Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Nódulo de la Hermana María José , Humanos , Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/secundario , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Nódulo de la Hermana María José/patología , Nódulo de la Hermana María José/secundario , Masculino , Tomografía Computarizada por Rayos X , Femenino , Persona de Mediana Edad , AncianoRESUMEN
An umbilical metastasis from an internal malignancy is called Sister Mary Joseph's nodule(SMJN)and has a poor prognosis. Herein, we report a case of umbilical metastasis of cervical cancer. A woman in her eighties underwent radiation therapy for cervical cancer(cT3bN0M0, cStage â ¢B). Primary tumor shrank after treatment, suggesting that radiation therapy induced complete response. Two years and 9 months after treatment, the patient presented with umbilical pain. A CT scan showed an umbilical mass near the umbilical hernia. PET-CT demonstrated high accumulation of FDG at the mass, which led to suspicion of umbilical metastasis(SMJN). Although she underwent radical surgery, she died from cancer 8 months after surgery.
Asunto(s)
Nódulo de la Hermana María José , Neoplasias del Cuello Uterino , Humanos , Femenino , Nódulo de la Hermana María José/secundario , Neoplasias del Cuello Uterino/radioterapia , Neoplasias del Cuello Uterino/cirugía , Tomografía Computarizada por Tomografía de Emisión de Positrones , Ombligo/patología , Tomografía Computarizada por Rayos XRESUMEN
ABSTRACT: A 76-year-old man with a history of prostate cancer diagnosed in 2008 developed biochemical recurrence in 2010 and started intermittent androgen deprivation therapy. In 2021, due to rising prostate-specific antigen, an 18 F-piflufolastat PSMA PET/CT was performed. It showed a radiotracer-avid sclerotic lesion in the right iliac bone and an indeterminate radiotracer-avid nodule in the umbilical region, demonstrating progressive enlargement and increased uptake on subsequent imaging. Pathologic analysis of the umbilical nodule revealed metastatic prostate cancer-a finding eponymically referred to as a Sister Mary Joseph nodule.
Asunto(s)
Neoplasias de la Próstata , Nódulo de la Hermana María José , Masculino , Humanos , Anciano , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Antagonistas de Andrógenos , Antígeno Prostático Específico , Radiofármacos , Nódulo de la Hermana María José/diagnóstico por imagen , Nódulo de la Hermana María José/secundarioRESUMEN
A metastatic tumor of the umbilicus is called"Sister Mary Joseph's nodule", and patients with this tumor show a poor prognosis. Sister Mary Joseph's nodule is a rare occurrence, and there are few case reports. We report a case of cecal cancer first presented with the metastatic tumor in the umbilicus. A 90-year-old woman, complained umbilical induration and foul-smelling discharge, had been treated as omphalitis for 2 months. Because her symptom didn't improve, biopsy of the umbilical tumor was performed, and the findings revealed an adenocarcinoma. She was referred to our hospital. Abdominal CT showed wall thickening in the cecum, and multiple liver metastases. Therefore, we performed lower gastrointestinal endoscopy, which revealed a cecal tumor. We performed biopsy of the tumor and the findings were consistent with adenocarcinoma. Based on these results, we diagnosed the umbilical tumor as a metastasis from the colorectal cancer. Umbilical resection and ileocecal resection were performed, and multiple peritoneal metastases was detected. Post operative course was uneventful, she died 11 months after surgery. Umbilical metastases may worsen the patient's quality of life; thus, the local resection of umbilicus was recommended positively.
