Tag: Pancoast Tumour

Pancoast Tumour

PANCOAST TUMOUR

Q. 1

A man with Pancoast tumor developed Horner’s syndrome. All of the following are the features of Horner’s syndrome, EXCEPT:

 A

Ptosis and Miosis in ipsilateral eye

 B

Anhidrosis of ipsilateral face

 C

Heterochromia irides

 D

Apparent exophthalmos

Q. 1

A man with Pancoast tumor developed Horner’s syndrome. All of the following are the features of Horner’s syndrome, EXCEPT:

 A

Ptosis and Miosis in ipsilateral eye

 B

Anhidrosis of ipsilateral face

 C

Heterochromia irides

 D

Apparent exophthalmos

Ans. D

Explanation:

Horner’s syndrome consists of unilateral enophthalmos, ptosis, miosis, and loss of sweating over the ipsilateral half of the face or forehead (anhidrosis). It is caused by ipsilateral involvement of the sympathetic pathways in the carotid plexus, the cervical sympathetic chain, the upper thoracic cord, or the brain stem.

 
Melanocyte maturation in the iris depends on sympathetic innervation; thus, a less pigmented (bluer) iris occurs in congenital or longstanding acquired Horner’s syndrome.
 
Ref: Riordan-Eva P., Hoyt W.F. (2011). Chapter 14. Neuro-Ophthalmology. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e.

 


Q. 2

In pancoast tumor, following is seen except‑

 A

Homer’s syndrome

 B

Rib erosion

 C

Haemoptysis

 D

Pain in shoulder and arm

Q. 2

In pancoast tumor, following is seen except‑

 A

Homer’s syndrome

 B

Rib erosion

 C

Haemoptysis

 D

Pain in shoulder and arm

Ans. C

Explanation:

Answer is ‘c’ i.e. Haemoptysis

Haemoptysis is seen in central tumors or endobronchial growth (Pancoast tumor is a peripheral tumor)

Pancoast’s tumor (also k/a superior sulcus tumor)

  • Is a tumor of the apex of the lung
  • It may grow to cause
  • shoulder and arm pain – d/t involvement of C8, TI & 72 nerves
  • Erosion of ribs
  • Homer’s syndrome (Enopthalmos, Ptosis, Miosis & Ipsilateral loss of sweating)

Q. 3

All seen in Pancoast syndrome except-

 A

Brachial plexus involvement

 B

Dyspnoea

 C

Clubbing

 D

Myasthenia gravis

Q. 3

All seen in Pancoast syndrome except-

 A

Brachial plexus involvement

 B

Dyspnoea

 C

Clubbing

 D

Myasthenia gravis

Ans. D

Explanation:

Ans. is ‘d’ i.e., Myasthenia gravis

Quiz In Between


Q. 4

Pancoast tumour is seen with cancer of – 

 A

Apical lobe of lung

 B

Lingual lobe

 C

Thyroid

 D

Pyriform fossa

Q. 4

Pancoast tumour is seen with cancer of – 

 A

Apical lobe of lung

 B

Lingual lobe

 C

Thyroid

 D

Pyriform fossa

Ans. A

Explanation:

Answer is ‘a’ i.e. Apical lobe of lung 

“Pancoast’s (or superior sulcus tumor) syndrome results from local extension of a tumor growing in the apex of the lung with involvement of the eighth cervical and first and second thoracic nerves, with shoulder pain that characteristically radiates in the ulnar distribution of the arm, often with radiologic destruction of the first and second ribs.” – Harrison


Q. 5

True about Pancoast tumour are all of the following except:       

March 2005

 A

Only 3-5% are small cell carcinomas

 B

Involves eighth cervical and first two thoracic nerves commonly

 C

Homer’s syndrome may be a manifestation

 D

Lower lobe Carcinoma

Q. 5

True about Pancoast tumour are all of the following except:       

March 2005

 A

Only 3-5% are small cell carcinomas

 B

Involves eighth cervical and first two thoracic nerves commonly

 C

Homer’s syndrome may be a manifestation

 D

Lower lobe Carcinoma

Ans. D

Explanation:

Ans. D: Lower lobe Carcinoma

Non-small cell lung cancer that originates in the upper portion of the lung and extends to other nearby tissues such as the ribs and vertebrae is known as Pancoast tumour. Also called a pulmonary sulcus tumor:

  • Definition – Apical Tumor of superior sulcus of lung
  • Course -Superior sulcus marked by subclavian artery and grows into thoracic outlet
  • Signs-Homer’s Syndrome, supraclavicular fullness, venous distension and upper extremity edema. The mass in the superior sulcus is an extension of a lung tumor; most of it lies outside the lung and involves the chest wall, nerve roots, lower trunks of the brachial plexus, sympathetic chain, stellate ganglion, ribs, and bone. Most Pancoast tumors are squamous cell carcinomas or adenocarcinomas.

Only 3-5% are small cell carcinomas.

Involvement of the phrenic or recurrent laryngeal nerve or superior vena cava obstruction is not representative of the classic Pancoast tumor


Q. 6

Pancoast tumor is

 A

Superior sulcus tumor 

 B

Inferior sulcus tumor

 C

Median sulcus tumor 

 D

None of the above

Q. 6

Pancoast tumor is

 A

Superior sulcus tumor 

 B

Inferior sulcus tumor

 C

Median sulcus tumor 

 D

None of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., Superior sulcus tumor [Ref Clinical Scenarios in Surgical Oncology p. 39]

  • It is a tumor of the pulmonary apex typically found in conjunction with a smoking history. It is situated at the top end of either the right or left lung.
  • Most Pancoast tumors are non-small cell cancers i.e. squamous cell carcinomas (SCCs) or adenocarcinomas.

Quiz In Between



Pancoast Tumour

PANCOAST TUMOUR


PANCOAST TUMOUR

  • Pancoast tumour or superior sulcus tumour is a bronchogenic carcinoma arising from the apex of the lung.
  • Involvement of structures-
  1. Apical chest wall above the level of the 2nd rib
  2. Brachial plexus
  3. First ribs
  4. Vertebrae
  5. Subclavian vessels or stellate ganglion
  • Pancoast’s syndrome refers to-
  1. Pancoast’s tumour
  2. Erosion of the first rib
  3. Paralysis of C8 & T1 nerve roots
  4. Horner’s syndrome
Horner’s syndrome consists of unilateral enophthalmos, ptosis, miosis, and loss of sweating over the ipsilateral half of the face or forehead (anhidrosis). It is caused by ipsilateral involvement of the sympathetic pathways in the carotid plexus, the cervical sympathetic chain, the upper thoracic cord, or the brain stem. 

ETIOLOGY-

  • Chronic smoker
  • Mesothelioma
  • Metastatic neoplasm
  • Hematologic neoplasm
  • Bacterial infection
  • Fungal infection
  • TB

CLINICAL FEATURES-

  • Seen in elderly male around 70 years
  • Common as squamous cell carcinoma
  • Cough, weight loss , dyspnoea and chest pain, clubbing
  • Tumour is hard in consistency, fixed, irregular.
  • Severe pain in shoulder

INVESTIGATIONS-

  • X- ray shows a dense mass
  • CT scan shows infiltration of tumour into ribs
  • Bronchoscopy shows tissue biopsy and sputum analysis
  • FNAC helps in diagnosis the disease

  

TREATMENT-

  • Pallliative radiotherapy

Exam Important

  • Pancoast tumour or superior sulcus tumour is a bronchogenic carcinoma arising from the apex of the lung.

 

 

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