title: A rare presentation of myxofibrosarcoma as a Pancoast tumor: a case report.
abstract: BACKGROUND
  Myxofibrosarcoma is an aggressive soft tissue neoplasm, classified as a variant of malignant fibrous histiocytoma. Most often, it occurs in middle to late adult life peaking in the seventh decade and involving the lower extremities (77%), trunk (12%), and retroperitoneum or mediastinum (8%). We report the first case of thoracic myxofibrosarcoma presenting as a Pancoast tumor.
  
  
  METHODS
  A 48-year-old non-tobacco smoking African-American man presented with a slow-growing mass in his neck along with 11 kg weight loss over 9 months. A review of his systems was positive for hoarseness and lowgrade intermittent fever without any shortness of breath or cough. A physical examination revealed a mass on the left side of his neck superior to his sternoclavicular joint measuring 3 × 3 × 1 cm. He had ptosis and miosis of his left eye. His breath sounds were decreased and coarse at the left apex. A neurological examination revealed 3/5 strength in his left upper arm. The remainder of the physical examination was unremarkable. Ultrasound of his neck showed an ill-defined heterogeneous mass lateral to his left thyroid lobe. A computed tomography scan of his chest showed a large multiloculated pleural-based mass in his left lung surrounding the adjacent neurovascular structures. A percutaneous biopsy was non-diagnostic. Subsequently, he underwent a left thoracotomy with biopsy. The mass extended from his anterior mediastinum medially at the level of the pulmonary trunk, superiorly into the superior sulcus and posteriorly into his chest wall. Surgical pathology confirmed the diagnosis of myxofibrosarcoma.
  
  
  CONCLUSIONS
  Here we present a case of Pancoast tumor with myxofibrosarcoma as the underlying etiology. Pancoast syndrome generally entails an infiltrating lesion in the superior sulcus presenting with upper extremity pain, atrophy of the hand muscles, and Horner's syndrome. The differential diagnosis of Pancoast syndrome includes inflammatory and infectious etiologies, as well as neoplasms of benign and malignant nature. Of the neoplasms implicated, the most common are non-small cell lung carcinomas; myxofibrosarcoma presenting as a Pancoast tumor has not been reported in the literature.
authors.affiliation: Department of Surgery, Weiss Memorial Hospital, Chicago, IL, USA.
authors.forename: Vasa
authors.initials: V
authors.lastname: Jevremovic
authors.affiliation: Department of Surgery, Weiss Memorial Hospital, Chicago, IL, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Yousuf
authors.affiliation: Department of Oncology, Meadville Medical Center, Meadville, PA, USA.
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Hussain
authors.affiliation: Department of Pathology, Weiss Memorial Hospital, Chicago, IL, USA.
authors.forename: Amer
authors.initials: A
authors.lastname: Abboud
authors.affiliation: Department of Surgery, Weiss Memorial Hospital, Chicago, IL, USA. echedraw@uic.edu.|Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA. echedraw@uic.edu.
authors.forename: Edgar G
authors.initials: EG
authors.lastname: Chedrawy
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D062005:Biopsy, Large-Core Needle / Q000379:methods; D001763:Blepharoptosis / Q000209:etiology; D005354:Fibrosarcoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D006258:Head and Neck Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015877:Miosis / Q000209:etiology; D009236:Myxosarcoma / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D010178:Pancoast Syndrome / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D012983:Soft Tissue Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D018906:Antineoplastic Agents, Alkylating; D007069:Ifosfamide
keywords: Case report; Horner’s syndrome; Malignant fibrous histiocytoma; Myxofibrosarcoma; Pancoast syndrome