Asunto(s)
Adenocarcinoma , Neoplasias del Ciego , Nódulo de la Hermana María José , Humanos , Femenino , Anciano de 80 o más Años , Nódulo de la Hermana María José/cirugía , Nódulo de la Hermana María José/secundario , Calidad de Vida , Neoplasias del Ciego/cirugía , Neoplasias del Ciego/patología , Ombligo/cirugía , Ombligo/patología , Adenocarcinoma/diagnósticoRESUMEN
We report a case of a 41-year-old pregnant woman who initially presented with a sub-umbilical lump, for nearly five months. Subsequently, an ultrasound study was performed, and the patient underwent a surgical drainage operation for a presumed inflammatory condition, at the periumbilical region. The patient returned after a week post-drainage with a faecal discharging fistula. One month later, the patient had an emergency lower caesarean section plus bilateral tubal ligation because of the transverse lie of the foetus. Onemonth post-operative caesarean section, the fistula opening showed a big protruding ulcerating mass. En-bloc resection of the transverse and the descending colon was performed, and the histopathologic diagnosis showed a moderately differentiated mucinous adenocarcinoma. This case highlights that a high index of suspicion was recommended in an unresolved periumbilical lump (pseudo Sister Mary Joseph's nodule), and periumbilical metastasis of colorectal cancer frequently indicates advanced disease and poor prognosis. In view of its rarity of occurrence and limited experience, in the management of an ambiguous case, we report this case.
Asunto(s)
Adenocarcinoma Mucinoso , Neoplasias del Colon , Nódulo de la Hermana María José , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/cirugía , Adulto , Cesárea , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Femenino , Humanos , Embarazo , Mujeres Embarazadas , Nódulo de la Hermana María José/diagnóstico , Nódulo de la Hermana María José/secundario , Nódulo de la Hermana María José/cirugía , Ombligo/patologíaRESUMEN
Umbilical metastases form a clinical challenge, especially when they represent the first sign of malignant disease and the primary tumor is unknown. Our study aims to generate insight into the origin and timing of umbilical metastasis, as well as patient survival, using population-based data. A nationwide review of pathology records of patients diagnosed with an umbilical metastasis between 1979 and 2015 was performed. Data was collected from the Nationwide Network and Registry of Histopathology and Cytopathology (PALGA) and the Netherlands Cancer Registry. Kaplan-Meier analyses and log-rank testing were used to estimate overall survival and a Cox proportional hazard model was used to determine multivariable hazard ratios. A total of 806 patients with an umbilical metastasis were included. There were 210 male (26.1%) and 596 female (73.9%) patients. Distribution of umbilical metastases was different between male and female patients due to the high incidence of umbilical metastases originating from the ovaries in females. They most frequently originated from the ovaries in female patients (38.8%) and from the colon in male patients (43.8%). In 18% of cases no primary tumor could be identified. Prognosis after diagnosis of an umbilical metastasis was dismal with a median survival of 7.9 months (95% confidence interval 6.7-9.1). The origin of the primary tumor was an independent prognostic factor for overall survival. In conclusion, umbilical metastases relatively rare, mainly originating from intraabdominal primary tumors. Survival is dependent on the origin of the primary tumor and poor overall survival rates warrant early recognition.
Asunto(s)
Neoplasias del Colon/epidemiología , Neoplasias Ováricas/epidemiología , Nódulo de la Hermana María José/epidemiología , Nódulo de la Hermana María José/secundario , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Colon/mortalidad , Femenino , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Mortalidad , Países Bajos/epidemiología , Neoplasias Ováricas/mortalidad , Pronóstico , Modelos de Riesgos Proporcionales , Caracteres Sexuales , Nódulo de la Hermana María José/mortalidad , Tasa de Supervivencia , Adulto JovenAsunto(s)
Carcinoma de Células en Anillo de Sello/secundario , Neoplasias del Colon/patología , Nódulo de la Hermana María José/secundario , Ombligo/patología , Enfermedades Asintomáticas , Biopsia , Carcinoma de Células en Anillo de Sello/diagnóstico por imagen , Neoplasias del Colon/diagnóstico por imagen , Colonoscopía , Humanos , Masculino , Persona de Mediana Edad , Nódulo de la Hermana María José/patología , Tomografía Computarizada por Rayos XRESUMEN
Sister Mary Joseph nodule (SMJN) is an umbilical nodule representing a metastatic deposit from an intra-abdominal primary malignancy. Most radiologists are unaware of this phenomenon, and cases of SMJN have rarely been described in the radiology literature, to our knowledge. We present an example of a patient with known primary pancreatic adenocarcinoma found to have an umbilical nodule as the first manifestation of metastatic disease after an initial misdiagnosis on computed tomography. In addition, we delineate the importance of maintaining a high index of suspicion and pattern recognition for SMJN during imaging when a patient presents with umbilical pain in the setting of known malignancy, since early diagnosis can alter management.
