Abstract:
Introduction: Pancoast tumours, a subtype of non-small cell lung carcinoma (NSCLC) was an obscure entity until Henry Pancoast first described them in the 20th century. These tumours primarily involve the apical chest wall and thoracic inlet structures, and their diagnosis requires the presence of lung apices origin and associated neurological dysfunction. Pancoast tumours commonly manifest as shoulder girdle and arm pain, often along the C8, T1, and T2 dermatomes, accompanied by weakness or atrophy of hand muscles and Horner's syndrome, a constellation of symptoms collectively known as Pancoast Syndrome. Despite comprising 5% of all NSCLC cases, Pancoast tumours are frequently diagnosed at advanced stages, exhibiting a propensity for metastasis and leading to a generally unfavourable prognosis.
This abstract presents a clinical case study that provides an accurate depiction of the signs and symptoms associated with Pancoast tumours, underscoring the crucial importance of early recognition through maintaining a high index of suspicion, even in routine clinical scenarios.
Case Study: A 56-year-old male patient presented at the emergency department with a sudden onset of left leg weakness and mild sensory loss. Upon further inquiry, the patient reported clumsiness in the left hand. Initially, the initial suspicion was that of a stroke; however, a CT scan of the head yielded unremarkable results. Subsequent examination revealed classical Horner's syndrome, characterized by miosis, partial ptosis, and hemifacial anhidrosis, which raised suspicion of an apical pathology. Although the chest radiograph appeared normal, a CT scan of the chest was subsequently conducted, revealing the presence of a left-sided Pancoast tumour. A subsequent MRI demonstrated cord compression at T2-T3 levels, along with tumour infiltration into the left brachial plexus. CT-guided biopsy conclusively confirmed the diagnosis of lung adenocarcinoma with distant spread.
Results: During the course of treatment, the patient underwent five cycles of radiotherapy, which led to the development of neuropathic pain in the left shoulder and upper chest. Encouragingly, there was clinical improvement noted in the left-sided Horner's syndrome. While the clumsiness in the left hand did not deteriorate further, some residual weakness persisted. Regrettably, the patient experienced permanent loss of bilateral leg function as a result of spinal cord metastasis.
Conclusion: In conclusion, this case study highlights the critical importance of conducting a thorough medical history, including a detailed assessment of smoking history, and performing meticulous examinations when evaluating patients who present with seemingly unrelated symptoms. It is crucial not to disregard the possibility of Pancoast tumours, even in the presence of normal findings in physical and imaging studies. The delay in diagnosis and management often arises from the failure to consider Pancoast tumours in the differential diagnosis. Recognizing these tumours early and initiating timely treatment have a significant impact on patient survival rates in cases of lung adenocarcinoma. Therefore, maintaining a high level of suspicion for Pancoast tumours is vital to optimize prognosis and enhance patient outcomes.
Audience Take Away Notes:
This case demonstrates the significance of a thorough medical history and examination while assessing patients with seemingly unrelated symptoms. The presence of "normal" physical and imaging studies should provoke the clinician to consider an alternative possibility
Pancoast tumors are challenging to be picked up on plain radiographs. It is always a good idea to seek radiologist input when there is a high suspicion of an apical tumor
The inability to include a Pancoast tumour in the differential diagnosis, especially with a significant smoking history, most commonly causes a delay in diagnosis and management
Early recognition is the key since the prognosis is directly dependent on timely treatment, which can affect patients' disability with lung adenocarcinoma and survival rate
