Pancoast's neoplasm

(Henry Khunrath Pancoast, 1875 - 1939, American radiologist) (also called superior sulcus neoplasm), neoplasm that occurs at the extreme apex of the lung in the superior sulcus. Such a tumour typically invades the chest wall and into the neck. Posterior extension may result in an involvement of the roots of the brachial plexus with spread to the spinal canal and vertebral bodies. Anterior extension leads to involvement of the subclavian artery with invasion of trunks, division and cords of the brachial plexus within the interscalenic space and medial invasion of the sympathetic stellate ganglion. The histological type of a Pancoast neoplasm is most often a pulmonary squamous cell carcinoma. Clinical manifestations are thoracic pain, Horner's syndrome, destruction of bone, atrophy of hand muscles and brachial plexopathy. On chest radiographs, Pancoast's neoplasm usually appears as an apical mass or an asymmetrical pleural thickening with irregularities sometimes associated with rib destruction (see apical cap). Spiral CT scanning with contrast enhancement and thin collimation and MRI are the preferred modalities for evaluating Pancoast neoplasm because of their ability to visualize structures at the apex of the thorax in multiple planes (see lung cancer staging) (Fig.1) (Fig.2). Such neoplasms, if the local tumour is not extensive and if there is no evidence of mediastinal or distant metastases, can be treated successfully with preoperative radiation therapy, followed by lobectomy and chest wall resection.

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