Collision tumor-concurrent involvement of Virchow's lymph node by Hodgkin's disease and metastatic gastric adenocarcinoma. A Troisier's sign and more?

We describe the case of a 59-year-old Caucasian male who presented to the outpatient clinic with intractable hiccups, upper abdominal pain, repeated bouts of vomiting, and stiff neck. Physical examination revealed a cachectic male with pallor, with enlarged left supraclavicular Virchow's lymph node and hepatosplenomegaly. Histologic examination of the excised lymph node revealed simultaneous presence of 2 malignant processes, nodular sclerosing classical Hodgkin's lymphoma and metastatic adenocarcinoma. Subsequent investigations of the patient, revealed the presence of gastric adenocarcinoma. Although factors governing the coexistence and the possible order of appearance of the 2 pathologies in the present case remain unknown, attempts are made to elucidate the pathogenetic mechanisms that led to their existence.