A woman is found to have isolated left supraclavicular (Virchow's) lymphadenopathy. Which primary intra-abdominal malignancy most commonly drains to this site, and through which lymphatic channel?

• A Colonic carcinoma via the inferior mesenteric nodes
• B Gastric carcinoma via the thoracic duct ✓
• C Hepatocellular carcinoma via the right lymphatic duct
• D Pancreatic tail carcinoma via the right lymphatic duct

Explanation

Virchow's node (left supraclavicular) receives lymph from the thoracic duct, which collects drainage from the entire abdomen, pelvis, and left thorax. Gastric carcinoma (especially from the lesser curvature and pylorus) drains to perigastric nodes → celiac nodes → cisterna chyli → thoracic duct → left supraclavicular node (Troisier's sign). While other GI malignancies can also metastasize here, gastric carcinoma is the classical and most common intra-abdominal cancer to present with Virchow's node. The right lymphatic duct drains the right side of the head/neck, right upper limb, and right thorax — not the abdomen.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.