Virchow's node
Encyclopedia
Virchow's node is a lymph node
in the left supraclavicular fossa
(the area above the left clavicle
). It takes its supply from lymph vessel
s in the abdominal cavity
. The finding of an enlarged, hard node (also referred to as Troisier's sign) has long been regarded as strongly indicative of the presence of cancer
in the abdomen, specifically gastric cancer, that has spread
through the lymph vessels. It is sometimes called the signal node or sentinel node for the same reason. Despite this, the concept is not directly related to the sentinel node procedure sometimes used in cancer surgery, and it is also unrelated to the "sentinel gland" of the greater omentum
.
It is named after Rudolf Virchow
(1821-1902), the German
pathologist
who first described the gland and its association with gastric cancer in 1848. The French
pathologist Charles Emile Troisier
noted in 1889 that other abdominal cancers, too, could spread to the node.
, for example, can remain symptom
less while metastatizing
. One of the first visible spots where these tumors metastasize is the left supraclavicular lymph node. 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
.The metastasis blocks the thoracic duct leading to regurgitation into the surrounding nodes ie. virchow's node. Another concept is that one of the supraclavicular nodes corresponds to the end node along the thoracic duct and hence the enlargement.
Differential diagnosis
of an enlarged Virchow's node includes lymphoma
, various intra-abdominal malignancies, breast cancer
, and infection
(e.g. of the arm). Similarly, an enlarged right supraclavicular lymph node tends to drain thoracic malignancies such as lung and esophageal cancer
, as well as Hodgkin's lymphoma
.
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
in the left supraclavicular fossa
Supraclavicular fossa
The Supraclavicular fossa is an indentation immediately above the clavicle.In terminologia anatomica, it is divided into fossa supraclavicularis major and fossa supraclavicularis minor-External links:*...
(the area above the left clavicle
Clavicle
In human anatomy, the clavicle or collar bone is a long bone of short length that serves as a strut between the scapula and the sternum. It is the only long bone in body that lies horizontally...
). It takes its supply from lymph vessel
Lymph vessel
In anatomy, lymph vessels are thin walled, valved structures that carry lymph. As part of the lymphatic system, lymph vessels are complementary to the cardiovascular system. Lymph vessels are lined by endothelial cells, and deep to that have a thin layer of smooth muscles, and adventitia that bind...
s in the abdominal cavity
Abdominal cavity
The abdominal cavity is the body cavity of the human body that holds the bulk of the viscera. It is located below the thoracic cavity, and above the pelvic cavity. Its dome-shaped roof is the thoracic diaphragm , and its oblique floor is the pelvic inlet...
. The finding of an enlarged, hard node (also referred to as Troisier's sign) has long been regarded as strongly indicative of the presence of cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
in the abdomen, specifically gastric cancer, that has spread
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
through the lymph vessels. It is sometimes called the signal node or sentinel node for the same reason. Despite this, the concept is not directly related to the sentinel node procedure sometimes used in cancer surgery, and it is also unrelated to the "sentinel gland" of the greater omentum
Greater omentum
The greater omentum is a large fold of parietal peritoneum that hangs down from the stomach...
.
It is named after Rudolf Virchow
Rudolf Virchow
Rudolph Carl Virchow was a German doctor, anthropologist, pathologist, prehistorian, biologist and politician, known for his advancement of public health...
(1821-1902), the German
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
pathologist
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
who first described the gland and its association with gastric cancer in 1848. The French
France
The French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
pathologist Charles Emile Troisier
Charles Emile Troisier
Charles Emile Troisier was a French doctor.The following are named for him:* Troisier's sign, a hard, enlarged, left supraclavicular lymph node.* Troisier-Hanot-Chauffard syndrome, a form of diabetes mellitus-References:...
noted in 1889 that other abdominal cancers, too, could spread to the node.
Clinical significance
Malignancies of the internal organs can reach an advanced stage before giving symptoms. Stomach cancerStomach cancer
Gastric cancer, commonly referred to as stomach cancer, can develop in any part of the stomach and may spread throughout the stomach and to other organs; particularly the esophagus, lungs, lymph nodes, and the liver...
, for example, can remain symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
less while metastatizing
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
. One of the first visible spots where these tumors metastasize is the left supraclavicular lymph node. The left supraclavicular node is the classical Virchow's node because it is on the left side of the neck where the lymphatic
Lymphatic system
The lymphoid system is the part of the immune system comprising a network of conduits called lymphatic vessels that carry a clear fluid called lymph unidirectionally toward the heart. Lymphoid tissue is found in many organs, particularly the lymph nodes, and in the lymphoid follicles associated...
drainage of most of the body (from the thoracic duct
Thoracic duct
In human anatomy, the thoracic duct of the lymphatic system is the largest lymphatic vessel in the body. It is also known as the left lymphatic duct, alimentary duct, chyliferous duct, and Van Hoorne's canal....
) enters the venous circulation via the left subclavian vein
Subclavian vein
The subclavian veins are two large veins, one on either side of the body. Their diameter is approximately that of the smallest finger.-Path:Each subclavian vein is a continuation of the axillary vein and runs from the outer border of the first rib to the medial border of anterior scalene muscle...
.The metastasis blocks the thoracic duct leading to regurgitation into the surrounding nodes ie. virchow's node. Another concept is that one of the supraclavicular nodes corresponds to the end node along the thoracic duct and hence the enlargement.
Differential diagnosis
Differential diagnosis
A differential diagnosis is a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible , and may also refer to any of the included candidate alternatives A differential diagnosis (sometimes abbreviated DDx, ddx, DD, D/Dx, or ΔΔ) is a...
of an enlarged Virchow's node includes lymphoma
Lymphoma
Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
, various intra-abdominal malignancies, breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
, and infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
(e.g. of the arm). Similarly, an enlarged right supraclavicular lymph node tends to drain thoracic malignancies such as lung and esophageal cancer
Esophageal cancer
Esophageal cancer is malignancy of the esophagus. There are various subtypes, primarily squamous cell cancer and adenocarcinoma . Squamous cell cancer arises from the cells that line the upper part of the esophagus...
, as well as Hodgkin's lymphoma
Hodgkin's lymphoma
Hodgkin's lymphoma, previously known as Hodgkin's disease, is a type of lymphoma, which is a cancer originating from white blood cells called lymphocytes...
.