Pancoast syndrome is usually secondary to lung cancer. We report a patient with Pancoast syndrome in whom a biopsy specimen of a cervical mass at first thought to be anaplastic carcinoma was found to stain positively for leukocyte common antigen and negatively for keratin, epithelial membrane antigen, and alpha-fetoprotein. A diagnosis of malignant lymphoma associated with Pancoast syndrome was made, and a salutary response was observed after combination chemotherapy. To our knowledge, this is the first reported case of Pancoast syndrome associated with malignant lymphoma. We emphasize the importance of using immunohistochemical stains to define the pathologic condition in difficult cases. Case ReportIn April 1988, an 86-year-old man was admitted to Long Beach Memorial Hospital. He complained of pain in the left shoulder radiating to the left arm of 1 months' duration that was associated with dyspnea. He also complained of weight loss of approximately 20 pounds and weakness of the left arm; however, he denied having fever or night sweats. He had smoked one pack of cigarettes a day for more than 20 years. His past medical history was unremarkable, except for osteoarthritis of many years. On physical examination, he was found to be in slight respiratory distress. Ptosis and a small pupil were found in the left eye, but he did not have sweating on either side of the body when he was moved into sunlight to induce sweating.A left supraclavicular mass measuring 3 X 4 cm was palpated.There was no other significant palpable lymphadenopathy. The liver and spleen were not enlarged on palpation. Diminished muscle power of the left hand also was observed. The results of a variety of routine laboratory tests, including complete blood count, platelet count, and blood chemistry screen, were normal. A chest radiograph showed an increased density in the left apex and an irregular density in the left paracardiac region (Fig. IA). A computed tomography (CT) scan of the chest showed a left upper lobe mass with erosion through the supraclavicular area and destruction of the second and third ribs ( Fig. 2A). There also was a left lower lobe mass. A biopsy specimen of the left supraclavicular mass showed poorly differentiated malignant tumor consistent with a poorly differentiated large cell carcinoma of the lung; however, a large cell malignant lymphoma could not be ruled out (Fig. 3). Immunoperoxidase staining of the paraffin-embedded specimen was performed subsequently. The specimen was shown to be positive for leukocyte common antigen (a mixture of PD7/26 and 2B11; Dako Corp., Santa Bar-2588
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