Continuous Cervical Epidual Anesthesia in a Patient Suffering from a Severe Pain Caused by Pancoast Tumor: Case Report

Pancoast tumor is a relatively rare form of non-small cell lung cancer. Due to its invasion of the brachial plexus, it often causes severe pain and sometimes it is difficult to control the pain. Radiotherapy is often chosen not only for the treatment of the cancer but also for pain relief in Pancoast tumors. However, radiotherapy requires the patient to be kept in a resting supine position, which can cause severe pain during treatment or make it impossible to continue treatment due to pain. In this article, we report our experience with a patient who presented with severe pain in the shoulder and upper extremities due to a Pancoast tumor. Although patient had difficulty in maintaining a resting supine position, continuous cervical epidural anesthesia enabled him to complete radiotherapy under pain control. Despite the risk of infection and bleeding from catheterization, it is important to consider the indication of continuous epidural anesthesia when pain control is poor.

Advance of Treatment for Superior Sulcus Tumor of the Lung / 中国肺癌杂志

Superior sulcus tumor of the lung is a bronchogenic tumor occurred in the apex of the upper lobe of the lung and is a unique clinical subtype of non-small cell lung cancer (NSCLC), which account for less than 5% of all bronchogenic carcinomas. It often involves the first rib, brachial plexus, subclavian vessels, sympathetic chain, stellate ganglion or vertebra. A lot of progress has been achieved in the treatment of superior sulcus tumor over the past decades. Several clinical trials reported in recent years have confirmed that concurrent chemoradiotherapy followed by surgical resection can improve the rate of complete resection, local control and pathological remission of the tumor, and prolong the total-survival time. It has become the most effective treatment mode for the superior sulcus tumor, and recommended as a standard treatment mode for superior sulcus tumor by National Comprehensive Cancer Network (NCCN) and American College of Chest Physicians (ACCP) guidelines. This article reviews relevant literatures at home and abroad, and briefly introduces the advances in surgical treatment and comprehensive treatment of superior sulcus tumor.
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Efficacy analysis of chemotherapy in combination with 125I seed implantation for treatment of inoperational pancoast tumor / 中华放射医学与防护杂志

Objective To explore the therapeutic effect of radioactive 125I seeds combined with chemotherapy on the treatment of inoperative pancoast tumor by CT-guided percutaneous implantation of treatment planning system (TPS).Methods From December 2002 to December 2010,36 patients with pancoast tumor were confirmed by imaging and pathology.Among them,26 cases suffered from squamous cell carcinoma and 10 cases with adenocarcinoma.At 1 week after radioactive 125I implantation,chemotherapy was administered as intravenous 1 000 mg / m2 gemcitabine at 1 and 8 d and intravenous cisplatin 75 mg/ m2 at 1 d for 4 consecutive cycles.The prescribed dose (PD) was 120 Gy,and the median activity of the seeds was 0.7 mCi (2.59 × 107 Bq) with the range of 0.68-0.82 mCi (2.52 × 107-3.03 × 107 Bq).The patients were followed-up and the median follow-up time was 48 months.The survival rate was observed.Results The mPD of the target tumor was (118.7 ± 7.2) Gy,D90(126 ± 4.7) Gy,D90 ＞ mPD.The rate of CR (11 cases) was 63.6％,and the effective rate (CR + PR) was 83.4％.The follow-up last till December 1st,2016.1-,3-and 5-year local control rates were 92％,83％,and 67％,respectively.1-,3-and 5-year cumulative survival rate were 84.1％,56.7％,and 36.8％,respectively.Median survival was 38 months.Conclusions Chemotherapy combined with tissue radioactive 125I seed implantation is a minimally invasive and effective method for the treatment of pancoast tumor.

