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case_images: Dissection of the left-sided posterior cervical triangle revealed the presence of a Virchow node obscured entirely by the platysma and clavicular head of the sternocleidomastoid muscle and partly by the superior belly of the omohyoid muscle. A - Superficial dissection revealing the platysma muscle (Plat); B - The sternocleidomastoid muscle (SCM) underlying the reflected platysma.
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case_images: Dissection revealed an enlarged left supraclavicular lymph node situated at the jugulo-subclavian venous junction (venous angle), a typical location for a VN (Figures 1 and 2).
case_images: Dissection of the left-sided posterior cervical triangle, after reflection of both the platysma and sternocleidomastoid muscles, revealed a Virchow node (VN) in the region of the lesser supraclavicular fossa.
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case_images: Dissection revealed an enlarged left supraclavicular lymph node situated at the jugulo-subclavian venous junction (venous angle), a typical location for a VN (Figures 1 and 2). The VN was deep to the platysma and clavicular head of the sternocleidomastoid muscle, underlying what would otherwise be considered the lesser supraclavicular fossa (Figure 2).
case_images: Gross dissection of the left-sided lower anterior cervical region revealing a Virchow node (VN). The node was partially obscured at its superior pole by the superior belly of the omohyoid muscle (Sup Omo m) which has been retracted in this image. The node joined the thoracic duct (TD) which joined together with the internal jugular vein (Int Jug v) to contribute to the subclavian vein (Subclav v). The platysma and sternocleidomastoid muscles are reflected posteriorly and proximal half of the clavicle was resected to reveal the Virchow node and its surrounding vascular anatomy. The long axis of the VN was oriented parallel to the internal jugular vein and the distal thoracic duct.
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case_images: Also, the superior pole of the VN was under the inferior aspect of the superior omohyoid muscle at its attachment with its intermediate tendon (Figure 3). The VN was located immediately lateral to the internal jugular vein and, along with the thoracic duct, was located just superior to the subclavian vein (Figure 3).
case_images: Serial sections of the Virchow node. The cut surfaces are almost entirely replaced by a grossly evident metastatic tumor.
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case_images: The VN was resected and macroscopically assessed, revealing that the node was enlarged by tumor (Figure 4).
case_images: Transverse section of the lower lobe of the left lung showing a 4.2 x 4.0 x 3.5 cm solid, pale, indurated mass that encases the adjacent vasculature and abuts the hilum. The uninvolved parenchyma is tan with dilated air spaces and many areas of environmental pigmentation.
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case_images: In the left lower lobe, a 4.2 x 4.0 x 3.5 cm white, indurated mass encased the adjacent vasculature and abutted the hilum (Figure 5).
case_images: Side-by-side histopathological comparison between the Virchow node and lung masses (Hematoxylin and eosin stain at 400X magnification) A & B - Virchow node sections revealing neoplastic cells embedded within residual lymphoid tissue. The cells have a high nuclear to cytoplasmic ratio and display marked bizarre nuclei with prominent macronucleoli. The neoplastic cells form mixed morphology consisting of glandular (A) and papillary (B) architecture. Intracellular as well as extracellular mucin is readily identified; C & D - Histological sections of the lung mass with morphologic findings that correspond with the characteristics found within the Virchow node, consistent with metastasis from the lung tumor.
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