Asunto(s)
Adenocarcinoma/patología , Neoplasias Pancreáticas/patología , Nódulo de la Hermana María José/diagnóstico , Ombligo/patología , Cavidad Abdominal/patología , Errores Diagnósticos , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Primarias Secundarias/patología , Radiólogos , Nódulo de la Hermana María José/diagnóstico por imagen , Nódulo de la Hermana María José/secundario , Tomografía Computarizada por Rayos X/métodos , Neoplasias PancreáticasRESUMEN
Cutaneous metastases from internal malignancies are uncommon. Umbilical metastasis, also known as Sister Joseph nodule (SJN), develops in patients with carcinomatous peritonitis or superficial lymphadenopathy, while non-SJN skin metastases develop after surgery, injury, and lymphadenopathy. In this review, the possible mechanisms of skin metastases are discussed. SJNs develop by the contiguous or lymphatic spread of tumor cells. After surgery and injury, tumor cells spread by direct implantation or hematogenous metastasis, and after lymphadenopathy, they spread by extranodal extension. The inflammatory response occurring during wound healing is exploited by tumor cells and facilitates tumor growth. Macrophages are crucial drivers of tumor-promoting inflammation, which is a source of survival, growth and angiogenic factors. Angiogenesis is promoted by the vascular endothelial growth factor (VEGF), which also mediates tumor-associated immunodeficiency. In the subcutaneous tissues that surround metastatic lymph nodes, adipocytes promote tumor growth. In the elderly, age-associated immunosuppression may facilitate hematogenous metastasis. Anti-VEGF therapy affects recurrence patterns but at the same time, may increase the risk of skin metastases. Immune suppression associated with inflammation may play a key role in skin metastasis development. Thus, immune therapies, including immune checkpoint inhibitors reactivating cytotoxic T-cell function and inhibiting tumor-associated macrophage function, appear promising.
Asunto(s)
Linfadenopatía/complicaciones , Peritonitis/complicaciones , Neoplasias Cutáneas/secundario , Procedimientos Quirúrgicos Operativos/efectos adversos , Humanos , Nódulo de la Hermana María José/patología , Nódulo de la Hermana María José/secundario , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapiaRESUMEN
Sister Mary Joseph (SMJ) nodules are rare malignant metastatic umbilical nodules, indicating disseminated disease and associated with a poor prognosis. This is the case of an 80-year-old woman who presented with umbilical discomfort and an ulcerated umbilical nodule. She was noted to have a bulky uterus and vaginal bleeding. CT abdomen-pelvis showed an enlarged uterus and right-sided lymphadenopathy, extending from the groin to the para-aortic area. Upper and lower endoscopies were normal. Biopsy of the umbilical nodule revealed metastatic endometrioid adenocarcinoma grade 1-2 with the endometrium and the ovary suggested as potential primary sites. The patient had cytoreductive surgery including en bloc resection of the umbilical tumour. Final histology confirmed Stage IVb endometrioid adenocarcinoma of the uterus. This unusual case highlights the diagnostic challenges faced with the presentation of an umbilical nodule. Gynaecological malignancy should always be considered within the initial differential diagnosis of an SMJ nodule.
