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Infections, lymphomas, and metastases1–3 are unique causes of Pancoast’s syndrome. The most common aetiological factor is non-small cell lung cancer (NSCLC). Pancoast’s syndrome resulting from metastatic renal cell carcinoma (RCC) has not previously been reported. We present the case of a metastatic Pancoast tumour in the left lung in a patient who had previously undergone resection for RCC.
A 49 year old woman was admitted with a pain in the left shoulder radiating to the arm which had been present for several months, eight years after excision of the left kidney for clear cell RCC. Computed tomographic scans of the chest and abdomen revealed a solitary irregular mass (4.5 cm) in the apical segment of the left lung adhering to the thoracic inlet with no evidence of local recurrence in the abdomen.
Extrapleural resection of the tumour with the apical segment of the lung was performed. Histological examination proved the metastatic origin of the tumour from RCC. Nine months after resection of the metastatic tumour the patient had a relapse in the left thoracic inlet. Residual left upper lobectomy with excision of ribs 1–4 and the infiltrated part of the brachial plexus was performed. Seven months later the patient underwent radiation therapy to the tumour bed and supraclavicular region because of metastases in the scalene nodes (total dose 60 Gy in 27 fractions over 41 days).
Twenty five months after the first metastatic resection the patient’s general condition deteriorated due to dissemination of the disease. Radiological examination showed several new foci in both lungs and a metastatic tumour in the brain. The patient died 31 months after the first thoracotomy and 11 years after nephrectomy.
We conclude that metastatic RCC should be considered as a possible cause of Pancoast’s syndrome. The resection should be as radical as in NSCLC—if necessary involving the adjacent structures—which should have been done in our first operation.
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