Standring S, Gray H. Gray's anatomy, the anatomical basis of clinical practice. Churchill Livingstone. Read it at Google Books - Find it at Amazon. Related articles: Anatomy: Head and neck. Promoted articles advertising. Case 1: right supraclavicular nodal metastases Case 1: right supraclavicular nodal metastases. Case 2: right supraclavicular necrotic metastases Case 2: right supraclavicular necrotic metastases.
Loading more images Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Following Virchow's and Troisier's work, researchers have conducted few studies on the anatomic description of Virchow's node. One of those studies by MitZutani et al. Another was by Matthew J Zdilla et al.
In this study, they found Virchow's node to be located in the lesser supraclavicular fossa deep to the platysma and clavicular head of the sternocleidomastoid muscle, superolateral to the venous angle, and anterior to the anterior scalene muscle forms the anterior border of the scalene triangle through which the brachial plexus and subclavian vessels run , phrenic nerve, and transverse cervical artery.
Virchow's node is a lymph node and is a part of the lymphatic system. It is the thoracic duct end node. It receives afferent lymphatic drainage from the left head, neck, chest, abdomen, pelvis, and bilateral lower extremities, which eventually drains into the jugulo-subclavian venous junction via the thoracic duct. Numerous studies have shown Virchow's node to be of clinical significance, especially concerning malignancies.
The left supraclavicular node is the classical Virchow's node because it is on the left side of the neck where the lymphatic drainage of most of the body from the thoracic duct enters the venous circulation via the left subclavian vein. Differential diagnosis of an enlarged Virchow's node includes lymphoma , various intra-abdominal malignancies, breast cancer , lung cancer , and infection e. It is named after Rudolf Virchow , the German pathologist who first described the association.
The presence of an enlarged Virchow's node is also referred to as Troisier's sign , named after Charles Emile Troisier, who also described this. Because an enlarged Virchow's node is often a harbinger of malignant disease, it is sometimes called the sentinel node. This needs to be contrasted with the technique of sentinel lymph node biopsy. It should also not be confused with the 'sentinel gland' of the greater omentum.
Zdilla , a, b, c Ali M. Aldawood , b Andrew Plata , b Jeffrey A. Wayne Lambert b. Find articles by Matthew J. Ali M. Find articles by Ali M.
Find articles by Andrew Plata. Jeffrey A. Find articles by Jeffrey A. Find articles by H. Wayne Lambert. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Contributed by Authors contributions: All authors collectively and equally contributed to the manuscript preparation.
Correspondence Matthew J. Received Jul 11; Accepted Oct 2. Autopsy and Case Reports. ISSN This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the article is properly cited. This article has been cited by other articles in PMC. 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.
Open in a separate window. Figure 1. Dissection of the left-sided posterior cervical triangle revealed the presence of a Virchow node obscured entirely by the platysma and clavicular head of the sternocleidomastoid muscle and partly by the superior belly of the omohyoid muscle. A - Superficial dissection revealing the platysma muscle Plat ; B - The sternocleidomastoid muscle SCM underlying the reflected platysma. Figure 2. Dissection of the left-sided posterior cervical triangle, after reflection of both the platysma and sternocleidomastoid muscles, revealed a Virchow node VN in the region of the lesser supraclavicular fossa.
Figure 3. Gross dissection of the left-sided lower anterior cervical region revealing a Virchow node VN. The node was partially obscured at its superior pole by the superior belly of the omohyoid muscle Sup Omo m which has been retracted in this image.
The node joined the thoracic duct TD which joined together with the internal jugular vein Int Jug v to contribute to the subclavian vein Subclav v. The platysma and sternocleidomastoid muscles are reflected posteriorly and proximal half of the clavicle was resected to reveal the Virchow node and its surrounding vascular anatomy.
The long axis of the VN was oriented parallel to the internal jugular vein and the distal thoracic duct. Figure 4.
Serial sections of the Virchow node. The cut surfaces are almost entirely replaced by a grossly evident metastatic tumor. Figure 5. Transverse section of the lower lobe of the left lung showing a 4. The uninvolved parenchyma is tan with dilated air spaces and many areas of environmental pigmentation. Figure 6. The cells have a high nuclear to cytoplasmic ratio and display marked bizarre nuclei with prominent macronucleoli.
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