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.