DISCUSSION
This case underscores importance of definitive diagnosis for head and neck masses and is a reminder of the diverse etiologies for tumors in this region [4]. There was no suggestion of visceral disease on clinical presentation [4]. The patient denied gastric pain, decreased appetite, or weight loss [6], consistent with the finding of metastases in 80% of patients with gastric cancer at time of diagnosis [7]; for this reason, Suh et al. suggested to perform excisional biopsy of suspect lymph node to detect these tumors in early stage [8]. Metastasis of gastric cancer to the head and neck is less common [5], although VN (Troisier’s sign) is well recognized [3].
The Virchow’s node observed in visceral malignancy arises from tumor metastasis via the thoracic duct, so it very very rare observing a jump in the lymph nodes station during cancer metastasizing [9,10]. VN may compress or invade neurovascular structures, causing thoracic outlet syndrome, brachial plexopathy, phrenic neuropathy, or Horner’s syndrome. Because of diverse sources of visceral malignancy, including gastrointestinal, hepatobiliary, and other origins, Virchow’s node and its variants are important across surgical specialties. Diagnosis of neck masses is inherently challenging, and the presence of V level lymph node without Virchow’s node is an atypical presentation that may obscure the source of the primary tumor. The most important point of this clinical case is the extreme rarity in identifying V lymph node without Virchow’s node involvement [10], in fact, another case only has been reported in literature in 2008 by Takashima et al [11].
FUNDING : none.
FINANCIAL DISCLOSURE/CONFLICT OF INTEREST: The authors have no financial conflicts of interest relevant to this article to disclose.
ETHICAL APPROVAL AND CONSENT TO PARTECIPATE: the study was approved by the IRB of the hospital without releasing of an authorization number. The patient signed a written consent before being included in the study.
PATIENT CONSENT FOR PUBLICATION: the patient authorized to publish her data previous anonymization.
AVAILABILITY OF DATA AND MATERIALS: original data are available under request to the corresponding author.
AUTHORS’ CONTRIBUTION: ADS, LdA, MB: study design and article writing; GL, PG, MP and TT collection of clinical data; GR and MM literature review, criticism and review of paper.
ACKNOWLEDGEMENT: not applicable