Virchow’s Node

Gastric Cancer is very prevalent in Costa Rica, and because of the rarity of finding a nodule as big as this one, I thought this could serve as an example for semiological studies. This case was published in this month’s issue of The Lancet.

The case is about a 70-year-old man presented to his primary care physician with postprandial epigastric pain. He was prescribed antacids, which were ineff ective; his weight then decreased by 11 kg in 3 months. Oesophagogastro duodenoscopy showed a mass in the antrum; histo pathological analysis of a biopsy sample established that the mass was a signet-ring adenocarcinoma. Even before the biopsy was analysed, examination of the neck supported the diagnosis of cancer: the left supraclavicular lymph node was firm and enlarged. The left supraclavicular lymph node is near the junction of the thoracic duct and the left subclavian vein, where the lymph from much of the body drains into the systemic circulation.

An enlarged node can be the first sign of gastric cancer, and is often called Virchow’s node, because the association between left supraclavicular lymphadenopathy and gastric cancer was first described by the German pathologist Rudolf Virchow (1821–1902).

Lancet 2007; 370: 1568

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