superior sulcus tumor
Summary
Superior sulcus tumor (Pancoast tumor) is a lung cancer located in the apex of the lung that invades local structures including the brachial plexus, sympathetic chain, and ribs. It presents with shoulder/arm pain, Horner's syndrome, and neurological deficits rather than typical respiratory symptoms.
Detail
Superior sulcus tumors arise in the pulmonary apex (superior sulcus) and are characterized by local invasion rather than distant metastasis at presentation. The tumor typically invades the lower trunk of the brachial plexus (C8-T1), causing severe shoulder and arm pain that radiates in an ulnar distribution. Invasion of the sympathetic chain at T1 produces ipsilateral Horner's syndrome (ptosis, miosis, anhidrosis). The tumor may also invade the subclavian vessels, stellate ganglion, and upper ribs. Most cases are non-small cell lung cancer (usually squamous cell or adenocarcinoma). Diagnosis requires high clinical suspicion as chest X-rays may appear normal or show only subtle apical thickening. MRI is the imaging modality of choice for evaluating local extension. Treatment typically involves multimodal therapy with induction chemoradiotherapy followed by surgical resection if feasible. The prognosis depends on resectability and absence of distant metastases.
Sources
- Robbins and Cotran Pathologic Basis of Disease
- Harrison's Principles of Internal Medicine
- DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology
- Murray and Nadel's Textbook of Respiratory Medicine
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