Colon cancer metastatic to lymph nodes including the Virchow node
Presentation
Known colon cancer, evaluate for metastatic disease.
Patient Data
Multiple enlarged, necrotic paraaortic and retrocrural lymph nodes. Right common iliac vein thrombus extending into the IVC. Surgical suture material distal sigmoid colon. Normal liver.
Enlarged left supraclavicular lymph node (Virchow node). Retrocrural lymphadenopathy, lungs clear.
Case Discussion
The left supraclavicular lymph nodes are also known as Virchow nodes and may become enlarged when cancers, especially abdominal cancers, metastasize to lymphatics. Most of the body's lymphatic drainage is to the thoracic or left lymphatic duct, which drains into the venous system at the confluence of the left internal jugular and left brachiocephalic veins (venous angle). Cancer may spread to the adjacent left supraclavicular nodes if there is leakage of lymph from the thoracic duct at the venous angle and uptake by surrounding nodes. Enlargement of a supraclavicular lymph node is know as Troisier sign and the node may be palpable even when the primary cancer is asymptomatic.
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