[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.

[A Case of Cecal Cancer Diagnosed from Sister Mary Joseph's Nodule].

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.

[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.

[Successful Conversion Surgery for Pancreatic Cancer with Sister Mary Joseph's Nodule-A Case Report].

A 66-year-old female with upper abdominal pain was diagnosed the pancreatic tail cancer infiltrating into the stomach and transverse colon by computed tomography(CT). Umbilical metastasis(so called Sister Mary Joseph's nodule)and peritoneal metastases in pouch of Douglas were detected by FDG-PET. The patient was diagnosed as unresectable pancreatic cancer with distant metastases. Thus, she received FOLFIRINOX therapy. After 9 courses of FOLFIRINOX therapy and 15 courses of FOLFIRI therapy, the pancreatic tumor shrunk on CT. In addition, umbilical metastasis and peritoneal metastases disappeared on FDG-PET. Therefore, conversion surgery was scheduled. Fourteen months after the initial treatment, we performed distal pancreatectomy with left adrenalectomy partial gastrectomy, transverse colectomy, and umbilical resection. The patient was discharged 15 days after the operation without serious complications. Histopathological findings revealed the presence of adenocarcinoma infiltrating into the preperitoneal adipose tissue in the umbilicus. Histological therapeutic effect was Grade Ⅰb according to the 7th Edition of the General Rules for the Study of Pancreatic Cancer. Seven months after the operation, local recurrence was showed. The patient is still alive 2 years and 5 months since the initial treatment.

A long-term survival case of Sister Mary Joseph's nodule caused by colon cancer and treated with a multidisciplinary approach.

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.

Sister Mary Joseph nodule: an unusual site for endometrioid cancer metastasis.

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.

[A Surgically Resected Case of Lung Metastases and Sister Mary Joseph's Nodule 24 Months after Operation for Pancreatic Cancer].

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.

Sister Mary Joseph nodule: a diagnostic challenge.

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.

[A Case of Sister Mary Joseph's Nodule from Multiple Colon Cancers].

A 94-year-old woman, who had been treated for multiple colon cancers 4 years ago, complained of umbilicus induration and had been followed up in a previous hospital with a diagnosis of periumbilical inflammation. Four years and 3 months postoperatively, the umbilical induration was enlarged, and umbilical metastasis of adenocarcinoma was diagnosed on biopsy. Umbilical resection was performed, and multiple peritoneal metastases were revealed. Umbilical metastases may worsen the patient's quality of life; thus, local resection was recommended positively.

[Gastric Cancer Diagnosed with Metastasis of the Navel(Sister Mary Joseph's Nodule) - A Case Report].

A woman in her 60s was admitted to our hospital with pain and induration of the navel. She was diagnosed with gastric cancer with metastasis to the navel and underwent total gastrectomy and navel extraction. Because disseminated nodules were detected in the Douglas pouch and sigmoid colon, sigmoidectomy was performed to prevent bowel obstruction. The navel tumor was histologically diagnosed as a metastasis of the gastric cancer. One month after surgery, a chest skin tumor, which was also a skin metastasis of the gastric cancer[T4aN3M1(SKI, OTH)H0P1, fStage IV ], was detected, and tumor enucleation was performed. Enucleation was followed by 47 courses of systemic chemotherapy consisting of capecitabine, cisplatin, and trastuzumab. No recurrence or metastasis has been observed via FDG-PET/CT as of 5 years after surgery. Gastric cancer with peritoneal dissemination in addition to navel metastasis has been reported to have an extremely poor prognosis. However, long-term, recurrence-free survival was obtained in this case owing to aggressive surgical resection, followed by persistent systemic chemotherapy.

Umbilical metastasis derived from early stage rectal cancer: a case report.

BACKGROUND: Umbilical metastasis, also called Sister Mary Joseph's nodule (SMJN), is defined as the umbilical nodule associated with advanced metastatic intra-abdominal and pelvic malignancies. A patient with umbilical metastasis has been deemed to have a poor prognosis. Rectal cancer presenting with a SMJN is a rare phenomenon, especially in the early stage and in middle-low rectal cancer. CASE PRESENTATION: We report a case of a 70-year-old male presenting with umbilical metastasis derived from rectal cancer (10 cm from the anal verge, T2N0). DISCUSSION AND CONCLUSION: For rectal cancer with umbilical metastasis, the exact metastatic routes as well as the criterion of diagnosis and treatments are not very clear. Here we review the literature on rectal cancer and SMJN to deepen the understanding of this disease.

Nódulo de la hermana María José y cáncer de páncreas / The Sister Mary Joseph nodule and cancer of the pancreas

Con el epónimo «nódulo de la hermana María José» nos estamos refiriendo a la presencia de una lesión umbilical, generalmente de larga evolución, y que en realidad representa una metástasis cutánea umbilical ya que se relaciona habitualmente con una neoplasia intraabdominal. La hermana María José (instrumentista de los hermanos Mayo y nacida en Rochester, EE. UU., en 1856) fue la primera persona en llamar la atención de la presencia de un nódulo paraumbilical que, a menudo, era la única señal de la existencia de un cáncer intraabdominal de carácter maligno. En 1949, Hamilton Bailey, en su décima primera edición de su manual titulado Physical Signs in Clinical Surgery, publicado en 1949, fue quien utilizó por vez primera el epónimo. Se presenta el caso de un paciente visto en el equipo de atención primaria (EAP) que presentaba lesión umbilical indicativa del nódulo de la hermana María José y que representaba la primera manifestación de un adenocarcinoma de páncreas (AU)

The eponymous “Sister Mary Joseph Nodule” refers to a palpable nodule bulging into the umbilicus, usually of long term onset, as a result of dermal umbilical metastasis of a malignant intra-abdominal cancer. Sister Mary Joseph was born in Rochester/USA in 1856, and she was the surgical assistant of the Mayo brothers. She drew attention to the nodule, which was sometimes the only sign of a malignant intra-abdominal neoplasm. The eponym was coined by Hamilton Bailey in Physical Signs in Clinical Surgery, 11th Edition, published in 1949. We present a patient from our clinic with an umbilical mass suggestive of a Sister Mary Joseph nodule, as the first sign of pancreatic adenocarcinoma (AU)

Carcinoma of the right side colon accompanied by Sister Mary Joseph's nodule and inguinal nodal metastases: a case report and literature review.

Umbilical metastases from intraperitoneal malignancies are universally referred to Sister Mary Joseph's nodule (SMJN). The most frequent primary tumor sites include the stomach and ovaries. SMJN caused by colon cancer is uncommon. Likewise, carcinoma of the right side colon metastasizing to inguinal lymph nodes is considered almost impossible. To the best of our knowledge, there is no report of right side colon cancer synchronously involving both the umbilicus and inguinal lymph nodes in the literature. We present a case of right side colon cancer (RSCC) metastasizing to the umbilicus and inguinal lymph nodes, which was confirmed by routine pathological evaluation and immuohistochemistry.