and diagnostic points, in the hope of stimulating a higher degree of suspicion and thereby facilitating appropriate diagnosis and treatment. From the results of this study, further clinical trials to evaluate the potential of SPECT as an efficient imaging tool for the work-up on cases of Pancoast tumor are recommended.
CONTEXTO: Carcinomas pulmonares de células não pequenas (NSCLCs) do sulco superior são considerados como o maior desafio nos tumores malignos torácicos. Nesta doença, as neoplasias se originam principalmente do ápice do pulmão e se expandem pela parede e pelas estruturas torácicas. Diversas técnicas de imagem têm sido utilizadas para identificar e estagiar os tumores, permitindo um prognóstico para a sua ressecção em procedimentos cirúrgicos. O exame clínico tem sido bastante usado para diagnóstico diferencial de tumores do sulco superior nas queixas de dores no ombro, síndrome de Horner e anormalidades observadas em exames paraclínicos. Embora diversos tipos de exames de imagem sejam utilizados para diagnóstico e estadiamento de tumores de Pancoast, praticamente não existem relatos sobre a eficácia do exame ósseo do corpo todo (WBBS) na detecção do nível de anormalidade em casos de tumores do sulco superior. RELATO DE CASO: Descrevemos um caso de tumor de Pancoast, em que foi realizada a tomografia computadorizada óssea por emissão de fóton único (SPECT) com metileno difosfonato de tecnécio-99 (Tc-99m MDP). Este exame foi capaz de detectar com acurácia as múltiplas áreas de anormalidade em vértebras e costelas. Ao descrever este caso, os autores ressaltam os pontos clínicos e diagnósticos, esperando estimular maior grau de suspeita, facilitando assim o diagnóstico e tratamento apropriados. A partir dos resultados deste trabalho, outros estudos clínicos podem avaliar o potencial do SPECT como uma ferramenta eficiente de imagem a ser recomendada na investigação de casos de tumor de Pancoast.
Subject(s)
Aged , Humans , Male , Pancoast Syndrome , Tomography, Emission-Computed, Single-Photon/methods , Carcinoma, Non-Small-Cell Lung/diagnosis , Lung Neoplasms/diagnosis , Radiopharmaceuticals , SpineABSTRACT
A síndrome de Pancoast consiste de sinais e sintomas decorrentes do acometimento do ápice pulmonar e estruturas adjacentes por um tumor. Na maioria das vezes, o processo causal é uma neoplasia. O carcinoma broncogênico é a principal neoplasia causadora da síndrome. Os subtipos histológicos mais encontrados são o adenocarcinoma e o carcinoma epidermoide. A ocorrência de carcinoma de pequenas células de pulmão como gênese da síndrome de Pancoast é rara, com poucos relatos na literatura. Descrevemos o caso de um doente com síndrome de Pancoast causado por um carcinoma de pequenas células de pulmão, discutindo aspectos referentes ao diagnóstico e à terapêutica.
Pancoast syndrome consists of signs and symptoms resulting from a tumor affecting the pulmonary apex and adjacent structures. The process is typically caused by a neoplasm. The majority of cases of Pancoast syndrome are caused by bronchogenic carcinoma. The most commonly found histologic subtypes are adenocarcinoma and epidermoid carcinoma. There have been very few reports of small cell lung carcinoma in the genesis of Pancoast syndrome. We describe the case of a patient with Pancoast syndrome caused by small cell lung carcinoma and discuss the aspects related to the diagnosis and treatment.