From the Guidelines
Virchow's nodes are enlarged lymph nodes located in the left supraclavicular region that may indicate the presence of malignancy, particularly gastrointestinal cancer. These nodes are clinically significant because they serve as a distant site for metastasis from primary tumors in the abdomen, especially the stomach, pancreas, gallbladder, and other gastrointestinal organs. The pathway for this metastasis involves cancer cells traveling through the thoracic duct, which drains into the left subclavian vein near these nodes. Named after Rudolf Virchow, a 19th-century German physician who first described their significance, these nodes are sometimes called the "sentinel" or "signal" nodes because their enlargement can be an early warning sign of underlying abdominal malignancy. When a healthcare provider detects an enlarged, firm, non-tender Virchow's node during physical examination, it warrants immediate investigation with imaging studies and possibly biopsy to determine the primary cancer source. This finding is sometimes referred to as Virchow's node syndrome or Troisier's sign in clinical practice, although the provided evidence does not directly discuss Virchow's nodes 1. Key points to consider include:
- The left supraclavicular region is the typical location for Virchow's nodes
- These nodes can be an indicator of gastrointestinal cancer
- Immediate investigation is necessary if an enlarged Virchow's node is detected
- The evidence provided does not directly address Virchow's nodes, but the definition and clinical significance are well-established in medical practice 1.
From the Research
Definition of Virchow's Nodes
- Virchow's nodes refer to the left supraclavicular lymph nodes, which are located above the collarbone on the left side of the body 2, 3, 4.
- These nodes are significant in the diagnosis of various cancers, particularly those originating in the abdomen or pelvis 2, 4.
Clinical Significance
- The left supraclavicular lymph node, also known as Virchow's node, is often involved in metastatic malignancies, including those of abdominal or pelvic origin 2.
- The presence of an enlarged left supraclavicular lymph node, known as Troisier's sign, raises suspicion for abdominopelvic malignancy, particularly in the absence of right supraclavicular lymphadenopathy 4.
- Supraclavicular lymph nodes, including Virchow's node, are a common site for metastasis from thoracic malignancies, although these cancers can involve either right or left supraclavicular nodes 4.
Diagnostic Approaches
- Fine-needle aspiration biopsy is an excellent initial procedure in the workup of an enlarged supraclavicular lymph node, including Virchow's node 2, 3.
- The diagnostic spectrum of Virchow's node includes metastatic malignancy, granulomatous lymphadenitis, reactive lymphadenitis, acute suppurative lymphadenitis, and lymphoproliferative disorder 3.