Thyroid carcinoma presenting as pancoast tumor: a rare case from syria

Abstract

Pancoast tumors [1] are classically associated with primary bronchogenic carcinoma, which arises at the lung apex and invades adjacent neurovascular structures. Thyroid carcinoma presenting as an apical lung mass mimicking a Pancoast tumor [1] is exceptionally rare and poses a significant diagnostic challenge. These cases may represent metastatic thyroid carcinoma, ectopic thyroid tissue undergoing malignant transformation, or intrathoracic extension of the thyroid malignancy. We report the case of a 68-year-old man with a history of subtotal thyroidectomy for follicular adenoma -13 years ago- who presented with progressive left-hand weakness, neck pain radiating to the fourth and fifth digits, and significant weight loss. Clinical examination revealed features consistent with Pancoast syndrome [1], including Horner’s syndrome and brachial plexopathy. Imaging revealed a 7 cm left apical lung mass infiltrating the T1–T2 vertebrae and adjacent structures. Ultrasound-guided core biopsy revealed the presence of thyroid carcinoma. The patient declined surgical resection and was treated with radioactive iodine therapy; however, his neurological deficits progressed despite treatment. He died three years later from an apparent sudden heart attack unrelated to the thyroid cancer, according to his family. This case highlights an extremely rare presentation of thyroid carcinoma as a superior sulcus tumor (Pancoast tumor) [1]. These findings underscore the importance of histopathological confirmation of atypical apical lung masses to avoid misdiagnosis and inappropriate management. Clinicians should consider thyroid carcinoma in the differential diagnosis of Pancoast syndrome [1], particularly in patients with a history of thyroid disease.