Correct!
5. All of the above
The completion of the patient’s staging should include brain MRI and bone scan to assess for distant metastatic disease, although the bone scan could potentially be omitted in light of the 18FDG-PET results showing no osseous metastatic disease. Pulmonary function testing would be required to assess the patient’s ability to undergo pulmonary resection. Finally, brachial plexus MRI is required to determine of the right apical neoplasm is resectable, in light of the patient’s right upper extremity complaints, because it is possible the tumor is invading and involving the brachial plexus- involvement of the brachial plexus, (C8 or above), would increase the patient’s T stage from T3 to T4.
The patient’s brain MRI and bone scan were negative, and her pulmonary function testing showed moderate obstruction and mildly decreased diffusion capacity with normal resting oximetry, not precluding surgery. She underwent brachial plexus MRI (Figure 7), which showed that the right apical lesion was in close proximity to and displacing the inferior trunk of the plexus, but no encasement or clear evidence of nerve involvement was seen.
Figure 8. Brachial plexus MRI.
The patient successfully completed several rounds of chemoradiation (carboplatin/paxlitaxel and 60 Gy) and subsequently underwent surgical resection of the right apical squamous cell neoplasm; a chest wall resection involving the posterior ribs and transverse processes of T1-3 was performed with neurosurgical assistance as well. The patient recovered uneventfully and remains recurrence-free 1.5 years later.
Diagnosis: Superior sulcus (Pancoast) tumor
References