Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Southeast University, Nanjing 210003, Jiangsu Province, China.
World J Gastroenterol. 2013 Feb 14;19(6):960-3. doi: 10.3748/wjg.v19.i6.960.
Left supraclavicular lymph node metastasis is a rare presentation of hepatocellular carcinoma (HCC). This phenomenon is easily neglected in the clinic. A 56-year-old man presented with HCC. On examination, a 1cm long left supraclavicular lymph node was palpated. Auxiliary examination indicated a lesion located in the right lobe of the liver. Fine needle aspiration cytology (FNAC) of the enlarged lymph node was performed; however, only necrosis was found. Hepatectomy was performed and HCC was confirmed by Hematoxylin-Eosin staining. However, 14 d after surgery, significantly enlarged left supraclavicular lymph nodes, a new intrahepatic lesion, and pulmonary and mediastinal metastasis appeared. An excisional biopsy of the left supraclavicular lymph node was performed, and its findings confirmed metastatic HCC. The patient's HCC rapidly progressed and he died one month later. It is possible for HCC to metastasize to the left supraclavicular lymph node. Surgeons should always consider an overall physical examination. When left supraclavicular lymphadenopathy of unknown origin is encountered, FNAC should be performed initially. If the results are negative, an excisional biopsy and subsequent Positron emission tomography - computed tomography scanning should be performed. These are very important for making the correct diagnosis and for selecting reasonable therapies.
左锁骨上淋巴结转移是肝细胞癌（HCC）的罕见表现。这种现象在临床上很容易被忽视。一名 56 岁男性因 HCC 就诊。检查时，可触及左锁骨上 1cm 长的淋巴结。辅助检查提示肝脏右叶有病变。对增大的淋巴结进行细针穿刺细胞学检查（FNAC），但仅发现坏死。行肝切除术，H&E 染色证实为 HCC。然而，术后 14 天，左锁骨上淋巴结明显增大，出现新的肝内病变和肺及纵隔转移。行左锁骨上淋巴结切除术，其结果证实为转移性 HCC。患者 HCC 迅速进展，一个月后死亡。HCC 可能转移至左锁骨上淋巴结。外科医生应始终进行全面的体格检查。当遇到不明原因的左锁骨上淋巴结病时，应首先进行 FNAC。如果结果为阴性，应进行切除活检和随后的正电子发射断层扫描-计算机断层扫描检查。这些对于做出正确诊断和选择合理治疗非常重要。
