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Reload this Page a palpable mass immediately below the left clavicle
Clinical Vignette A clinical vignette is a concise presentation of an interesting or challenging patient encounter that stimulated an interesting learning issue.

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Clinical MCQs 12 - 26-06-2006, 08:12 PM
A 65-year-old man presents to a physician because of a palpable mass immediately below the left clavicle. Biopsy of the mass demonstrates metastatic adenocarcinoma in a lymph node. Which of the following organs should be most strongly suspected as containing the primary tumor?
A. Bladder
B. Large bowel
C. Liver
D. Pancreas
E. Stomach

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Last edited by Oak; 26-06-2006 at 08:15 PM.
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Re: Clinical MCQs 12 - 27-06-2006, 06:51 PM
well i will go for option E.stomach cancer
coz. all gastric carcinomas eventually penetrate the wall to involve the serosa and spread to the regional & more distant lympth node.
Local invasion into the duodenum, pancreas, and retroperitoneum is characteristic of this type of carcinoma.
the earlist lymph node metastasis may sometimes involove a supraclavicular lymph node (Virchows node ) .
Is not that correct bro.?
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The correct answer is E - 27-06-2006, 09:33 PM
You are right

The correct answer is E. The supraclavicular nodes (Virchow's node) can be involved early in mediastinal and neck cancers. A palpable mass in the left node can also be the presenting finding of gastric carcinoma, which is worth remembering when you cannot find the primary in the lungs or neck.

Bladder cancer (choice A) typically presents with hematuria or urinary symptoms.

Colon cancer (choice B) typically presents with blood in stool or changes in bowel habits.

Primary liver cancer (choice C) and pancreatic cancer (choice D) unfortunately tend to be clinically silent until well advanced.

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