1 / 15

morning report

Pancoast syndrome. Superior Pulmonary Sulcus Tumor. Henry Pancoast. First professor of roentgenology at the University of Pennsylvania. Reported several cases of the syndrome in 1924 JAMA article. Described clinical features of the

Ava
Download Presentation

morning report

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Morning report Bridger Clarke 10/22/08

    2. Pancoast syndrome Superior Pulmonary Sulcus Tumor

    3. Henry Pancoast First professor of roentgenology at the University of Pennsylvania. Reported several cases of the syndrome in 1924 JAMA article. Described clinical features of the “superior sulcus tumor” in his presidential address to the AMA in 1932.

    4. Pancoast Tumor “Pancoast Tumor” is a neoplasm located at the apical pleuropulmonary groove adjacent to the subclavian vessels. Symptoms arise as a result of neoplastic involvement of the brachial plexus, nerve roots, sympathetic chain, ribs, and chest wall.

    5. Symptoms Shoulder pain- present in 44-96%. Most common initial symptom. Extends down ulnar aspect of arm with T1 and C8 nerve root involvement.

    6. Symptoms Neurological- present in 8-22% Weakness and atrophy of the intrinsic hand muscles Paresthesias of the medial aspect of the arm Spinal chord compression and paraplegia occur in 5% of patients.

    7. Symptoms Horner’s Syndrome- Ptosis, miosis, anhydrosis. Caused by involvement of the paravertebral sympathetic chain and the stellate ganglion.

    8. Symptoms Other Manifestations- Superior vena cava syndrome Recurrent laryngeal nerve involvement Due to peripheral location of tumor, pulmonary symptoms such as cough, hemoptysis, and dyspnea occur late.

    9. Etiology Non-small cell lung cancer accounts for 90-95% of cases. Primarily squamous cell carcinoma. Other lesions arising in the superior sulcus: adenoid cystic carcinoma, mesothelioma, lymphoma, vascular aneurysms, amyloid nodules, TB, hydatid cysts, fungi.

    10. Diagnosis: imaging

    11. Diagnosis Sputum cytology: ~15% yield Bronchoscopy: 30-40% yield CT-guided biopsy: 90-95% yield VATS or thoracotomy: if less invasice techniques are nondiagnostic.

    12. Staging Identical to NSCLC elsewhere in thorax At least stage T3 given involvement of chest wall Invasion of vertebral body or subclavian vessels increases stage to T4

    13. Treatment Typically a combination of surgical resection and radiation (pre- or post-op). Induction chemotherapy prior to radiation may have mortality benefit.

    14. Prognostic Factors 5 year survival with uninvolved nodes 30-40%. <10% with lymph node involvement. Poor Survival: Horner’s syndrome Mediastinal lymph node involvement Incomplete resection Invasion of vertebral bodies

    15. The End

More Related