A 72-year-old man presents with hoarseness and right shoulder pain. Chest CT shows a 4 cm mass in the left upper lobe apex with destruction of the adjacent first and third ribs. Which diagnosis is most likely?

• A Germ cell tumor
• B Mesothelioma
• C Thymoma
• D Pancoast tumor ✓

Explanation

Pancoast tumor (superior sulcus tumor) is a lung apex tumor that invades the brachial plexus, ribs, and sympathetic chain, producing shoulder pain, Horner syndrome, and hoarseness due to recurrent laryngeal nerve involvement. Mesothelioma presents with pleural-based thickening. Thymoma and germ cell tumors are anterior mediastinal masses, not apical lung tumors 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.