Virchow’s Node Not Always Signifies a Primary Gut or Lung Malignancy. Look Further and Farther

A L Hemalatha,Hemalatha Batra,Deepthi Ramesh,S D Shashikumar

doi:10.5171/2013.616832

A L Hemalatha, Hemalatha Batra + Show 2 more

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https://doi.org/10.5171/2013.616832

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Abstract

Virchow’s node generally signifies metastasis from primary malignancy either in gastrointestinal tract or lung. Apart from the commonly recognized primary sites, 4.5-5% of primary testicular cancers are also known to metastasize to the left supraclavicular lymph node. Amidst the time and space restraint of a busy FNAC practice, one may tend to overlook considering testis as one of the possible primary sites for malignancy while aspirating a left supraclavicular lymph node and interpreting the smears. This case report throws light on the importance of considering primary germ cell tumor of the testis as one of the differential diagnoses, while aspirating a Virchow’s lymph node, especially in a young male patient, besides emphasizing the need for a thorough clinical examination.

Highlights

Presence of Virchows nodes generally alerts the clinician and the pathologist alike to suspect and investigate for the primary in the gastro-intestinal tract or lung malignancy
Apart from the commonly recognized primary sites, 4.5-5% of primary testicular cancers are known to metastasize to the left supraclavicular lymph node
The present case report highlights this importance and reinforces the need to include metastatic germ cell tumors in the differential diagnosis of left supraclavicular lymphadenopathy. It stresses on the necessity for thorough history elicitation and detailed clinical examination, impractical it may seem in a busy FNAC clinic

Summary

Introduction

Presence of Virchows nodes generally alerts the clinician and the pathologist alike to suspect and investigate for the primary in the gastro-intestinal tract or lung malignancy. Apart from the commonly recognized primary sites, 4.5-5% of primary testicular cancers are known to metastasize to the left supraclavicular lymph node. Amidst the time and space restraint of a busy FNAC practice, one may tend to overlook considering testis as one of the possible primary sites for malignancy while aspirating a left supraclavicular lymph node and interpreting the smears. This case report throws light on the importance of considering primary germ cell tumor of the testis as one of the differential diagnoses, while aspirating a Virchow’s lymph node, especially in a young male patient, besides emphasizing the need for a thorough clinical examination.

Results

Conclusion