Virchow’s Node: A Look Beyond Gut Carcinoma

Abstract

Virchow’s node, left supraclavicular lymph node contains metastasis of many abdominal visceral malignancies. Urothelial carcinoma comprises 90% of all primary bladder tumors with metastases usually limited to the pelvic nodes. Though distant lymph node involvement is rare but cannot be entirely overlooked. Presence of Virchow’s node with bladder tumor is considered as incurable metastatic disease. A 40 year old male presented with history of fever, intermittent hematuria and burning micturition since one week. Incidentally left supraclavicular lymph node was found to be enlarged. FNAC showed the features of urothelial carcinoma. Patient was subjected to further relevant investigations. CT-Scan showed well defined enhancing lesion with intra-luminal extension. Biopsy was done which revealed primary tumor to be urothelial carcinoma of bladder. Supraclavicular lymph node metastases are rare in this case and indicate widespread disease with poor prognosis. Conclusion: This case is a rare presentation of urothelial carcinoma metastases to Virchow’s node. Picking up nodal metastases may influence therapeutic decisions and FNAC may be a useful tool in diagnosing such metastases with certainty.