Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2021; 9(32): 9917-9925
Published online Nov 16, 2021. doi: 10.12998/wjcc.v9.i32.9917
Isolated synchronous Virchow lymph node metastasis of sigmoid cancer: A case report
Jian-Qiao Yang, Liang Shang, Le-Ping Li, Hai-Yan Jing, Kang-Di Dong, Jian Jiao, Chun-Shui Ye, Hui-Cheng Ren, Qin-Feng Xu, Ping Huang, Jin Liu
Jian-Qiao Yang, Chun-Shui Ye, Qin-Feng Xu, Cheeloo College of Medicine, Shandong University, Jinan 250000, Shandong Province, China
Jian-Qiao Yang, Department of Gastroenterological Surgery, Shandong Provincial Hospital, Jinan 250000, Shandong Province, China
Liang Shang, Le-Ping Li, Kang-Di Dong, Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
Liang Shang, Le-Ping Li, Department of Gastrointestinal Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250000, Shandong Province, China
Liang Shang, Le-Ping Li, Key Laboratory of Engineering of Shandong Province, Shandong Provincial Hospital, Jinan 250000, Shandong Province, China
Hai-Yan Jing, Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250000, Shandong Province, China
Jian Jiao, Hui-Cheng Ren, Department of Gastroenterological Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan 250000, Shandong Province, China
Ping Huang, Department of General Surgery, Huaiyin Hospital Affiliated to Shandong Provincial Hospital, Jinan 250000, Shandong Province, China
Jin Liu, Department of Gastroenterology, Shandong Provincial Hospital Shandong Affiliated to First Medical University, Jinan 250000, Shandong Province, China
Jin Liu, Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, Jinan 250021, Shandong Province, China
Author contributions: Liu J and Yang JQ drafted the paper; Shang L and Li LP revised the manuscript; Jing HY provide pathological image; Dong KD and Jiao J collected patient’s information; Ye CS, Ren HC, Xu QF and Huang P performed the treatment for this patient.
Supported by Key Research and Development Program of Shandong Province, No.2019JZZY010104; Special Foundation for Taishan Scholars Program of Shandong Province, No. ts20190978; and Science and Technology Innovation Development Program of Jinan, No. 2020019082.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin Liu, MD, Doctor, Department of Gastroenterology, Shandong Provincial Hospital Shandong Affiliated to First Medical University, No. 324 Jingwuweiqi Road, Huaiyin District, Jinan 250000, Shandong Province, China. 15069801810@163.com
Received: July 5, 2021
Peer-review started: July 5, 2021
First decision: August 9, 2021
Revised: August 25, 2021
Accepted: September 26, 2021
Article in press: September 26, 2021
Published online: November 16, 2021
Abstract
BACKGROUND

Colorectal cancer (CRC) is one of the most common malignant tumors of the digestive tract. Lymphatic metastases of this tumor are mostly confined to the regional lymph nodes, and distant supraclavicular lymph node metastases are very rare.

CASE SUMMARY

In this report, we describe a patient with sigmoid carcinoma and isolated synchronous supraclavicular lymph node metastases. A 56-year-old male presented with a left cervical mass that was confirmed as a lymph node metastasis from sigmoid cancer by several auxiliary examinations. After 6 cycles of chemotherapy with the 5-fluorouracil, leucovorin and oxaliplatin + cetuximab regimen, the sigmoid colon tumor and Virchow’s lymph node metastasis were significantly smaller than before treatment, and no new metastatic sites were observed. Considering the effects of chemotherapy on quality of life, resection of the primary tumor was performed followed by 4 cycles of chemotherapy with the original chemotherapy regimen. Virchow’s lymph node dissection was selected by mutual consultation between the patient and us. After the second surgery, the patient received capecitabine and cetuximab chemotherapy and did not experience recurrence or metastasis during follow-up.

CONCLUSION

In conclusion, supraclavicular lymph node metastasis without any other solid organ metastasis is a potential metastatic pathway for CRC. In addition, after resection of the primary lesion, postoperative chemotherapy combined with supraclavicular lymph node dissection is feasible for the treatment of patients with CRC and isolated synchronous Virchow’s lymph node metastases.

Keywords: Virchow’s lymph node, Metastasis, Colorectal cancer, Case report

Core Tip: A 56-year-old male presented with Virchow lymph node metastasis of sigmoid cancer. We treated the primary tumor and metastatic lymph nodes with chemotherapy combined with surgery. No recurrence or metastasis occurred during the follow-up period. According to our findings, supraclavicular lymph node metastasis without any other solid organ metastasis may be a potential metastatic pathway for colorectal cancer (CRC). In addition, after resection of the primary lesion, postoperative chemotherapy combined with supraclavicular lymph node dissection is feasible in the treatment of patients with CRC and isolated synchronous Virchow lymph node metastases.