Virchow's node

Virchow's node (or signal node) is a lymph node in the left supraclavicular
fossa (the area above the left clavicle). It takes its supply from lymph Virchow's node
vessels 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.[1]
The French pathologist Charles Emile Troisier noted in 1889 that other
abdominal cancers, too, could spread to the node.[2]

Clinical significance
Malignancies of the internal organs can reach an advanced stage before
giving symptoms. Stomach cancer, for example, can remain asymptomatic
while metastasizing. One of the first visible spots where these tumors
metastasize is the left supraclavicular lymph node.
Regional lymph tissue. (Supraclavicular
The left supraclavicular node is the classical Virchow's node because it is near top, in green.)⋅
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 i.e. 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.[3]

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.

Additional images
Deep Lymph Nodes
1. Submental
2. Submandibular (Submaxillary)

Anterior Cervical Lymph Nodes (Deep)

3. Prelaryngeal
4. Thyroid
5. Pretracheal
6. Paratracheal
Superficial lymph
glands and Deep Cervical Lymph Nodes
lymphatic vessels of 7. Lateral jugular
head and neck. 8. Anterior jugular
9. Jugulodigastric
References
Inferior Deep Cervical Lymph Nodes
1. ↑ Virchow R (1848). "Zur Diagnose der Krebse in Unterleibe". Med. Reform. 10. Juguloomohyoid
45: 248.
11. Supraclavicular (scalene)
 2. ↑ Troisier CE (1889). "L'adénopathie sus-claviculaire dans les cancers de Anatomical terminology
l'abdomen". Arch. Gen. Med. 1: 129–138 and 297–309.
3. ↑ Mizutani, Masaomi; Nawata, Shin-Ichi; Hirai, Ichiro; Murakami, Gen; [edit on Wikidata]
Kimura, Wataru (2005). "Anatomy and histology of Virchow's node".
Anatomical Science International. 80 (4): 193–8. doi:10.1111/j.1447-
073X.2005.00114.x. PMID 16333915.

Further reading
Cervin, J. R.; Silverman, J. F.; Loggie, B. W.; Geisinger, K. R. (1995). "Virchow's
node revisited. Analysis with clinicopathologic correlation of 152 fine-needle
aspiration biopsies of supraclavicular lymph nodes". Archives of pathology &
laboratory medicine. 119 (8): 727–30. PMID 7646330.
Negus, D.; Edwards, J. M.; Kinmonth, J. B. (1970). "Filling of cervical and
mediastinal nodes from the thoracic duct and the physiology of virchow's
node—studies by lymphography". British Journal of Surgery. 57 (4): 267–71. Virchow's node as seen on CT
doi:10.1002/bjs.1800570407. PMID 5437920.
Mizutani, Masaomi; Nawata, Shin-Ichi; Hirai, Ichiro; Murakami, Gen; Kimura,
Wataru (2005). "Anatomy and histology of Virchow's node". Anatomical Science International. 80 (4): 193–8.
doi:10.1111/j.1447-073X.2005.00114.x. PMID 16333915.

External links
synd/1222 at Who Named It?
1973026851 at GPnotebook

Anatomy of the lymphatic system

Occipital · Mastoid/retroauricular · Parotid ( Superficial · Deep (
Back
preauricular · infra-auricular · intraglandular))
Head
Facial ( buccinator · nasolabial) · Mandibular ( Submandibular) ·
Front
Submental
Superficial anterior · lateral
Head and neck Deep anterior cervical ( pretracheal · paratracheal · prelaryngeal ·
thyroid) · Deep lateral cervical ( superior deep cervical ·
Cervical Deep
inferior deep cervical · retropharyngeal · jugulodigastric ·
jugulo-omohyoid)

Other Anterior cervical · Lateral cervical · Supraclavicular ( Virchow's)

Vessels Jugular trunk

Axillary ( Brachial · Pectoral · Subscapular · Central · Apical) · Arm ( Supratrochlear ·

Nodes
Arm and axilla Deltopectoral)

Vessels Subclavian lymph trunk

Parasternal · Intercostal · Superior diaphragmatic · Trachea and bronchi ( superior ·
Nodes
Chest inferior · bronchopulmonary · paratracheal · intrapulmonary)

Vessels Thoracic duct · Right lymphatic duct · Bronchomediastinal lymph trunk

Abdomen Retroaortic · Lateral aortic · Preaortic · (Celiac ( gastric · hepatic ·

Paraaortic splenic) · Superior mesenteric ( mesenteric · ileocolic · mesocolic) ·
Nodes Inferior mesenteric ( pararectal))
Iliac ( Common ( external · internal) · Sacral) ·
Other
Retroperitoneal lymph nodes

Vessels Lumbar lymph trunk · Intestinal trunk · Cisterna chyli

 Leg Inguinal ( deep ( Cloquet's node) · superficial) · Popliteal

Eponymous medical signs for oncology

Hematological malignancy Russell bodies · Auer rod · Bence Jones protein

Lymph nodes Virchow's node ( Troisier's sign ) · Sister Mary Joseph nodule · Lund's node
Call-Exner bodies · Leser–Trélat sign · Trousseau sign of malignancy ·
Other
Courvoisier's law · Schiller–Duval body

Eponymous medical signs for hematology

Red blood cell ( Cabot rings · Howell–Jolly body · Pappenheimer bodies · Heinz body) ·
Inclusion bodies Neutrophil ( Döhle bodies) · Plasma cell ( Russell bodies) · Myeloblast ( Auer rod) · Histiocyte (
Birbeck granules)
Tests Apt test · Coombs test

Other Arneth count · Mentzer index · Virchow's triad · Anaemia ( Pagophagia)

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