Extrapulmonary lymphomatoid granulomatosis presenting as Pancoast's syndrome

Horner's Syndrome as Initial Manifestation of Possible Brachial Plexopathy Neurolymphomatosis

Introduction: Horner's syndrome is an established clinical finding unique to neoplastic brachial plexopathy.

Background: We present the case of a patient who developed Horner's syndrome as the first manifestation of neurolymphomatosis (NL) of the brachial plexus that did not have the usually associated bulky adenopathy/Pancoast syndrome phenotype.

Discussion: We discuss the clinical utility of Horner's syndrome with regards to brachial plexopathy of indeterminate etiology, as well as the utility of other diagnostic modalities in NL.

Concluding Remarks: NL, particularly of the brachial plexus, is particularly challenging to diagnose. MRI and CSF studies are often inconclusive. FDG-PET imaging can be difficult to get insurance to approve. The presence of Horner's syndrome in brachial plexopathy of indeterminate etiology, even in the absence of bulky adenopathy, should raise clinical suspicion of NL, possibly prompting such interventions as fascicular nerve biopsy.

Horner syndrome: clinical perspectives

Horner syndrome consists of unilateral ptosis, an ipsilateral miotic but normally reactive pupil, and in some cases, ipsilateral facial anhidrosis, all resulting from damage to the ipsilateral oculosympathetic pathway. Herein, we review the clinical signs and symptoms that can aid in the diagnosis and localization of a Horner syndrome as well as the causes of the condition. We emphasize that pharmacologic testing can confirm its presence and direct further testing and management.

Pancoast tumors: characteristics and preoperative assessment

Superior sulcus tumors (SSTs), or as otherwise known Pancoast tumors, make up a clinically unique and challenging subset of non-small cell carcinoma of the lung (NSCLC). Although the outcome of patients with this disease has traditionally been poor, recent developments have contributed to a significant improvement in prognosis of SST patients. The combination of severe and unrelenting shoulder and arm pain along the distribution of the eighth cervical and first and second thoracic nerve trunks, Horner's syndrome (ptosis, miosis, and anhidrosis) and atrophy of the intrinsic hand muscles comprises a clinical entity named as "Pancoast-Tobias syndrome". Apart NSCLC, other lesions may, although less frequently, result in Pancoast syndrome. In the current review we will present the main characteristics of the disease and focus on the preoperative assessment.

Pancoast syndrome: A rare presentation of non-Hodgkin's lymphoma

Pancoast syndrome is a common presentation of bronchogenic carcinoma, but other malignancies are rarely cited as its cause. Pancoast syndrome due to non-Hodgkin's lymphoma is rarely described in the literature. Here, we report a case of Pancoast syndrome due to non-Hodgkin's lymphoma to increase the awareness of the clinicians regarding essentiality of tissue diagnosis of Pancoast tumor before starting the treatment.

[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.

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.