images of swollen supraclavicular lymph nodes

However, the diagnosis may sometimes be difficult, with the potential for clinically important diagnostic errors. For palpable left supraclavicular lymph nodes, FNAC is not only useful for diagnosing various lesions, but also can help in deciding on appropriate management. In this situation, it is more appropriate for patients to adopt non-operative treatment, including hepatic arterial chemoembolization, molecular targeted therapy, chemotherapy and radiotherapy, instead of surgery. When the left supraclavicular lymph node is involved in the tumor, patients already have advanced disease.

However, left supraclavicular lymphadenopathy is not the initial presentation in most conditions therefore, overall physical examination, especially of the supraclavicular fossa, should not be overlooked. Early discovery of distant metastasis is important for tumor staging, prognosis judgment and therapy determination in those patients with HCC. HCC metastasis to left supraclavicular lymph nodes, although uncommon, does occur, probably via the hepatic node and then through the thoracic duct.

A previous study revealed that the incidence of lymph node metastasis in operable HCC patients was low, but patients with lymph node metastasis had a poorer prognosis. Nowadays, a hepatectomy has become one of the most popular treatments for HCC, and understanding lymph node metastasis in HCC is indispensable at surgery for improving the patient’s prognosis. Hilar lymph nodes and para-aortic nodes are the major metastatic sites. Lymphatic metastasis has been documented in 25.5% of patients at different stages of HCC. Hematogenous dissemination is common, whereas lymphatic metastasis is uncommon. The patient rapidly declined and died one month later.ĭistant metastasis of HCC occurs in three main ways: Hematogenous dissemination, lymphatic metastasis and implantation metastasis. His alpha-fetoprotein (AFP) level was 695.4 ng/mL (normal 1050 ng/mL. Laboratory examination revealed a platelet count of 89 × 10 9/L. Neurological examination did not demonstrate any deficit. Varicose veins on the thoracic and abdominal wall were not observed. Examination of the chest did not reveal any signs of bronchospasm. On examination, a 1 cm long left supraclavicular lymph node was palpated and it was slightly tender. He had hypertension that was successfully treated with oral medication. These are very important for making the correct diagnosis and for selecting reasonable therapies.Ī 56-year-old man suffering from HCC was referred to our hospital. If the results are negative, an excisional biopsy and subsequent Positron emission tomography - computed tomography scanning should be performed.

When left supraclavicular lymphadenopathy of unknown origin is encountered, FNAC should be performed initially. Surgeons should always consider an overall physical examination. It is possible for HCC to metastasize to the left supraclavicular lymph node. The patient’s HCC rapidly progressed and he died one month later. An excisional biopsy of the left supraclavicular lymph node was performed, and its findings confirmed metastatic HCC. However, 14 d after surgery, significantly enlarged left supraclavicular lymph nodes, a new intrahepatic lesion, and pulmonary and mediastinal metastasis appeared. Hepatectomy was performed and HCC was confirmed by Hematoxylin-Eosin staining. Fine needle aspiration cytology (FNAC) of the enlarged lymph node was performed however, only necrosis was found. Auxiliary examination indicated a lesion located in the right lobe of the liver. On examination, a 1cm long left supraclavicular lymph node was palpated. This phenomenon is easily neglected in the clinic. Left supraclavicular lymph node metastasis is a rare presentation of hepatocellular carcinoma (HCC).

Images of swollen supraclavicular lymph nodes