Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2018.053
Autopsy and Case Reports
Article / Autopsy Case Report

Troisier sign and Virchow node: the anatomy and pathology of pulmonary adenocarcinoma metastasis to a supraclavicular lymph node

Matthew J. Zdilla; Ali M. Aldawood; Andrew Plata; Jeffrey A. Vos; H. Wayne Lambert

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Abstract

ABSTRACT: Metastatic spread of cancer via the thoracic duct may lead to an enlargement of the left supraclavicular node, known as the Virchow node (VN), leading to an appreciable mass that can be recognized clinically — a Troisier sign. The VN is of profound clinical importance; however, there have been few studies of its regional anatomical relationships. Our report presents a case of a Troisier sign/VN discovered during cadaveric dissection in an individual whose cause of death was, reportedly, chronic obstructive pulmonary disease. The VN was found to arise from an antecedent pulmonary adenocarcinoma. Our report includes a regional study of the anatomy as well as relevant gross pathology and histopathology. Our anatomical findings suggest that the VN may contribute to vascular thoracic outlet syndrome as well as the brachial plexopathy of neurogenic thoracic outlet syndrome. Further, the VN has the potential to cause compression of the phrenic nerve, contributing to unilateral phrenic neuropathy and subsequent dyspnea. Recognition of the Troisier sign/VN is of great clinical importance. Similarly, an appreciation of the anatomy surrounding the VN, and the potential for the enlarged node to encroach on neurovascular structures, is also important in the study of a patient. The presence of a Troisier sign/VN should be assessed when thoracic outlet syndrome and phrenic neuropathy are suspected. Conversely, when a VN is identified, the possibility of concomitant or subsequent thoracic outlet syndrome and phrenic neuropathy should be considered.

Keywords

Anatomy, Lung Cancer, Metastasis, Supraclavicular Node, Virchow, Troisier, Thoracic Outlet Syndrome

References

Morgenstern L. The Virchow-Troisier node: a historical note. Am J Surg. 1979;138(5):703. http://dx.doi.org/10.1016/0002-9610(79)90353-2. PMid:386813.

Virchow R. Zur Diagnose der Krebse in Unterleibe. Med Reform. 1848;45:248.

Troisier CE. L’adénopathie sus-claviculaire dans les cancers de l’abdomen. Arch Gen de Med. 1889;1:129-39; 297-309.

Westreich R, Brower S, Lawson W. Primary lymph node malignant gastrinoma with metastasis to Virchow’s node: a case report. Otolaryngol Head Neck Surg. 2004;131(6):1027-8. http://dx.doi.org/10.1016/j.otohns.2004.03.017. PMid:15577814.

Sugawara H, Ichiki M, Sai K, et al. Noticeable clinical response to S-1/CDDP combination therapy for Virchow node recurrence after surgery for advanced gastric carcinoma with marked involvement of the esophagus - report of a case. Gan To Kagaku Ryoho. 2009;36(5):855-8. PMid:19461194.

Katayama M, Matsumoto H, Kanda T, et al. Complete histological response in advanced gastric cancer with Virchow’s node metastasis after chemotherapy including S-1/CDDP--report of a case. Gan To Kagaku Ryoho. 2010;37(11):2173-6. PMid:21084821.

Sundriyal D, Kumar N, Dubey SK, Walia M. Virchow’s node. BMJ Case Rep. 2013;2013(sep12 1):1-2. http://dx.doi.org/10.1136/bcr-2013-200749. PMid:24031077.

Yoon EWT, Nishihara K. Virchow’s node together with an Irish node. Clin Case Rep. 2017;5(6):1046-7. http://dx.doi.org/10.1002/ccr3.967. PMid:28588870.

Sato T, Mori M, Aoki J, Tanabe K. Pulmonary Tumor Thrombotic Microangiopathy due to Advanced Gastric Cancer with Virchow’s Node Metastasis. Int Heart J. 2018;59(2):443-7. http://dx.doi.org/10.1536/ihj.17-249. PMid:29503403.

Yamada Y, Honda N, Hayase Y, Senda H, Fukatsu H, Segawa A. Two cases of primary urethral carcinoma in females. Hinyokika Kiyo. 1983;29(8):941-5. PMid:6675444.

Cebesoy FB, Balatt O, Aydin A. Virchow’s node as a first manifestation of ovarian serous carcinoma: case report. Eur J Gynaecol Oncol. 2008;29(2):182-3. PMid:18459560.

Rahman M, Nakayama K, Rahman MT, Katagiri H, Ishibashi T, Miyazaki K. Enlarged Virchow’s node as an initial complaint of serous ovarian adenocarcinoma. Eur J Gynaecol Oncol. 2012;33(5):546-8. PMid:23185810.

Scott AF, Mohr DW, Ling H, Scharpf RB, Zhang P, Liptak GS. Characterization of the genomic architecture and mutational spectrum of a small cell prostate carcinoma. Genes (Basel). 2014;5(2):366-84. http://dx.doi.org/10.3390/genes5020366. PMid:24823478.

Kemal Y, Kokcu A, Kefeli M, et al. Virchow’s node metastasis: an unusual presentation of ovarian cancer. Eur J Gynaecol Oncol. 2016;37(3):398-400. PMid:27352573.

Park EJ, Stroie FA, McArdle BJ, Psutka SP. Metastatic adenocarcinoma of the prostate presenting as supraclavicular and bulky generalized lymphadenopathy with a benign digital rectal exam. Urol Case Rep. 2017;13:128-30. http://dx.doi.org/10.1016/j.eucr.2017.04.005. PMid:28567325.

