Anatomy and histology of Virchow's node

Abstract

A regional lymphatic system is composed of the first, second, third and even fourth or much more intercalated nodes along the lymptatic route from the periphery to the venous angle or the thoracic duct. The third or fourth node is usually termed the last-intercalated node or end node along the route. Similarly, one of the supraclavicular nodes is known to correspond to the end node along the thoracic duct. It is generally called 'Virchow's node', in which the famous 'Virchow's metastasis' of advanced gastric cancer occurs. The histology of this node has not been investigated, although region-specific differences in histology are evident in human lymph nodes. We found macroscopically the end node in five of 30 donated cadavers. Serial sections were prepared for these five nodes and sections stained with hematoxylin and eosin. Histological investigation revealed that, on the inferior or distal side of the end node, the thoracic duct divided into three to 10 collateral ducts and these ducts surrounded the node. The node communicated with the thoracic duct and its collaterals at multiple sites in two to three hilus-like portions, as well as along the subcapsular sinus. Thus, the end node was aligned parallel to the thoracic duct. Moreover, the superficial and deep cortex areas of the end node were fragmented to make an island-like arrangement, which may cause the short-cut intranodal shunt. Consequenly, the filtration function of most of Virchow's node seemed to be quite limited.

A Voice From the Past: Rediscovering the Virchow Node With Prostate-specific Membrane Antigen-targeted 18 F-DCFPyL Positron Emission Tomography Imaging

“…The end node of the thoracic duct is the so-called Virchow node and is located near or at this jugulo-subclavian venous junction. 25 The involvement of the Virchow node by metastasis can be seen in several types of cancer. Viacava and Pack investigated 4365 patients suffering from abdominal and thoracic tumors and found an enlarged Virchow node in 2.8% of the patients.…”

“…More specifically, in 2005, Mizutani et al found that the thoracic duct is divided into 3-10 several collateral ducts and these ducts surround the Virchow node. 25 …”

Recurrent ovarian cancer presenting in the right supraclavicular lymph node with isolated metastasis: a case report

“…LSCLN collects lymph through the thoracic duct and from most areas of the body. In contrast, RSCLN takes its supply mainly from the mediastinum, lungs, and esophagus [1]; in a patient with OC, the route of ILNR in LSCLN is lymphatic dissemination, and that in RSCLN is lymphatic dissemination from the transcoelomic spread site. In the present case, although the diagnosis of ILNR was surgically confirmed, the suspected presence of a peritoneal lesion was based on PET/CT findings.…”

“…A finding of an enlarged node has been regarded as strongly indicative of the presence of cancer in the abdomen. In contrast, right supraclavicular lymph node (RSCLN) takes its supply mainly from the mediastinum, lungs, and esophagus [1]. We report a case of recurrent OC presenting with an isolated RSCLN metastasis with no evidence of any other recurrent part after 52 months from initial surgery.…”

Prognostic significance of supraclavicular lymphadenopathy in patients with high-grade serous ovarian cancer

“…This is the junction where incoming lymph is introduced back into venous circulation through the left subclavian vein. An enlarged Virchow node is referred to as the Troisier sign, and is highly suggestive of abdominal malignancy 4. Supraclavicular lymph nodes are a common location for metastasis from lung, gastric, and esophageal cancers, and their presence may contraindicate surgical management of these diseases 5…”