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A 54-year-old woman, affected by metastatic breast cancer, presented for severe shoulder pain, paraesthesia and numbness in the right arm. Despite further multiple lines of systemic chemotherapy, she developed a progressive enlargement of retropectoral, supraclavicular and infraclavicular lymph node metastases, which involved brachial plexus, apex of lung and anterior mediastinum. Physical examination revealed severe weakness of proximal muscles of the right arm. Neuropathic pain was managed with pharmacological treatment. Lastly, the patient has been treated with intrathecal analgesia with morphine and ziconotide with a good control of pain. The patient died after 3\u2009months.<\/jats:p>","DOI":"10.1136\/bcr-2018-226793","type":"journal-article","created":{"date-parts":[[2018,12,18]],"date-time":"2018-12-18T17:19:47Z","timestamp":1545153587000},"page":"e226793","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Pancoast\u2019s syndrome caused by lymph node metastasis from breast cancer"],"prefix":"10.1136","volume":"11","author":[{"given":"Vincenzo","family":"Di Stefano","sequence":"first","affiliation":[{"name":"Department of Neuroscience, Imaging and Clinical Sciences, \"G. d\u2019Annunzio\" University, Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Valdesi","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Imaging and Clinical Sciences, \"G. d\u2019Annunzio\" University, Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marinella","family":"Zilli","sequence":"additional","affiliation":[{"name":"Medical Oncology Unit, \"SS Annunziata\" hospital, Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Peri","sequence":"additional","affiliation":[{"name":"Department of Medical, Oral and Biotechnological Sciences, \"G. d\u2019Annunzio\" University, Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,11,28]]},"reference":[{"key":"2025082710300606000_11.1.e226793.1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.31.1.45"},{"key":"2025082710300606000_11.1.e226793.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199711063371907"},{"key":"2025082710300606000_11.1.e226793.3","first-page":"S342","article-title":"Superior sulcus (Pancoast) tumors: current evidence on diagnosis and radical treatment","volume":"5","author":"Foroulis","year":"2013","journal-title":"J Thorac Dis"},{"key":"2025082710300606000_11.1.e226793.4","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.breast.2010.03.022","article-title":"A retrospective study of metachronous and synchronous ipsilateral supraclavicular lymph node metastases in breast cancer patients","volume":"19","author":"Fan","year":"2010","journal-title":"Breast"},{"key":"2025082710300606000_11.1.e226793.5","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.20.4.g00jl091023"},{"key":"2025082710300606000_11.1.e226793.6","doi-asserted-by":"publisher","DOI":"10.3171\/foc.2007.22.3.1"},{"key":"2025082710300606000_11.1.e226793.7","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1067\/mdr.2003.12007","article-title":"MR imaging of the brachial plexus: current imaging sequences, normal findings, and findings in a spectrum of focal lesions with MR-pathologic correlation","volume":"32","author":"Kichari","year":"2003","journal-title":"Curr Probl Diagn Radiol"},{"key":"2025082710300606000_11.1.e226793.8","doi-asserted-by":"crossref","unstructured":"Bruera ED , Portenoy RK . 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