Pancoast Tumor Secondary to Large Cell Neuroendocrine Carcinoma.

SESSION TITLE: Cancer Student/Resident Case Report Posters IISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Pancoast tumor is defined as a neoplasm located at the apical pleuropulmonary groove. The majority of the tumors are non small cell lung cancers (NSCLCs).

CASE PRESENTATION: A 44 year old male with 20 pack year history of smoking who presented with headache, axillary chest wall discomfort and numbness in the medial aspect of the left forearm for 2 weeks. He denied any pulmonary symptoms. His past medical history was significant for hypertension, treated with hydrochlorothiazide 12.5 mg daily. Physical examination revealed scattered wheezing and non diagnostic sensory deficit on the medical aspect of the left forearm. Computer tomography (CT) of the chest demonstrated a 4.8 cm left upper lobe mass abutting the apical pleura without pathologically enlarged regional adenopathy (fig 1). CT-guided biopsy was performed which demonstrated large cell neuroendocrine tumor. The tumor cells were strongly immunoreactive to chromogranin and pan-cytokeratin. Synaptophysin showed weak patchy staining (fig 2). Further evaluations included, MRI of the chest which revealed the left upper lobe mass invading the chest wall and extending to the thoracic inlet, involving the C8-T2 nerve roots as well as the lower brachial plexus; associated with left supraclavicular adenopathy. Staging workup included, PET scan and MRI of the brain which were negative for regional nodal involvement or metastatic disease. The initial TNM stage was cT4,cN0. He received concurrent chemoradiation using two cycles of cisplatin/etoposide and 46 Gy of radiation in 23 Fx. Subsequently, left upper lobectomy with En Bloc chest wall resection was performed 6 weeks following completion of concurrent chemoradiation. Patient achieved a complete pathologic remission (ypT0, ypN0). Two additional cycles of consolidation chemotherapy with cisplatin/etoposide were given. Patient has been free of disease for 2 years post surgery and is doing well.DISCUSSION: Pancoast tumors account for less than 5% of all bronchogenic carcinomas. NSCLC predominates as the cause of pancoast tumors specially squamous cell lung cancer, but rarely adenocarcinoma and small cell lung cancer can be seen. Based on recent evidence, induction chemoradiotheraphy followed by surgery has been adopted as a standard of treatment for pancoast tumors without distant metastases. The overall 2-year survival rate after induction chemoradiotherapy and resection varies from 55% to 70%. Our patient was treated with induction chemoradiotherapy and followed by resection. He responded well to standard treatment. To the best of our knowledge, pancoast tumor secondary to large cell neuroendocrine carcinoma has not been reported previously.CONCLUSIONS: Pancoast tumor due to large cell neuroendocrine carcinoma is rare, but responds to standard induction chemoradiotheraphy as for after NSCLCs. Reference #1: Foroulis CN. Superior sulcus (Pancoast) tumors: current evidence on diagnosis and radical treatment. J Thorac Dis. 2013 Sep;5(Suppl 4):S342-S358.

DISCLOSURE: The following authors have nothing to disclose: Nirosshan Thiruchelvam, Jaskirat Randhawa, Hamed Daw, Timothy Spiro, Abdo HaddadNo Product/Research Disclosure Information.