A Case of Pancoast Tumor with Unusual Presentation

Introduction

 The Pancoast syndrome (PS) has been termed after Henry Pancoast. Its neurologic core symptoms include pain, radicular sensory and motor syndromes, and Horner syndrome. A PS is often the presenting sign of lung cancer and bears a grim prognosis.

Methods

 This case report describes an atypical onset of a lung tumor causing a PS. Electrophysiological examination was not conclusive. The diagnosis was confirmed by MRI, CT scan, and biopsy. The intervention consisted of preoperative chemo- and radiotherapy and was followed by an extensive surgical approach with histologically confirmed perineural invasion of the brachial plexus.

Results

 The postoperative period was dominated by neuropathic pain. Despite considerable loss of distal sensorimotor function of the right hand, the patient uses the extremity and has returned to professional life.

Discussion

 This observation triggered by the advances in general oncology and surgery also demonstrates the management of a lesion of the peripheral nervous system caused by cancer.     

Human Neuroendocrine Tumor Cell Lines as a Three-Dimensional Model for the Study of Human Neuroendocrine Tumor Therapy

Neuroendocrine tumors (NETs) are rare tumors, with an incidence of two per 100, 000 individuals per year, and they account for 0.5% of all human malignancies.¹ Other than surgery for the minority of patients who present with localized disease, there is little or no survival benefit of systemic therapy. Therefore, there is a great need to better understand the biology of NETs, and in particular define new therapeutic targets for patients with nonresectable or metastatic neuroendocrine tumors. 3D cell culture is becoming a popular method for drug screening due to its relevance in modeling the in vivo tumor tissue organization and microenvironment.^2,3 The 3D multicellular spheroids could provide valuable information in a more timely and less expensive manner than directly proceeding from 2D cell culture experiments to animal (murine) models.To facilitate the discovery of new therapeutics for NET patients, we have developed an in vitro 3D multicellular spheroids model using the human NET cell lines. The NET cells are plated in a non-adhesive agarose-coated 24-well plate and incubated under physiological conditions (5% CO₂, 37 °C) with a very slow agitation for 16-24 hr after plating. The cells form multicellular spheroids starting on the 3^rd or 4^th day. The spheroids become more spherical by the 6^th day, at which point the drug treatments are initiated. The efficacy of the drug treatments on the NET spheroids is monitored based on the morphology, shape and size of the spheroids with a phase-contrast light microscope. The size of the spheroids is estimated automatically using a custom-developed MATLAB program based on an active contour algorithm. Further, we demonstrate a simple method to process the HistoGel embedding on these 3D spheroids, allowing the use of standard histological and immunohistochemical techniques. This is the first report on generating 3D spheroids using NET cell lines to examine the effect of therapeutic drugs. We have also performed histology on these 3D spheroids, and displayed an example of a single drug''s effect on growth and proliferation of the NET spheroids. Our results support that the NET spheroids are valuable for further studies of NET biology and drug development.