Asunto(s)
Carcinoma Endometrioide/diagnóstico , Nódulo de la Hermana María José/diagnóstico , Neoplasias Uterinas/diagnóstico , Anciano de 80 o más Años , Carcinoma Endometrioide/diagnóstico por imagen , Carcinoma Endometrioide/secundario , Carcinoma Endometrioide/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Metástasis de la Neoplasia , Nódulo de la Hermana María José/diagnóstico por imagen , Nódulo de la Hermana María José/secundario , Nódulo de la Hermana María José/cirugía , Ombligo/patología , Neoplasias Uterinas/diagnóstico por imagen , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugíaRESUMEN
Umbilical metastasis from intra-abdominal or pelvic malignancy, which is called Sister Mary Joseph's nodule (SMJN), is rare, and it has a poor prognosis. Its most common primary sites are the stomach and ovaries. SMJN caused by colon cancer is uncommon. A 42-year-old woman visited local clinics with complaints of an umbilical mass. After a detailed examination, she was diagnosed with peritoneal and umbilical metastasis caused by colon cancer. A radical surgery was performed after 12 months of chemotherapy. 6 months later, local recurrence and ovarian metastasis were suspected. Further radical surgery was performed, and 14 months after that (50 months after starting treatment), no recurrences have been observed. We experienced a long-term survival case of SMJN caused by colon cancer and treated with a multidisciplinary approach.
Asunto(s)
Neoplasias del Colon/complicaciones , Neoplasias del Colon/mortalidad , Nódulo de la Hermana María José/mortalidad , Nódulo de la Hermana María José/secundario , Adulto , Neoplasias del Colon/cirugía , Femenino , Humanos , Nódulo de la Hermana María José/cirugíaRESUMEN
Sister Mary Joseph nodule is an umbilical metastatic lesion typically originating from gastrointestinal or gynecologic malignancies. In pancreatic cancer, Sister Mary Joseph nodule is a sign of advanced disease with an associated poor prognosis. 18F-FDG PET/MRI provides an imaging tool in the identification of Sister Mary Joseph nodule and helps to improve the staging of pancreatic cancer.
Asunto(s)
Adenocarcinoma/patología , Fluorodesoxiglucosa F18 , Imagen por Resonancia Magnética , Imagen Multimodal , Neoplasias Pancreáticas/patología , Nódulo de la Hermana María José/diagnóstico por imagen , Nódulo de la Hermana María José/secundario , Adenocarcinoma/diagnóstico por imagen , Anciano , Humanos , Masculino , Estadificación de Neoplasias , Neoplasias Pancreáticas/diagnóstico por imagenAsunto(s)
Neoplasias Esofágicas/patología , Carcinoma de Células Escamosas de Esófago/diagnóstico , Metástasis Linfática/diagnóstico , Nódulo de la Hermana María José/secundario , Ombligo/patología , Adulto , Biopsia , Neoplasias Esofágicas/cirugía , Carcinoma de Células Escamosas de Esófago/secundario , Carcinoma de Células Escamosas de Esófago/cirugía , Esofagectomía , Esófago/diagnóstico por imagen , Esófago/patología , Esófago/cirugía , Humanos , Masculino , Tomografía Computarizada por Tomografía de Emisión de Positrones , Nódulo de la Hermana María José/diagnóstico , Ombligo/diagnóstico por imagenAsunto(s)
Cirugía Bariátrica/efectos adversos , Laparoscopía/efectos adversos , Neoplasias Peritoneales/diagnóstico , Nódulo de la Hermana María José/diagnóstico , Neoplasias Gástricas/diagnóstico , Cirugía Bariátrica/instrumentación , Humanos , Laparoscopía/instrumentación , Masculino , Persona de Mediana Edad , Obesidad Mórbida/cirugía , Cuidados Paliativos , Neoplasias Peritoneales/secundario , Nódulo de la Hermana María José/secundario , Estómago/diagnóstico por imagen , Estómago/patología , Estómago/cirugía , Neoplasias Gástricas/etiología , Neoplasias Gástricas/patología , Tomografía Computarizada por Rayos XRESUMEN
Metastatic umbilical tumors from internal malignancy, known as Sister Mary Joseph's Nodule(SMJN), are a relatively rare prognostic sign. An 86-year-old woman with pancreatic body carcinoma underwent distal pancreatectomy for D2 lymph node removal in 20XX. No peritoneal dissemination was found at that time. Postoperative chemotherapy was not administered due to her age. Eighteen months postoperatively, tumor marker values increased and chest computed tomography(CT) revealed a single mass in the left lung. We resected the suspected lung metastasis. Positron emission tomography-CT performed 23 months postoperatively for increased tumor marker values after resection showed a 18F-fluorodeoxyglucose accumulation ofapproximately 4 cm in the umbilicus. The diagnosis by biopsy was umbilical metastasis ofthe pancreatic cancer. No recurrence or other metastases were found, so we performed an umbilical tumor resection and abdominoplasty 24 months postoperatively. No peritoneal dissemination was found in her abdomen and the ascites cytology was negative. The tumor was in the subcutaneous tissue; thus, the possibility of infiltration from the primary site or peritoneal dissemination was low. The tumor marker values decreased after the resection. She was followed-up without postoperative anticancer chemotherapy. However, the tumor marker values increased again, so chemotherapy was initiated. We report a case ofresection of pancreatic cancer and operation for lung and umbilical metastases of pancreatic cancer.
