15/05/2025
Testicular cancer spreading to the supraclavicular lymph node follows a specific lymphatic pathway. Although the te**es are located in the sc***um, they develop in the abdomen, and their lymphatic drainage follows their embryological origin. Here’s how the spread occurs with key anatomical landmarks:
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Primary Lymphatic Drainage of the Te**es:
• The te**es drain initially to the para-aortic (lumbar) lymph nodes, particularly at the level of L1–L2, near the renal vessels.
• Landmark: Located along the abdominal aorta near the origin of the renal arteries.
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Pathway to Supraclavicular Lymph Nodes:
1. Para-aortic Nodes (L1–L2):
• First station of metastatic spread via testicular lymphatics.
2. Cisterna Chyli:
• Lymph from the para-aortic nodes collects in the cisterna chyli, a sac-like structure at the level of L1–L2, just below the diaphragm.
3. Thoracic Duct:
• From the cisterna chyli, lymph ascends through the thoracic duct.
• Landmarks:
• Passes through aortic hiatus at T12.
• Ascends posterior to the esophagus between the azygos vein (right) and the descending aorta (left).
• Crosses from right to left around T5 level.
4. Left Supraclavicular Lymph Node (Virchow’s Node):
• At the termination of the thoracic duct, lymph enters the left venous angle (junction of left internal jugular and subclavian veins).
• Cancer cells may seed the left supraclavicular lymph node (also called Virchow’s node).
• Landmark: Located in the left supraclavicular fossa, above the clavicle, lateral to the sternocleidomastoid muscle.
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Clinical Note:
• Left supraclavicular lymphadenopathy in testicular cancer is a sign of advanced disease and indicates retrograde lymphatic spread via the thoracic duct.
• This spread pathway explains why a pelvic or inguinal node enlargement is not typically seen in primary testicular cancer unless there’s scrotal involvement or prior surgery disrupting normal lymphatic drainage.