INTRODUCTION
Despite clinical practice guidelines to guide evaluation and management of neck masses [1], the diverse etiologies of neck masses may make accurate diagnosis challenging [2]. A neck mass in an adult most often represents lymphatic transit of metastasis from a mucosal squamous cell carcinoma or less commonly a primary tumor. Visceral malignancy [3] may also affect the head and neck, usually via lymphatic spread that classically presents as an enlarged Virchow’s lymph node (VN), a left-sided supraclavicular fossa lymph node. Muscle metastasis may also occur via hematogenous spread [4,5]. We describe a rare case of signet ring cell-variant gastric adenocarcinoma that bypassed Virchow’s node to involve the posterolateral neck.