Pancoast described a clinical syndrome that occurs in patients with a lung cancer involving the superior sulcus at the apex of the lung near the pleural surface.
Spread of the tumor:
(1) C8 and T1 extraspinal roots (lower portion of the brachial plexus)
(2) sympathetic chain
(3) stellate ganglion
(4) necks of the first 3 ribs
(5) transverse processes and borders of the vertebral bodies of C7 through T3
Clinical features:
(1) severe shoulder pain that radiates to the head and neck, axilla, chest and arm
(2) pain and paresthesias along the medial (ulnar) aspect of the arm and fourth and fifth digits
(3) weakness with atrophy of the intrinsic hand muscles
(4) Horner's syndrome
(5) ipsilateral warm, dry hand (from sympathetic denervation)
Metastatic cancer from other sites may rarely cause the Pancoast syndrome.
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