Sister Mary Joseph's nodule as a presenting sign of internal malignancy

Multiple Cutaneous Metastases as Initial Presentation in Advanced Colon Cancer

Skin metastases from advanced colorectal cancer are relatively rare and occur most often when the cancer is advanced, following the spread to other organs. Cutaneous metastases occur in about 3% of advanced colorectal cancers. We present an extremely rare case of a 68-year-old woman with advanced ascending colon adenocarcinoma that presented with multiple rapidly progressing painless cutaneous metastatic lesions with no other distant metastases. Of all the tumors, breast cancer most commonly spreads as cutaneous metastasis is followed by lung, colorectal, renal, ovarian, and bladder cancers. Cutaneous metastases can present in a variety of clinical manifestations, such as a rapidly growing painless dermal or subcutaneous nodule with intact overlying epidermis or as ulcers. In cases where the cutaneous deposit is isolated, as in visceral metastasis, there is a role for radical management such as wide local excision and reconstruction. In our patient, since she had multiple cutaneous metastases she began treatment with palliative systemic combination chemotherapy.

Sister Mary Jospeh's nodule as initial presentation of carcinoma caecum-case report and literature review

Umbilical metastases [Sister Mary Joseph's nodules (SMJN)] are relatively rare and are associated usually with advanced intra-abdominal tumors from the gastrointestinal tract (GIT) or from the gynecological malignancies and they carry poor prognosis. Here we report a case of carcinoma caecum whose initial presentation was with umbilical metastases and a review of literature in relation to the umbilical metastases from colonic tumors.

Sister Mary Joseph's nodule in a patient with metastatic small cell lung cancer

We present a case of 56-year-old male with small cell carcinoma of the lung with metastatic tumor nodule of the umbilicus. To our knowledge, this is only the second reported case of small cell lung cancer associated with Sister Mary Joseph's nodule.

Sister Mary Joseph's nodule

BACKGROUND

Sister Mary Joseph's nodule (SMJN) represents an unusual clinical feature of metastatic deposit at the umbilicus originating from an intra-abdominal malignancy.

OBJECTIVE

To outline the paucity of such a condition, review the associated pathologies, and demonstrate the importance of clinical and histopathologic correlation.

METHODS

Case report of a 75-year-old man with vesical and prostatic cancers treated 2 years prior to presenting with an umbilical lesion. Histopathologic and radiologic examinations were performed to confirm the clinical diagnosis.

RESULTS

Histopathology of the umbilical biopsy revealed a carcinoma of urothelial origin, but immunohistochemistry suggested a squamous cell carcinoma. Clinically, the lesion did not support a diagnosis of primary squamous cell carcinoma; in addition, the positron emission tomographic scan revealed a captation at the ureterovesical junction that was compatible with vesical cancer relapse.

CONCLUSION

SMJN is a rare but typical cutaneous metastasis of internal malignancy, and its recognition is of great importance because it may be the first presenting sign in a patient with an unknown malignant disease.

Umbilical complications of malignancy

INTRODUCTION

Cancer patients may manifest a variety of intraabdominal complications occurring during various phases of their illness; however, little in the literature exists regarding umbilical abnormalities in this population.

DISCUSSION

Umbilical metastases (Sister Mary Joseph's sign) are the most common malignant complication involving the umbilicus and may be the presenting manifestation of visceral malignancy. Cancer patients may occasionally experience periumbilical ecchymosis (Cullen's sign), infection, hernia, or varices, each of which may require therapy. This review succinctly presents several umbilical complications that the clinician may encounter in patients with malignant disease.