Virchow's node
Virchow's node

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Virchow's Node

82-year-old female presented with a 3-month history of epigastric pain, weight loss, and nausea. In the previous 3 months, she had lost 30 libs. On examination, she was noted to have two nontender, firm, fixed, left supraclavicular lymph nodes measuring 2.5 by 2.5 cm each. Upper endoscopy revealed an adenocarcinoma of the gastric antrum, of intestinal type.

 

 

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Virchow's node Image

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Bilobular Virchow's Node

Virchow's node, or Troisier's node, refers to carcinomatous involvement of the supraclavicular nodes at the junction of the thoracic duct and the left subclavian vein. Usually, nodal enlargement is caused by metastatic gastric carcinoma, although supraclavicular nodal involvement can also be seen in other gastrointestinal, thoracic, and pelvic cancers. Gastric cancers tend to metastasize to this region by means of migration of tumor emboli through the thoracic duct, where subdiaphragmatic lymphatic drainage enters the venous circulation in the left subclavian vein. Given the patient's low performance status, according to his Karnofsky performance-status score and his score on the Eastern Cooperative Oncology Group Performance Status scale,

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Virchow's node

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Bilobular 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 vessels in the abdominal cavity. Virchow's node is also sometimes coined "the seat of the devil given its ominous association with malignant disease. 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.

 

 

 

 

 

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Virchow node

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Bilobular Virchow's Node

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.

 

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Virchow's node

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A Virchow's node on physical examination should always alert physicians to the possibility of gastric malignancy. An enlarged left supraclavicular lymph node positive for malignancy is most likely to be of abdominal or pelvic origin, but a minority will be due to lymphoma. The presence of palpable lymphadenopathy in the context of constitutional symptoms and other alarm signs should always raise suspicion for lymphoma. Painless jaundice with constitutional symptoms is not always indicative of pancreatic or gastric cancer. Malignant lymphoma can rarely present with jaundice.

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Virchow's node

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Virchow's node

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Virchow's node

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Virchow's node

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Virchow's node

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Virchow's node

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Virchow's node

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Sister Mary Joseph nodule

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Sister Mary Joseph nodule or Sister Mary Joseph Sign

Sister Mary Joseph nodule or Sister Mary Joseph Sign refers to a palpable nodule bulging into the umbilicus as a result of metastasis of a malignant cancer in the pelvis or abdomen. Gastrointestinal malignancies account for about half of the underlying sources (gastric, colonic, pancreatic cancer), gynecologic (ovarian, uterine cancer), unknown primary tumors and rarely bladder or respiratory malignancies cause umbilical metastasis. Mechanism of spread of cancer to the umbilicus is unknown but proposed mechanisms include direct transperitoneal spread via lymphatic running along the obliterated umbilical vein, hematogenous spread or via remnant structures like the falciform ligament, median umbilical ligament or a remnant of the umbilical duct. Sister Mary Joseph nodule is associated with multiple peritoneal metastases and signifies a poor prognosis. A rare case of Sister Mary Joseph nodule, manifesting as ascites, cachexia and bleeding per rectum, is presented without any primary tumor despite extensive search for the same.

This condition was named for Sister Mary Joseph (1856 –1939), a surgical assistant for Dr. William Mayo, who noted the association between paraumbilical nodules observed during skin preparation for surgery and metastatic intraabdominal cancer confirmed at surgery.


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Sister Mary Joseph Sign

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Sister Joseph nodule is a metastatic umbilical lesion secondary to a primary malignancy of any viscera. It can be a presenting symptom (a sign of undiagnosed malignancy) or a symptom or sign of progression or recurrence in a known case. Its incidence is 1%–3% of all intra-abdominal or pelvic malignancies. Here, we present 4 such cases, with Sister Joseph nodule as a finding of

  • presentation in a case of gallbladder carcinoma,
  • progression in a case of malignant gastrointestinal stromal tumour,
  • recurrence in a case of ovarian carcinoma, and
  • presentation in a case of rectal carcinoma.

 

 

 

 

 

 

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Sister Mary Joseph nodule

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Typically, smjn will be a firm irregular nodule, averaging in size from 1 cm to 1.5 cm, and occasionally reaching a maximum of 10 cm in diameter . Sister Mary Joseph nodule can be a presenting symptom or sign of undiagnosed underlying malignancy, or an alarming symptom or sign of disease progression or recurrence in a known patient. 

 

 

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