Definition and Management of Superior Sulcus Tumors

In 1838, Edwin Hare described the first case of Superior Sulcus Tumor who presented with 1) a history of pain, tingling, and numbness in the distribution of the left ulnar nerve, 2) Horner’s syndrome, and 3) a palpable mass in the “inferior triangular space” on the left side of his neck. The mass continued to grow until the patient became paraplegic, developed urinary retention, and eventually died of the disease. The postmortem examination revealed a hard tumor extending superiorly toward the origin of the brachial plexus and involving the carotid artery, the cervical sympathetic nerves, the vagal and phrenic nerves, the spine, and intervertebral foramina [1]. In 1932, Pancoast defined the SST as bronchogenic carcinomas that developed in the apex of the lungs and invaded the superior pulmonary sulcus [2-4]. These tumors are situated in the thoracic inlet and invade the lymphatics of the endothoracic fascia and extend to the lower roots of the brachial plexus, inter costal nerves, the stellate ganglion, the sympathetic chain, and adjacent ribs and vertebral bodies. The resulting severe pain and Horner’s syndrome (pupillary constriction, ptosis of the upper eyelid, slight elevation of lower lid, sinking in of the eye ball, narrowing of the palpebral fissure, an hidrosis and flushing of the affected side of the face) have been given the name “Pancoast’s syndrome” because of his description given above.