[Surgical Resection as Local Therapy for Sister Mary Joseph's Nodule Due to Pancreatic Tail Cancer].

We experienced a case of resection of a metastatic umbilical tumor(Sister Mary Joseph's nodule: SMJN)derived from a pancreatic tail carcinoma. The patient was a 70-year-old woman. She visited her previous doctor with a chief complaint of lower abdominal pain and came to our hospital due to suspicion of pancreatic tail cancer. She was found to have metastases to multiple organs which was unresectable by surgery. After chemotherapy up to the second-line of treatment, she was diagnosed to have progressive disease. The decision was made to provide the best supportive care for the patient. Thereafter, the patient developed SMJN. She had hemorrhage from the tumor accompanied by body movement, and her activity of daily living became impaired. She had difficulty controlling the bleeding despite repeated hemostatic treatment at the outpatient clinic and at her home. However, she required frequent blood transfusions for her severe anemia. Therefore, we performed a resection of the SMJN to control bleeding and to relieve her symptoms. She had a good postoperative course and was discharged on the fifth postoperative day. Due to deterioration of her general condition, she expired on the 59th day after surgery. However, the patient was able to live at home without bleeding or pain by the umbilical tumor. The local resection was considered to be useful as a palliative surgical treatment for SMJN.

Umbilical nodule - A not always innocuous abdominal finding.

ABSTRACT: Sister Mary Joseph's nodule is an umbilical nodule found in patients with metastatic abdominal cancers. It is quite rare finding and needs a high index of suspicion for diagnosis. Detection of Sister Mary Joseph's nodule should warrant widespread search for abdominal carcinoma and it universally carries quite poor clinical prognosis. Here, we describe the case of a 28-year-old patient who presented with Sister Mary Joseph's Nodule and was found to have metastatic signet ring cell gastric carcinoma on investigation. A brief discussion about this rare condition is also presented.

[Peritoneal Mesothelioma Diagnosed with a Sister Mary Joseph's Nodule].

In August 2022, a 59-year-old female noted a mass in her umbilicus and sought evaluation at Toyokawa City Hospital. Abdominal computed tomography(CT)scan revealed a 1.6 cm mass in the umbilical region, ascites in the pelvis, and increased absorption in the omentum. Peritoneal dissemination of the carcinoma and Sister Mary Joseph's nodule due to an unknown primary tumor were suspected because no abnormalities were detected during upper and lower gastrointestinal endoscopy. She underwent an umbilical lumpectomy and diagnostic laparoscopy to establish a definitive diagnosis. The surgical findings included numerous white nodules throughout the abdominal cavity. The umbilical mass and omental white nodules were resected. A final diagnosis of epithelial peritoneal mesothelioma was made based on the histopathologic examination. In general, peritoneal mesothelioma has a poor prognosis, and early treatment is essential; however, making a timely definitive diagnosis is difficult. Peritoneal mesothelioma should be included in the differential diagnosis for a patient with unexplained ascites and abdominal pain. Diagnostic laparoscopy and biopsy will facilitate the establishment of a definitive diagnosis.

Colonic mucinous adenocarcinoma in a pregnant woman presented as pseudo Sister Mary Joseph's nodule: A case report.

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.

[A woman with a bleeding umbilical nodule]. / Een vrouw met een bloedende navel.

A 39-year-old woman was referred to the Dermatology outpatient clinic with a bleeding umbilical nodule. A Sister Mary Joseph's nodule - an ominous sign of periumbilical cutaneous metasasis - was in the differential diagnosis. However, punch biopsy of the nodule revealed cutaneous endometriosis.

Sister Mary Joseph nodule: an often overlooked or misdiagnosed entity on imaging.

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.

Sister Mary Joseph's nodule: the tip of an iceberg.

Sister Mary Joseph's nodule is a rare palpable umbilical cutaneous lesion as a result of an advanced intra-abdominal and/or pelvic malignancy. It may be the initial clinical manifestation of an underlying malignancy, originating mainly from the gastro-digestive or genito-urinary tract. We present here a rare case of a 67-year-old woman with a Sister Mary Joseph's nodule. On surgical exploration, a left ovarian mass with anterior abdominal wall metastasis, ascites and extensive intra-abdominal metastatic lesions were observed. Our case report shows the importance of a careful physical examination as an invaluable diagnostic tool in modern medicine. High index of suspicion and awareness of this clinical sign may lead to the detection of the primary source, to its diagnosis and more appropriate treatment options in order to achieve the best survival possibility. KEY WORDS: Ovarian cancer, Sister Mary Joseph's nodule, Umbilical metastasis.