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.

Nódulo de la hermana María José como presentación inicial de adenocarcinoma pancreático / Sister Mary Joseph's Nodule as Initial Presentation of Pancreatic Adenocarcinoma

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Umbilical metastasis of a pancreatic origin: Sister Mary Joseph's nodule.

An 84-year-old male patient presented with an umbilical mass. Upon examination, he had an umbilical lesion of approx. 2 cm that was nodular and painful on palpation. The abdominal CT showed a soft tissue mass of 20 x 22 mm in the umbilical subcutaneous tissue, associated with inflammatory changes. In addition, a hypodense tumor of 3.6 x 3.6 x 3.8 cm was seen located in the pancreatic tail, infiltrating the splenic hylum. Bloodwork revealed the following: haemoglobin 7.9 mg/dl, platelets: 175 x 100 /µl, prothrombin activity: 81%, INR: 1.13, Ca 19.9: 4289 U / ml, CEA: 4.38 ng / ml. The histopathological study of the umbilical lesion showed an adenocarcinoma with a moderately differentiated primary pancreatic origin, compatible with an umbilical metastasis of pancreatic cancer.

Metástasis umbilical de origen pancreático: nódulo de la hermana María José / Umbilical metastasis of a pancreatic origin: Sister Mary Joseph's nodule

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Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms.

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.

Abdominal tuberculosis with a Pseudo-Sister Mary Joseph nodule mimicking peritoneal carcinomatosis.

A 46-year-old woman presented in severe abdominal pain on a background of 3 months of weight loss and intermittent vomiting. She had visited East Africa 6 months prior but reported no unwell contacts. On examination, she had generalised abdominal tenderness, distension and a painful paraumbilical swelling. CT scanning confirmed small bowel obstruction and revealed widespread peritoneal nodules, lymphadenopathy, ascites and a soft tissue paraumbilical mass. CA-125 tumour marker was elevated. However, transvaginal ultrasound scanning showed normal-appearing ovaries. She underwent a diagnostic laparoscopy for ascitic fluid analysis and biopsy of omental and peritoneal nodules, which revealed a lymphocytic exudate and caseating granulomas, respectively. Interferon-γ release assay and repeated stains for acid-fast bacilli were negative. She was commenced on antituberculous chemotherapy for a presumed diagnosis of abdominal tuberculosis. Positive culture results 2 weeks later confirmed Mycobacterium tuberculosis infection. The patient experienced a complete resolution of symptoms within 6 weeks of treatment.

Sister Mary Joseph's nodule in endometrial cancer: A case report and review of the literature.

Sister Mary Joseph's nodule (SMJN) is an umbilical mass referring to an intraabdominal and/or pelvic tumor's metastasis. SMJN is frequently associated with gynecological malignancies, but only 30 cases of SMJN originated from endometrial cancer have been described in the literature. We reported a case of SMJN detected within the primary diagnosis of endometrial cancer, in which a 1-year vaginal relapse occurs. A robotic single-site total hysterectomy and a bilateral salpingo-oophorectomy were performed to treat the primary tumor, followed by an adjuvant radiotherapy. The SMJN was resected during the surgical procedure. The relapse was treated by a partial colpectomy. No evidence of disease has been observed to date, and an overall survival of 31 months has been achieved. Due to the rare occurrence of an umbilical metastasis from an endometrial carcinoma, SMJN is difficult to recognize in this contest; nevertheless, its diagnosis is becoming increasingly important in relation to the choice of a proper treatment.

Nódulo de la hermana María José y linfoma difuso de células grandes B / Sister Mary Joseph's nodule and diffuse large B-cell lymphoma

Se describe el caso de un varón de 38 años que consultó por distensión abdominal, saciedad precoz y pérdida de 7kg de peso de 2 meses de evolución. Presentaba una masa pétrea abdominal y una tumoración umbilical de 3cm que había aumentado de tamaño en las semanas previas. En la analítica destacaba elevación de lactato deshidrogenasa y beta-2 microglobulina, así como hipogammaglobulinemia. Se realizó una tomografía computarizada abdominal, en la cual se observó un gran tumor retroperitoneal que englobaba el riñón izquierdo y desplazaba la aorta, esplenomegalia, afectación peritoneal, adenopatías mesentéricas y un nódulo umbilical. El diagnóstico anatomopatológico fue de linfoma no Hodgkin de células grandes B inmunofenotipo centro germinal (según algoritmo de Hans). Las metástasis umbilicales, también denominadas «nódulo de la hermana María José», son infrecuentes, generalmente asociadas a neoplasias gastrointestinales y ginecológicas diseminadas. Solo se han descrito unos pocos casos en linfomas, asociados en general a mejor pronóstico (AU)

A 38-year-old patient presented with abdominal distention, anorexia and a weight loss of 7kg over the previous two months. Physical examination revealed a solid abdominal mass and a 3cm umbilical nodule. He had raised lactate dehydrogenase and beta-2 microglobulin levels, as well as hypogammaglobulinemia. An abdominal CT showed a solid retroperitoneal mass invading the left kidney and displacing the aorta, splenomegaly and an umbilical nodule. Histopathology revealed a diffuse large b cell lymphoma germinal center type. Umbilical metastases, also known as Sister Mary Joseph's nodule, are uncommon and usually associated with disseminated gastrointestinal and gynecological malignancies; indeed only a few cases of lymphomas with this presentation have been reported, most of which have a much better prognosis (AU)