Asunto(s)
Neoplasias Pulmonares , Neoplasias Pancreáticas , Nódulo de la Hermana María José , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Recurrencia Local de Neoplasia , Nódulo de la Hermana María José/secundario , Nódulo de la Hermana María José/cirugía , OmbligoRESUMEN
A 47-year-old woman presented with a hard umbilical nodule that appeared red and was painful. A biopsy of the umbilical nodule revealed adenocarcinoma. As a result of general examinations, the patient was diagnosed with umbilical, hepatic, and ovarian metastases from transverse colon cancer. She was treated with S-1 and oxaliplatin(SOX)plus bevacizumab chemotherapy. After 4 courses of chemotherapy, CT revealed that the primary lesion and umbilical and hepatic metastases had reduced in size. We considered this to be a partial response and thus administered 4 additional courses of SOX plus bevacizumab chemotherapy. Finally, she remained well for 22 months and achieved relatively good prognosis. An umbilical metastasis from an internal malignancy is known as a Sister Mary Joseph's nodule, and it has very poor prognosis. Most studies show that the survival period from the time of diagnosis is within 1 year. However, our case suggests that novel anti-cancer drugs or molecular-targeted agents may improve survival.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Colon Transverso/patología , Neoplasias del Colon/tratamiento farmacológico , Nódulo de la Hermana María José/tratamiento farmacológico , Adenocarcinoma/secundario , Bevacizumab/administración & dosificación , Neoplasias del Colon/patología , Combinación de Medicamentos , Femenino , Humanos , Persona de Mediana Edad , Oxaliplatino/administración & dosificación , Ácido Oxónico/administración & dosificación , Nódulo de la Hermana María José/secundario , Tegafur/administración & dosificaciónRESUMEN
A 76-year-old man was sent to the dermatology department because of a red, sore belly button since 3 weeks. Based on histology, a CT-scan and increased Cancer Antigen 19-9 levels, this was interpreted as a pancreas carcinoma metastasis. This type of metastasis is also called a 'Sister Mary Joseph's nodule'.
Asunto(s)
Neoplasias Pancreáticas/diagnóstico , Nódulo de la Hermana María José/diagnóstico , Ombligo/patología , Anciano , Humanos , Masculino , Dolor/diagnóstico , Dolor/etiología , Neoplasias Pancreáticas/patología , Nódulo de la Hermana María José/secundario , Tomografía Computarizada por Rayos X/métodos , Neoplasias PancreáticasRESUMEN
We present the case of a 72-year-old woman who presented with, to our knowledge, the largest reported Sister Mary Joseph lesion in the literature. Often associated with a poor prognosis, the patient went on to have a wide local excision of the lesion and has made a full recovery 2 years after the nodule initially developed. Histological examination confirmed the presence of underlying endometrial cancer and the patient subsequently underwent a total hysterectomy and bilateral salpingo-oopherectomy.