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. 2018 Jul:117:18-21.
doi: 10.1016/j.urology.2018.03.030. Epub 2018 Apr 4.

A Voice From the Past: Rediscovering the Virchow Node With Prostate-specific Membrane Antigen-targeted 18F-DCFPyL Positron Emission Tomography Imaging

Rudolf A Werner  1 , Christian Andree  2 , Mehrbod S Javadi  3 , Constantin Lapa  4 , Andreas K Buck  4 , Takahiro Higuchi  5 , Martin G Pomper  6 , Michael A Gorin  6 , Steven P Rowe  7 , Kenneth J Pienta  8
Affiliations

A Voice From the Past: Rediscovering the Virchow Node With Prostate-specific Membrane Antigen-targeted 18F-DCFPyL Positron Emission Tomography Imaging

Rudolf A Werner et al. Urology. 2018 Jul.
No abstract available

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Figures

Figure 1
Figure 1
Images from a 18F-DCFPyL PET-CT scan in a 57-year-old man with untreated, biopsy-proven Gleason 5 + 4 = 9 prostate cancer with serum prostate specific antigen level of 109.2 ng/mL. (A) Whole-body maximum intensity projection image demonstrates extensive adenopathy including a left supraclavicular Virchow node (red arrow) as well as radiotracer-avid lymph nodes in left cervical levels IV and V, the mediastinum (red arrowhead), the retrocrural space (thin red arrow), the retroperitoneum (double thin red arrow), and the pelvis. The (B) CT, (C) PET, and (D) PET-CT axial images at the level of the Virchow node show that its small size (5-mm short axis, red arrows) would make it occult on conventional anatomic imaging and indicate the importance of molecular imaging with a PSMA-targeted agent to uncover this site of disease. Additional axial PET-CT images through (E) the mediastinum, (F) the retrocrural space, and (G) the retroperitoneum demonstrate additional involved lymph nodes (red arrowhead in [E], thin red arrow in [F], and double thin red arrow in [G]) and suggest a pathway for involvement of the Virchow node, that is, the cancer likely spread up to the cisterna chyli in the proximity of the retrocrural node, then through the thoracic duct where it was able to establish sites of metastasis in both the mediastinum and left supraclavicular fossa. CT, computed tomography; PET, positron emission tomography; PET-CT, positron emission tomography-computed tomography; PSMA, prostate-specific membrane antigen. (Color version available online.)
Figure 2
Figure 2
(A) Original German article, “Zur Diagnose der Krebse im Unterleibe” by Rudolf Karl Ludwig Virchow, published in the Medicinische Reform (45:248) in 1848. The article is within the section titled “Kleinere Mittheilungen” (Brief Communication). Description of the Virchow node and the name of the author (Virchow) were both highlighted in a red frame. (B) Excerpt of “Zur Diagnose der Krebse im Unterleibe” showing the magnified paragraph of the Virchow node description (upper red frame). The lower red frame highlights the name “Dr. Rud. Virchow”, who is the author of the article and the editor-in-chief of the journal “Medicinische Reform”. (Universitätsbibliothek Heidelberg/Zur Diagnose der Krebse im Unterleibe/Die Medicinische Reform + Extrabl. [Signatur: Friedreich 297: 1-52.1848-49]; Seite 248). (Color version available online.)
See this image and copyright information in PMC

References

    1. Virchow R.L.K. Zur diagnose der krebse im unterleibe. Med Reform. 1848;45:248.
    1. Viacava E.P., Pack G.T. Significance of supraclavicular signal node in patients with abdominal and thoracic cancer—a study of one hunded and twenty-two cases. Arch Surg. 1944;48:109–199.
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    1. Gorin M.A., Pomper M.G., Rowe S.P. PSMA-targeted imaging of prostate cancer: the best is yet to come. BJU Int. 2016;117:715–716. - PubMed

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