NCMP-01. Rare presentation of a Pancoast tumor with contralateral hyperhidrosis: A case report

Abstract Hyperhidrosis is an excessive sweating in quantities greater than is needed to cool the body either due to a primary idiopathic cause or a secondary cause. Hyperhidrosis occurs as a response to sympathetic nervous system stimulation. In patients with a Pancoast tumor which lies in the superior pulmonary sulcus, there is potential for Pancoast syndrome and sympathetic nervous system activation if the tumor encroaches on surrounding structures.1 Here we present a patient with left facial hyperidrosis, that started after initiation of radiation therapy and chemotherapy for a right sided Pancoast tumor. Horner’s syndrome which occurs through disruption of the sympathetic innervation and causes a constellation of symptoms including ipsilateral miosis, normally reactive pupil, ptosis and in some cases, ipsilateral facial anhidrosis, results due to damage to the ipsilateral oculo-sympathetic pathway.2 When evaluating a patient with a Horner’s with associated anhidrosis it is thought that anhidrosis that affects the face, arms, and trunk is due to a central cause, where anhidrosis that affects the face only is due to a preganglionic cause, and the absence of anhidrosis altogether indicates a postganglionic cause.3 There are numerous case reports presenting patients with hyperidrosis ipsilateral to a Pancoast tumor. Hyperhidrosis on the contralateral side, however, as is seen in our patient, is not frequently reported. This phenomenon of contralateral anhidrosis has been reported in a patient with syringomyelia where sympathetic nerve fibers made connections with contralateral sympathetic sudomotor neurons, and it is possible a similar mechanism occurred in our patient. 4 This case illustrates a rare phenomenon and raises the importance of being aware of unique sequalae to tumors we may see in our clinical practice.