A 65-year-old patient presents with severe shoulder and arm pain, along with Horner's syndrome. Chest X-ray reveals an apical lung mass with associated rib destruction. Which of the following is the most likely diagnosis?

• A Bronchogenic cyst
• B Apical pleural plaque
• C Pulmonary hamartoma
• D Pancoast tumor (superior sulcus tumor) ✓

Explanation

Pancoast tumor is a superior sulcus tumor located at the lung apex that invades the brachial plexus, ribs, and sympathetic chain, causing shoulder/arm pain and Horner's syndrome (ptosis, miosis, anhidrosis). Rib destruction on chest X-ray is characteristic. Apical pleural plaques are benign and asymptomatic. Hamartomas are peripheral nodules with popcorn calcification. Bronchogenic cysts are mediastinal, not apical masses with rib destruction.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.