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Left Supraclavicular (Virchow’s) Node Metastasis Detected Before Diagnosis of the Primary Infradiaphragmatic Tumor


 Background and Purpose: Malignant infradiaphragmatic tumors that metastasize to the left supraclavicular (Virchow’s) node are relatively rare. Since Virchow's time, the survival rates of cancer patients have improved because of dramatic research advances in the epidemiology of cancer and the development of screening technologies and treatment methods. However, when metastasis is detected in the left supraclavicular node in patients with head and neck carcinoma, locating the primary cancer remains a difficult and time-consuming challenge. We report three cases of malignant infradiaphragmatic tumors diagnosed following the initial finding of left supraclavicular node (LSN) metastasis after surgery for tongue squamous cell carcinoma (follow-up period, range 18–62 months).Methods: In these cases, adenocarcinoma was diagnosed based on LSN biopsies, and a second primary tumor was found, including cholangiocarcinoma, bladder carcinoma, and prostate carcinoma.Results: CA19-9 and alpha-fetoprotein levels helped to diagnose cholangiocarcinoma. In the bladder carcinoma case, immunopathological examination of the metastatic LSN and bladder lesion showed GATA 3(+), and the tongue squamous cell carcinoma showed GATA 3(-). GATA 3 staining aided in the diagnosis of urothelial bladder cancer with LSN metastasis. In the prostate carcinoma case, PSA levels and weak FDG-PET/CT uptake aided the diagnosis process. This patient underwent bilateral orchiectomy and adjuvant hormonal therapy and survived for 47 months after the diagnosis of LSN metastasis. The other patients died within 1 year.Discussion and Conclusions: These cases suggest that the prognosis of malignant infradiaphragmatic tumors after LSN metastasis depends on the tumor characteristics and that rapid diagnosis is important for providing appropriate treatment.