Pancoast syndrome in a patient with malignant lymphoma

Recurrent Diffuse Large B-Cell Lymphoma Presenting with Pancoast Syndrome: A Rare Cause of Radicular Neck Pain in the Emergency Department

BACKGROUND

Pancoast syndrome is an uncommon complication of apical lung tumors. Symptoms include pain, brachial plexopathy, and Horner's syndrome, and are the result of extrinsic compression of tissues within the thoracic inlet. Lymphoma is a very rare etiology.

CASE REPORT

We describe the presentation of a 59-year-old male with recurrent diffuse large B-cell lymphoma presenting with Pancoast syndrome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Cancer is an uncommon cause of radicular neck pain but should be considered in the differential, particularly when constitutional complaints are also present. Symptoms and physical examination findings associated with Pancoast syndrome are the consequence of compression of the C7-T2 vertebral roots and sympathetic chain. Computed tomography is usually required to definitively visualize the mass.

[Pancoast syndrome and endobronchial tumor infiltration as the first manifestation of Hodgkin lymphoma]

The most common cause of Pancoast syndrome is bronchogenic carcinoma. Other less common causes are solid tumor metastases, other chest tumors, infections, and hematologic neoplasms. Pancoast syndrome due to lymphoma is very rare, and cases described in the literature are essentially associated with non-Hodgkin lymphomas. In a review of the literature we found a single case of Pancoast syndrome secondary to a Hodgkin lymphoma; however, the syndrome manifested during recurrence of disease in that patient. We report a case of nodular sclerosis Hodgkin lymphoma which first manifested clinically as Pancoast syndrome and which was initially diagnosed by bronchial biopsy.

Pancoast's syndrome in a patient with B-cell lymphoma diagnosed and confirmed with immunoglobulin gene rearrangement

Pancoast's syndrome due to malignant lymphoma is extremely rare. A case of diffuse large B-cell lymphoma presenting as Pancoast's syndrome is described. A 66-year-old man complained of pain and weakness of the right arm, and CXR revealed a right apical lung tumour. Histological findings were consistent with it being a diffuse large cell type lymphoma and Southern blot analysis revealed clonal rearrangement of the immunoglobulin heavy-chain JH. Thus, the tumour in this patient was diagnosed to be diffuse large B-cell lymphoma. Malignant lymphoma is an extremely rare cause of Pancoast's syndrome and only five cases have been described. This is the first reported case of Pancoast's syndrome caused by B-cell lymphoma, which was accurately diagnosed by analysis of gene rearrangement.

[Pancoast-Tobias syndrome disclosing a primary pulmonary non-Hodgkin lymphoma]

INTRODUCTION

Pancoast's syndrome is generally due to superior sulcus tumors, generally bronchial cancer. In rare cases, other causes are found, but these are potentially curable.

CASE-REPORT

A 78-year old woman with a long history of tobacco intake presented with Pancoast's syndrome in the form of a locally invasive left apical lung mass. Despite her advanced age and the diagnosis of the high probability of lung cancer, a transparietal biopsy procedure was nevertheless performed, with the subsequent diagnosis of primary malignant pulmonary lymphoma. The patient was satisfactorily treated by combined chemotherapy.

CONCLUSION

The present study has shown that malignant non-Hodgkin lymphomas should be considered in the etiology of the disease, and as a rare but potentially treatable cause of Pancoast's syndrome.

[Pancoast's syndrome secondary to neck metastasis with normal radiography of the thorax]

Pancoast's syndrome is characterized by pain in the shoulders and upper extremities, Horner's syndrome, bone loss and hand muscle atrophy. Bronchogenic carcinoma is the most common cause, although other neoplasms or lung infection are occasionally responsible. An apical mass on the chest film can be seen in over 90% of cases, although apical pleural thickening is sometimes the only radiographic finding. We describe a patient whose clinical picture was highly suggestive of Pancoast's syndrome but whose chest film was normal. Magnetic resonance imaging disclosed a cervical mass adjacent to the brachial plexus that proved to be cervical metastasis from an unknown primary tumor. We emphasize the need to consider the possibility of a metastatic cervical tumor compromising the brachial plexus in patients with a normal chest X-ray but clinical signs highly suggestive of Pancoast's syndrome.

Non-Hodgkin's lymphoma presenting as Pancoast's syndrome

Pancoast's syndrome is generally caused by primary or metastatic epithelial tumors. Other causes of the syndrome are unusual but well described. The present case report describes a rare case of Pancoast's syndrome caused by non-Hodgkin's lymphoma. This report emphasises the importance of establishing a firm pathologic diagnosis of the etiology of Pancoast's syndrome before instituting treatment.

[Pancoast's syndrome secondary to non-Hodgkin's lymphoma]

Pancoast's syndrome is usually found coincident with bronchogenic carcinoma. We describe a case of non-Hodgkin's lymphoma presenting with Pancoast's syndrome in a patient with a history of thoracoplasty.

Pancoast syndrome caused by a high grade B cell lymphoma

The case history is presented of a 20 year old man with Pancoast syndrome caused by a high grade B cell lymphoma.