Cirugía de cáncer de pulmón en combinación con cirugía reductora de volumen / Lung cancer surgery in combination with volume-reducing surgery

En cirugía torácica la evaluación de un paciente con enfermedad pulmonar obstructiva crónica muy grave constituye un reto para el equipo quirúrgico, dado que los resultados espirométricos pueden contraindicar la intervención. Este reporte de caso describe los criterios seguidos para definir las intervenciones quirúrgicas; la estrategia asumida por el grupo de tórax; el manejo anestésico y la evolución posterior del paciente, al cual se le realizó cirugía reductora del volumen pulmonar, con abordaje unilateral inicial en lóbulo superior derecho y cirugía definitiva al mes, con toracotomía posterolateral izquierda ulterior para resecar un tumor de Pancoast. Se evidenció disminución de la disnea e incremento gradual en la capacidad física después de cada proceder quirúrgico. El volumen espiratorio forzado en el primer segundo con relación a los valores predichos mejoró, de 25 por ciento a 38 por ciento, después de la cirugía y 41 por ciento a los seis meses. El índice de Tiffeneau varió de 0,43 a 0,57 y 0,60 después de dos cirugías torácicas. Como única complicación el paciente presentó dolor torácico crónico para el cual mantiene tratamiento médico. Se concluye que la realización de cirugía reductora del volumen pulmonar es una alternativa a evaluar en pacientes que presenten neoplasia de pulmón y enfisema pulmonar bulloso. El enfoque multidisciplinario perioperatorio es un pilar fundamental para lograr resultados satisfactorios(AU)

In thoracic surgery, assessing a patient with very severe chronic obstructive pulmonary disease is a challenge for the surgical team, since spirometric results may contraindicate the intervention. This case report describes the criteria used to define surgical interventions, the strategy assumed by the thorax group, the anesthetic management and subsequent evolution of the patient, who underwent lung volume reduction surgery, with an initial unilateral approach in the right upper lobe and final surgery a month later, with posterior left posterolateral thoracotomy to resect a Pancoast tumor. There was a decrease in dyspnea and a gradual increase in physical capacity after each surgical procedure. The forced expiratory volume in the first second in relation to the predicted values improved from 25 percent to 38 percent after surgery, and 41 percent six months later. Tiffeneau index varied from 0.43 to 0.57 and 0.60 after two thoracic surgeries. As a single complication, the patient presented chronic chest pain for which he maintains medical treatment. It is concluded that the performance of pulmonary volume reduction surgery is an alternative to gauge in patients with lung cancer and bullous pulmonary emphysema. The multidisciplinary perioperative approach is a fundamental pillar to achieve satisfactory results(AU)

Tumor de pancoast presentación de un caso / Pancoast´s tumor case presentation

Introducción: El Tumor de Pancoast se produce por crecimiento local de un tumor del vértice pulmonar que penetra fácilmente en el canal neural y destruye las raíces nerviosas octava cervical y primera y segunda torácicas. Su causa más frecuente es el cáncer de pulmón. Objetivo: Al presentar este caso, nuestro objetivo es mostrar de forma ilustrativa una de las formas neurológicas de presentación del cáncer de pulmón y señalar una vez más cómo este tipo de paciente casi siempre acude por Ortopedia y rara vez por Neumología o Medicina Interna. Presentación del caso: Se presentó una paciente que aquejó primeramente dolor en hombro derecho, acude al ortopédico y al reumatólogo, este último al verle las manos (uñas en vidrio de reloj y dedos hipocráticos), la remite a Neumología, se realiza radiografía de tórax, se ingresa en Medicina Interna, donde se le practica una serie de estudios, incluida cirugía de mínimo acceso por el Grupo de Tórax. Conclusiones: El estudio histológico corroboró el diagnóstico de carcinoma bronquial epidermoide, así como demostró cómo estos casos entran por Ortopedia, lo cual atrasa el accionar médico. Motivación: Tuvimos a bien presentar este caso, que ilustra cómo los pacientes con esta patología, en muchas ocasiones, entran por Ortopedia, lo cual demora el diagnóstico y, por ende, la conducta.

