lambert eaton syndrome

[arda]

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Question is attached,

i picked mediastinal mass since i thought patient had small cell ca and lambert eaton syndrome but the answer is superior sulcus tumor meaning pancoast tumor compressing brachial plexus but i really cannot make that differential diagnosis.Pt is also a smoker which makes small ca more logical i think

 

[jokerman55]

Question is attached,

i picked mediastinal mass since i thought patient had small cell ca and lambert eaton syndrome but the answer is superior sulcus tumor meaning pancoast tumor compressing brachial plexus but i really cannot make that differential diagnosis.Pt is also a smoker which makes small ca more logical i think

So when you say mediastinal mass, I think of two things. (1) Tumor causing SVC syndrome in which I would expect patient's head to be swollen. or (2) Thymoma which would lead to Myasthenia Gravis (diplopia, drooping eye lids at the end of day and such).

In this question, the patient has pain and weakness. Because there is pain, it is unlikely to be one of those autoimmune at NMJ

 

[arda]

Does pancoast tumor caues pain ?

Great logic,but mediastinal mass like small cell ca can also cause lambert eaton right ? but i think your logic makes more sense.

Thanks @jokerman55

 

[acciddropping]

Does pancoast tumor caues pain ?

Great logic,but mediastinal mass like small cell ca can also cause lambert eaton right ? but i think your logic makes more sense.

Thanks @jokerman55

Thymoma is associated with MG which is not associated with cancer. PC tumor is associated with para-neoplastic syndromes like cushing syndrome - the question probably includes some types of Honer's syndrome syxs. SCC (which is seen in heavy smokers as well) is associated with Eaton Lambert (paraneoplastic).

 

[jokerman55]

Does pancoast tumor caues pain ?

Great logic,but mediastinal mass like small cell ca can also cause lambert eaton right ? but i think your logic makes more sense.

Thanks @jokerman55

If the pancoast tumor is compressing the brachial plexus you can get pain due to nerve compression. You also get the muscle weakness due to the compression.

 

[igcgnerd]

Yep had this question. This isn't lambert eaton syndrome. This is a pancoast tumor pressing directly on the brachial plexus. Most likely effecting the median nerve which accounts for the isolated extremity weakness and pain. Lambert eaton is painless and is diffuse weakness. This is painful and isolated to one extremity.

 

[thehundredthone]

Yep had this question. This isn't lambert eaton syndrome. This is a pancoast tumor pressing directly on the brachial plexus. Most likely effecting the median nerve which accounts for the isolated extremity weakness and pain. Lambert eaton is painless and is diffuse weakness. This is painful and isolated to one extremity.

This is key. Lambert Eaton syndrome is caused by autoantibodies to a component of the NMJ, they will not choose only one isolated part of the body to attack.

 

[notbobtrustme]

LE is going to present with proximal muscle weakness, not really pain.

 

[conan31]

Shoulder pain is typically associated with Pancoast tumor. One limb weakness also makes sense.