Virchow’s node as the initial presentation of metastatic prostate cancer: a case series of a common cancer in uncommon location

Abstract

Prostate cancer is one of the commonest cancers among men contributing significantly to the overall cancer burden globally. Most patients present with lower urinary tract symptoms. Metastasis to supraclavicular lymph nodes is unusual presentation, which has been rarely reported particularly as the primary presentation. We report two rare cases of advanced prostatic adenocarcinoma presenting with firm, non-tender lump in the left supraclavicular region between the two heads of the sternocleidomastoid muscle, (that is Virchow’s node) as initial primary symptom. Examination of the patients revealed an elevated prostatic-specific antigen (PSA) of > 100 ng/ml levels, and the diagnosis was confirmed by histological evaluation and immunostaining with PSA of the supraclavicular lymph nodes and prostate biopsies. This case series emphasizes the importance of considering prostate cancer in the differential diagnosis of male patients with supraclavicular lymphadenopathy.

Case report: PSMA PET/CT addresses the correct diagnosis in a patient with metastatic prostate cancer despite negative core biopsies and mpMRI. A diagnostic challenge

“…Our case reflects this concept, not common but well known among clinicians, displaying a heterogeneous scenario in a single patient with absent PSMA expression in the primary tumour but with high PSMA expression in multiple nodes and bone Pca metastasis. Moreover, although other episodes of uncommon locations for Pca presentation are reported in literature, like Virchow’s node or gingival metastasis ( 10 – 12 ), the peculiarity of this case is represented by the metastatic presentation in whom, interestingly, none of the diagnostic techniques were able to detect the primary tumour within the prostate gland. It is well recognized that several malignancies can present with subdiaphragmatic nodal findings and PSMA is not a purely prostate-specific radiotracer, therefore the presence of multiple PSMA avid lymphadenopathies could have also raised the suspicion of lymphoma; however, the osteoblastic bone lesion was more suggestive of Pca.…”

Left axillary lymphadenopathy as initial presentation of metastatic prostate cancer: A rare case report

“…Lymphatic metastasis to axillary lymph nodes is a very rare manifestation of prostate cancer [ 11 ]. Several reports of prostate cancer with non-regional supra-diaphragmatic lymphatic metastases described no cases of axillary lymph node involvement [ 8 , 12 , 13 ]. Interestingly, expression of chemokine receptors has been associated with unusual predilection of prostate cancer to lymph nodes [ 14 ].…”

Effectiveness of Virchow’s Node Fine-Needle Biopsy for the Discovery of Occult Metastatic Prostate Cancer

“…The patient did not have any other palpable nodes. Virchow's node correlates with metastatic cancer in the gastric regions, and, in rare cases, it can be present because of prostate cancer [3]. Thus, this case highlights the importance of considering prostate cancer in the differential diagnosis of male patients presenting with Virchow's node and performing a fine-needle aspiration (FNA) biopsy to confirm the diagnosis.…”