Superior Pulmonary Sulcus Tumor or Pancoast Syndrome

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THE term “superior pulmonary sulcus tumor” and the eponym “Pancoast syndrome” are used almost interchangeably. In 1932, Pancoast1 coined the former term to describe a malignant neoplasm, at the extreme apex of the pleural cavity, characterized by four features: (l) pain, (2) Homer’s syndrome, (3) destruction of bone, and (4) atrophy of hand muscles. This symptom complex quite naturally has come to be called the “Pancoast syndrome.”

As to the etiopathogenesis of this tumor, Doctor Pancoast1 wrote: “One can practically rule out primary lung cancer.” Although he believed the superior pulmonary sulcus tumor to be a fatal malignant neoplasm, he did suggest the use of radon-seed implants.

It is now generally agreed that the clinical picture is usually caused by a peripherally located bronchogenic carcinoma; and it seems likely that a histologic re-evaluation of Pancoast’s1 original cases, as well as those in other early reports,2 would bear out this finding. Over the years, students of pulmonary disease have found that the tumors and the symptom complex are rather common.

Several years ago we were investigating the palliative value of radon-seed implantation in patients with extensive bronchogenic carcinoma. In January, 1954, I operated upon a man with intractable pain, in the right shoulder girdle, caused by a rather large apical cavitating squamous-cell bronchogenic carcinoma (Fig. 1). The neoplastic mass was avulsed from the apical pleura, and the upper and middle lobes were resected. The entire region of pleural involvement was then coagulated with the Bovie-Davis unit, and fifteen 1-mc. radon seeds. . .



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