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