Introduction: Pancoast tumor refers to a tumor located in the vertex of the lung. It can easily penetrate the neural channel destroying the eight cervical and first and second thoracic nervous roots. The most frequent cause of this tumor is lung cancer. Objective: To present this case, we wants to show a neurological presentation form of lung cancer and demostrate again that this type of patient often not consult in Neumology or Internal Medicine inicially. Case presentation: Female patient complaining of pain in the right shoulder was seen in the orthopedic and rheumatology office. On Physical exam the rheumatologists detects watch glass nails and Hippocratic fingers and refers the patient to the pneumatological department. A decrease in the breath sounds of the right vertex was detected. An x-ray of the thorax was taken and the patient was admitted in the internal medicine ward. Studies carried out included minimal access thoracic surgery. Conclusions: Histologically the diagnosis was an epidermoid bronchial carcinoma, also demostrate that this type of patient often not consult in Neumology or Internal Medicine inicially. Motivation: This case shows how often patients with this pathology consult by orthopedic, retarding diagnosis and the treatment.

Actinomicose pulmonar simulando tumor de Tobias-Pancoast / Pulmonary actinomycosis simulating Tobias-Pancoast tumor

A actinomicose é uma infecção rara que pode envolver diversos órgãos. O envolvimento torácico é incomum (10-20 por cento). No presente trabalho, é descrito o caso de um paciente de 33 anos, HIV negativo, com dor torácica posterior à esquerda em queimação com irradiação para membro superior esquerdo e diminuição da força com parestesias. A tomografia computadorizada evidenciou uma massa em contato com a parede torácica. Após realização de toracotomia foi visualizada lesão pulmonar sólida vascularizada aderida no lobo superior esquerdo, infiltrando a parede torácica posterior e ápice da cavidade. A biopsia incisional da lesão e o estudo microbiológico evidenciaram actinomicose.

Actinomycosis is a rare infection that may involve several organs. Thoracic involvement is uncommon (10-20 percent). This article describes the case of a 33 year-old patient, HIV negative, complaining of burning pain in the left posterior chest radiating to the left upper arm and reduced strength and paresthesias. The CT scan showed a mass in close contact with the chest wall. Following a thoracotomy, observation verified a solid pulmonary lesion adhered to the left upper lobe, infiltrating the posterior thoracic wall and apex of the cavity with rich vascularization. An incisional biopsy of the lesion and microbiological study revealed actinomycosis.

Pancoast tumor as a cause of profound brachial plexopathy.

Pancoast tumor is also called superior sulcus tumor. The classic presentation is an aching pain about the shoulder region with some radiation to the scapula and weakness in the intrinsic hand muscles unilaterally (C8-T1 distribution). This case report demonstrates a rare case of Pancoast tumor which involved the fifth cervical through the first thoracic nerve roots with pain and severe muscle weakness throughout the arm.

Combined en Bloc Spondylectomy and Chest Wall Resection for Malignant Tumors Invading Spinal Column and Chest Wall

We performed combined spondylectomy for 2 patients of malignant tumors invading spinal column and chest wall. For one patient with Pancoast tumor, anterolateral thoracotomy, apical lobectomy, chest wall resection, and hemispondylectomy were performed. For another patient with solitary metastatic tumor from nasopharyngeal cancer, posterolateral thoracotomy, chest wall resection, and total en bloc spondylectomy were performed with anterior and posterior instrumentation. The tumor including invaded chest wall and spinal column werewas removed completely in both patients. No local recurrence was found at 18 months follow-up evaluation in both patients.

Brachial Plexopathy Caused by Pancoast Tumor: A case report

Pancoast tumor is a specific lung carcinoma that has symptoms according to the location. It often involves the extrathoracic structure more than parenchyme of lung, that cause shoulder pain. A 61-years old man had been complaining of shoulder pain and limitation of range of motions of shoulder joint. Conservative management of the shoulder pain was not effective with physical therapy and injection therapy and the symptom of right upper extremity radiating pain had been aggravated. We had examination of the eletro-diagnostic test in 17 months after shoulder pain was developed. The findngs of the electrodiagnostic test was suspected as the injury of lower trunk of brachial plexus, so we had checked MRI on brachial view. The pancoast tumor was found in the extrathoracic region that invaded the lower trunk of the brachial plexus. The shoulder pain related with tumor was rare and could cause brachial plexopathy.