Autopsy and Case Reports
Autopsy and Case Reports
Autopsy Case Report

Bilateral Virchow nodes: an unusual finding of pulmonary small-cell neuroendocrine carcinoma metastasis

Matthew J. Zdilla; Alexander R. Gross; Tara Hajarat; Jeffrey A. Vos

Downloads: 0
Views: 335


An enlarged left-sided supraclavicular node is a signal node for cancer metastasis. In such a case, the enlarged lymph node is often referred to as a Virchow node. The left-sided nature of the node is due to the drainage of the thoracic duct. So, the enlargement of a Virchow node is typically associated with malignancies, including gastrointestinal, pulmonary, and genitourinary carcinomas, in addition to lymphomas. This report documents a particularly unusual finding: bilateral Virchow nodes, representing metastasis of small-cell neuroendocrine carcinoma.


anatomy, carcinoma, lymph nodes, neoplasm metastasis, neoplasms


1 Virchow R. Zur diagnose der krebse in unterleibe. Med Reform. 1848;45:248.

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

3 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. PMid:29626569.

4 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. PMid:16482930.

5 Loh KY, Yushak AW. Images in clinical medicine. Virchow’s node (Troisier’s sign). N Engl J Med. 2007;357(3):282. PMid:17634463.

6 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. PMid:21922372.

7 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):66-70. PMid:21206107.

8 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. PMid:28727141.

9 Zdilla MJ, Aldawood AM, Plata A, Vos JA, Lambert HW. Troisier sign and Virchow node: the anatomy and pathology of pulmonary adenocarcinoma metastasis to a supraclavicular lymph node. Autops Case Rep. 2019;9(1):e2018053. PMid:30863728.

10 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. PMid:17068502.

11 Levy Z, Schottland E. Active tuberculosis presenting as enlarged Virchow node in an otherwise well patient. Crit Care Med. 2018;46(1):501.

12 Maslovsky I, Gefel D. Virchow’s node and Horner’s syndrome. Am J Med. 2006;119(2):180-1. PMid:16443433.

13 Fernández Aceñero MJ, Caso Viesca A, Díaz Del Arco C. Role of fine needle aspiration cytology in the management of supraclavicular lymph node metastasis: review of our experience. Diagn Cytopathol. 2019;47(3):181-6. PMid:30468321.

14 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. PMid:16333915.

15 Song SW, Jun BC, Cho KJ, Lee S, Kim YJ, Park SH. CT evaluation of vocal cord paralysis due to thoracic diseases: a 10-year retrospective study. Yonsei Med J. 2011;52(5):831-7. PMid:21786449.

16 Benninger MS, Gillen JB, Altman JS. Changing etiology of vocal fold immobility. Laryngoscope. 1998;108(9):1346-50. PMid:9738754.

Submitted date:

Accepted date:

Publication date:

6552587aa95395443b03c4c3 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections