title: Misdiagnosis of left supraclavicular lymph node metastasis of hepatocellular carcinoma: a case report.
abstract: Left supraclavicular lymph node metastasis is a rare presentation of hepatocellular carcinoma (HCC). This phenomenon is easily neglected in the clinic. A 56-year-old man presented with HCC. On examination, a 1cm long left supraclavicular lymph node was palpated. Auxiliary examination indicated a lesion located in the right lobe of the liver. Fine needle aspiration cytology (FNAC) of the enlarged lymph node was performed; however, only necrosis was found. Hepatectomy was performed and HCC was confirmed by Hematoxylin-Eosin staining. However, 14 d after surgery, significantly enlarged left supraclavicular lymph nodes, a new intrahepatic lesion, and pulmonary and mediastinal metastasis appeared. An excisional biopsy of the left supraclavicular lymph node was performed, and its findings confirmed metastatic HCC. The patient's HCC rapidly progressed and he died one month later. It is possible for HCC to metastasize to the left supraclavicular lymph node. Surgeons should always consider an overall physical examination. When left supraclavicular lymphadenopathy of unknown origin is encountered, FNAC should be performed initially. If the results are negative, an excisional biopsy and subsequent Positron emission tomography - computed tomography scanning should be performed. These are very important for making the correct diagnosis and for selecting reasonable therapies.
authors: Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Southeast University, Nanjing 210003, Jiangsu Province, China. lt9821@163.com
authors: Tao
authors: T
authors: Liu
authors: Jun-Fang
authors: JF
authors: Gao
authors: Yong-Xiang
authors: YX
authors: Yi
authors: Hai
authors: H
authors: Ding
authors: Wei
authors: W
authors: Liu
mesh_terms: D044963:Biopsy, Fine-Needle; D006528:Carcinoma, Hepatocellular / Q000556:secondary* / Q000601:surgery; D003951:Diagnostic Errors; D017809:Fatal Outcome; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008479:Mediastinal Neoplasms / Q000556:secondary*; D008875:Middle Aged; D011237:Predictive Value of Tests; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
keywords: Fine needle aspiration cytology; Hepatocellular carcinoma; Left supraclavicular lymph node; Metastasis; Misdiagnosis