Franzen A, Günzel T, Buchali A, Coordes A. Etiologic and differential diagnostic significance of tumor location in the supraclavicular fossa. Laryngoscope. 2018;128(3):646-50. http://dx.doi.org/10.1002/lary.26775. PMid:28727141.

de la Riva-Pérez PA, García-Gómez FJ, Buján-Lloret C, Calvo-Morón MC, Castro-Montaño J. Virchow Node From Prostate Carcinoma by 18F-Choline PET/CT. Clin Nucl Med. 2018;43(4):271-2. PMid:29356745.

Werner RA, Andree C, Javadi MS, et al. A voice from the past: rediscovering the virchow node with prostate-specific membrane antigen-targeted 18F-DCFPyL positron emission tomography imaging. Urology. 2018;117:18-21. http://dx.doi.org/10.1016/j.urology.2018.03.030. PMid:29626569.

Matono S, Fujita H, Sueyoshi S, Tanaka T, Yamana H, Shirouzu K. Long-term survival after three-field lymph-adenectomy for an adenocarcinoma in Barrett’s esophagus with metastasis to Virchow’s node. Jpn J Thorac Cardiovasc Surg. 2006;54(1):11-5. http://dx.doi.org/10.1007/BF02743777. PMid:16482930.

Ochiai T, Ikoma H, Inoue K, et al. Long-term survival of a patient with common bile duct cancer after Virchow’s node recurrence: Report of a case. Surg Today. 2011;41(10):1432-5. http://dx.doi.org/10.1007/s00595-010-4447-1. PMid:21922372.

Mondal RK, Dutta A, Basu K, Chakraborti S. Virchows node: rare presentation of childhood hepatocellular carcinoma. Indian J Pediatr. 2005;72(2):177-8. http://dx.doi.org/10.1007/BF02760707. PMid:15758545.

Selvasekaran R, Cherian JV, Venkataraman J. Metastasis of hepatocellular carcinoma to Virchow’s node: have the tumor cells gone astray? Hepatobiliary Pancreat Dis Int. 2007;6(6):650-2. PMid:18086635.

Loh KY, Yushak AW. Images in clinical medicine. Virchow’s node (Troisier’s sign). N Engl J Med. 2007;357(3):282. http://dx.doi.org/10.1056/NEJMicm063871. PMid:17634463.

Soto Iglesias S, Baltar Arias R, Vázquez Rodríguez S, et al. Virchow’s node as the form of onset of squamous cell carcinoma of the pancreas. Gastroenterol Hepatol. 2009;32(10):693-6. http://dx.doi.org/10.1016/j.gastrohep.2009.06.006. PMid:19748706.

Saif MW, Hotchkiss S, Brennan M, Kaley K. Pancreatic adenocarcinoma with supraclavicular lymph node metastasis: Is this the Virchow’s node? JOP. 2011;12(1):66-7, author reply 70. PMid:21206107.

Soussi G, Daboussi S, Mhamdi S, et al. Second lung malignancy and Richter syndrome in chronic lymphocytic leukemia: case report and literature review. Multidiscip Respir Med. 2017;12(1):24. http://dx.doi.org/10.1186/s40248-017-0107-2. PMid:28975027.

Cervin JR, Silverman JF, Loggie BW, Geisinger KR. Virchow’s node revisited. Analysis with clinicopathologic correlation of 152 fine-needle aspiration biopsies of supraclavicular lymph nodes. Arch Pathol Lab Med. 1995;119(8):727-30. PMid:7646330.

Anastassiades CP, Poterucha TH. Virchow’s node, jaundice, and weight loss--lymphoma mimicking gastrointestinal malignancy. Nat Clin Pract Gastroenterol Hepatol. 2006;3(11):645-8. http://dx.doi.org/10.1038/ncpgasthep0635. PMid:17068502.

Levy Z, Schottland E. Active tuberculosis presenting as enlarged Virchow node in an otherwise well patient. Crit Care Med. 2018;46:501. http://dx.doi.org/10.1097/01.ccm.0000529041.92531.7e.

Duman U, Yeşıl C, Gündüz M, Denız IK. Isolated left supraclavicular hydatid cyst mimicking Virchow’s node. Turk J Gastroenterol. 2012;23(5):612-4. http://dx.doi.org/10.4318/tjg.2012.0447. PMid:23161314.

Maslovsky I, Gefel D. Virchow’s node and Horner’s syndrome. Am J Med. 2006;119(2):180-1. http://dx.doi.org/10.1016/j.amjmed.2005.07.067. PMid:16443433.

Mizutani M, Nawata S, Hirai I, Murakami G, Kimura W. Anatomy and histology of Virchow’s node. Anat Sci Int. 2005;80(4):193-8. http://dx.doi.org/10.1111/j.1447-073X.2005.00114.x. PMid:16333915.

Siosaki MD, Souza AT. Images in clinical medicine. Virchow’s node. N Engl J Med. 2013;368(6):e7. http://dx.doi.org/10.1056/NEJMicm1204740. PMid:23388028.

Sanghvi DA, Merchant N, Iyer VR. Malignant brachial plexopathy: a pictorial essay of MRI findings. Indian J Radiol Imaging. 2010;20(4):274-8. http://dx.doi.org/10.4103/0971-3026.73543. PMid:21423902.

Szaraz ZT. The thoracic outlet syndrome: first rib subluxation syndrome. In: Gatterman MI, editor. Foundations of chiropractic: subluxation. St. Louis, Missouri: Elsevier Health Sciences; 2005. p. 461.

Pancoast HK. Importance of careful roentgen-ray investigation of apical chest tumors. JAMA. 1924;83(18):1407. http://dx.doi.org/10.1001/jama.1924.02660180025007.
 


Publication date:
02/25/2019

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