Metastasis of hepatocellular carcinoma to Virchow's node: have the tumor cells gone astray?

BACKGROUND Virchow's node is a common site for metastasis in cancers of the stomach and pancreas. It is rarely involved in hepatocellular carcinoma. METHOD We report on a patient with hepatoma who had metastasis to the left supraclavicular node at presentation. RESULTS This 25-year-old man presented with abdominal pain, fever, weight loss, hard nodular hepatomegaly and a hard, fixed left supraclavicular lymphadenopathy. He was hepatitis B surface antigen positive, had elevated serum alpha-fetoprotein levels, and transabdominal imaging showed a space-occupying lesion in the right lobe of the liver. Fine needle aspiration of the left supraclavicular node revealed a poorly differentiated carcinoma. CONCLUSION Metastasis to the Virchow-Trosier node in hepatoma, although uncommon, can occur probably via the hepatic node and then through the thoracic duct.