Zdilla Matthew J, Aldawood Ali M, Plata Andrew, Vos Jeffrey A, Lambert H Wayne
West Liberty University, Department of Natural Sciences & Mathematics and Graduate Health Sciences. West Liberty, West Virginia, USA.
West Virginia University School of Medicine, Department of Pathology, Anatomy & Laboratory Medicine.Morgantown, West Virginia, USA.
Autops Case Rep. 2019 Feb 25;9(1):e2018053. doi: 10.4322/acr.2018.053. eCollection 2019 Jan-Mar.
Metastatic spread of cancer via the thoracic duct may lead to an enlargement of the left supraclavicular node, known as the Virchow node (VN), leading to an appreciable mass that can be recognized clinically - a Troisier sign. The VN is of profound clinical importance; however, there have been few studies of its regional anatomical relationships. Our report presents a case of a Troisier sign/VN discovered during cadaveric dissection in an individual whose cause of death was, reportedly, chronic obstructive pulmonary disease. The VN was found to arise from an antecedent pulmonary adenocarcinoma. Our report includes a regional study of the anatomy as well as relevant gross pathology and histopathology. Our anatomical findings suggest that the VN may contribute to vascular thoracic outlet syndrome as well as the brachial plexopathy of neurogenic thoracic outlet syndrome. Further, the VN has the potential to cause compression of the phrenic nerve, contributing to unilateral phrenic neuropathy and subsequent dyspnea. Recognition of the Troisier sign/VN is of great clinical importance. Similarly, an appreciation of the anatomy surrounding the VN, and the potential for the enlarged node to encroach on neurovascular structures, is also important in the study of a patient. The presence of a Troisier sign/VN should be assessed when thoracic outlet syndrome and phrenic neuropathy are suspected. Conversely, when a VN is identified, the possibility of concomitant or subsequent thoracic outlet syndrome and phrenic neuropathy should be considered.
癌症通过胸导管发生转移扩散可能导致左锁骨上淋巴结肿大，即所谓的魏尔啸淋巴结（VN），形成一个临床上可识别的明显肿块——特鲁瓦西埃征。VN具有重要的临床意义；然而，对其局部解剖关系的研究却很少。我们的报告介绍了一例在尸体解剖过程中发现的特鲁瓦西埃征/VN病例，据报道，该个体的死因是慢性阻塞性肺疾病。发现VN源自先前的肺腺癌。我们的报告包括对该区域的解剖学研究以及相关大体病理学和组织病理学研究。我们的解剖学发现表明，VN可能导致血管性胸廓出口综合征以及神经源性胸廓出口综合征的臂丛神经病变。此外，VN有可能压迫膈神经，导致单侧膈神经病变及随后的呼吸困难。认识特鲁瓦西埃征/VN具有重要的临床意义。同样，了解VN周围的解剖结构以及肿大淋巴结侵犯神经血管结构的可能性，对患者的研究也很重要。当怀疑有胸廓出口综合征和膈神经病变时，应评估是否存在特鲁瓦西埃征/VN。相反，当识别出VN时，应考虑同时或随后发生胸廓出口综合征和膈神经病变的可能性。
