A 70-year-old heavy smoker presents with superior vena cava syndrome and Horner's syndrome ipsilateral to a right apical lung mass. This presentation is most consistent with:

• A Small cell carcinoma of the lung with paraneoplastic SIADH
• B Thymoma with myasthenia gravis
• C Superior mediastinal lymphoma causing compression
• D Pancoast tumor (superior sulcus tumor) — squamous cell or adenocarcinoma at lung apex ✓

Explanation

Pancoast (superior sulcus) tumors arise in the apex of the lung and invade the brachial plexus, subclavian vessels, sympathetic chain, and first rib, producing ipsilateral Horner syndrome (ptosis, miosis, anhidrosis) from stellate ganglion invasion, arm/shoulder pain, and sometimes SVC syndrome from vessel involvement. They are most commonly squamous cell carcinoma or adenocarcinoma. Small cell carcinoma classically causes SIADH and ACTH secretion paraneoplastically but not the specific anatomic syndrome described. Thymoma is an anterior mediastinal mass.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.