Virchow's node

Overview
Virchow's node (or signal node) is an enlarged, hard, left supraclavicular lymph node which can contain metastasis of visceral (abdominal) malignancy.

Clinical significance
Malignancies of the internal organs can reach an advanced stage before giving symptoms. Stomach cancer, for example, can remain symptomless while metastatizing. One of the first visible spots where these tumors metastatise 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.

Differential diagnosis of an enlarged Virchow's node includes lymphoma, various intra-abdominal malignancies, breast cancer, lung cancer, and infection (e.g. of the arm).

Eponym
It is named after Rudolf Virchow (1821-1902), 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.

Acknowledgements
The content on this page was first contributed by: C. Michael Gibson M.S., M.D.

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