A case of recurring hepatocellular carcinoma with a solitary Virchow's lymph node metastasis

A 73-year-old male with C type liver cirrhosis and poor liver function reserve was diagnosed with hepatocellular carcinoma (HCC)(Segment V, 2 x 2 cm in diameter) and underwent open microwave coagulation therapy (MCT). Ten months later, a movable hard mass about the size of a quail egg was palpable at the left supra-clavicular lymph node (LN)(Virchow's LN) and blood tests revealed an elevated serum alpha-fetoprotein (AFP) level of 26.7 ng/dl. Abdominal and chest CT showed no evidence of recurrence in liver or lung, and no metastases of abdominal LN. Barium and bone scintigraphy revealed no abnormal spots. The affected left supra-clavicular LN was extirpated. The tumor was confirmed to be an LN metastasis from HCC by histopathological examination. After the operation, the patient developed uncontrollable pleural effusion and ascites, and intrahepatic and abdominal LN metastases were visible on abdominal CT with great haste. He died 1.5 months after the LN was extirpated. We herein report a case of HCC treated by MCT which later resulted in a solitary Virchow's LN metastasis in the absence of any abdominal LN or recurrence in the liver or lung.