Pseudo Sister Mary Joseph's nodule

Sister Mary Joseph's Nodule: Where Umbilicus Holds the Truth!

An umbilical metastasis from an internal visceral malignancy is defined as Sister Mary Joseph's nodule (SMJN), and, although a rare finding, it is a very poor prognostic indicator. We describe an interesting case of metastatic colon cancer with SMJN, emphasizing the significance of this classic finding. A 64-year-old female with a history of stage IV colon cancer with palliative right hemicolectomy and left hepatectomy presented to the hospital with nausea and abdominal discomfort. A computed tomography (CT) scan of the abdomen was performed, which showed small bowel obstruction secondary to metastatic tumor mass compressing the duodenum. She refused to undergo any chemotherapy or endoscopic intervention and was eventually discharged on hospice care. During the hospital stay an umbilical ulcerative lesion was also noted, which was violaceous, measuring 4.5 x 4 cm in size, firm in consistency with irregular borders, and tender to touch. Therefore, further history was obtained from the patient about it. Several months ago, she had developed localized swelling around the umbilicus, which gradually enlarged and ulcerated later. She eventually underwent the biopsy of that umbilical lesion, which confirmed it as SMJN with metastasis from the colonic primary. However, the patient refrained from the surgical intervention of the umbilical lesion. SMJN presents as a palpable periumbilical metastatic mass with diameter usually not exceeding 5 cm in size. It can be variable in color from violaceous to reddish brown. Once discovered, such lesions should be worked up with biopsy and imaging studies such as CT scan of the abdomen, as the nodule may be indicative of underlying malignancy or cancer recurrence. Its presence indicates a poor prognosis, with average survival time after diagnosis of SMJN of 10 months.

Calcified Sister Mary Joseph nodule as the presenting complaint of advanced low-grade serous ovarian cancer

A healthy 38-year-old woman presented with a hard umbilical mass that has been growing for a few months in duration with no other significant symptoms and signs. Computed tomography images identified a lobulated densely calcified umbilical mass, left ovarian cysts, a subcentimeter calcified omental nodule, and nonspecific punctate pelvic calcifications. Histopathology of the mass revealed low-grade serous carcinoma with postsurgical diagnosis of International Federation of Gynecology and Obstetrics (FIGO) stage IV ovarian cancer. This case presentation emphasizes the importance of increased awareness of interpreting radiologists of a seemingly benign appearing imaging finding such as umbilical calcification on CT as a sign of intra-abdominal/pelvic malignancies.

Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imagıng in Pseudo Sister Mary Joseph's Nodule

Sister Mary Joseph's nodule (SMJN) refers to umbilical metastatic lesions and indicates widespread intra-abdominal malignancy. The most common primary sites are gastrointestinal and genital tract. Benign umbilical nodules are called pseudo-SMJN (PSMJN) and have been also reported in nonmalignant lesions such as endometriosis, fibroma, papillomas, myxoma, keloid, omphalith, nevi, foreign-body granulomas, and epidermoid cysts. We report a case with PSMJN as an extremely rare manifestation of intra-abdominal tuberculosis.

Sister Mary Joseph's nodule at a University teaching hospital in northwestern Tanzania: a retrospective review of 34 cases

BACKGROUND

Sister Mary Joseph's nodule is a metastatic tumor deposit in the umbilicus and often represents advanced intra-abdominal malignancy with dismal prognosis. There is a paucity of published data on this subject in our setting. This study was conducted to describe the clinicopathological presentation and treatment outcome of this condition in our environment and highlight challenges associated with the care of these patients, and to proffer solutions for improved outcome.

METHODS

This was a retrospective study of histologically confirmed cases of Sister Mary Joseph's nodule seen at Bugando Medical Centre between March 2003 and February 2013. Data collected were analyzed using descriptive statistics.

RESULTS

A total of 34 patients were enrolled in the study. Males outnumbered females by a ratio of 1.4:1. The vast majority of patients (70.6%) presented with large umbilical nodule > 2 cm in size. The stomach (41.1%) was the most common location of the primary tumor. Adenocarcinoma (88.2%) was the most frequent histopathological type. Most of the primary tumors (52.9%) were poorly differentiated. As the disease was advanced and metastatic in all patients, only palliative therapy was offered. Out of 34 patients, 11 patients died in the hospital giving a mortality rate of 32.4%. Patients were followed up for 24 months. At the end of the follow-up period, 14(60.9%) patients were lost to follow-up and the remaining 9 (39.1%) patients died. Patients survived for a median period of 28 weeks (range, 2 to 64 weeks). The nodule recurred in 6 (26.1%) patients after complete excision.

CONCLUSION

Sister Mary Joseph's nodule of the umbilicus is not rare in our environment and often represents manifestation of a variety of advanced intra-abdominal malignancies. The majority of the patients present at a late stage and many with distant metastases. The patient's survival is very short leading to a poor outcome. Early detection of primary cancer at an early stage may improve the prognosis.

Lesions of the umbilicus: what the minimally invasive gynecologic surgeon needs to know about the belly button

The umbilicus is viewed as a portal by the laparoscopic surgeon, a doorway to the real business at hand. However, the umbilicus itself may be the site of a variety of lesional conditions. Some of these may be iatrogenic, caused by prior surgical interventions, such as endometriosis or seeding of a malignant neoplasm. Some may be the initial presenting complaint. This review discusses umbilical lesions that may be encountered by the minimally invasive gynecologic surgeon.

Sonographic findings of Sister Mary Joseph's nodule from ovarian cancer

Sister Mary Joseph's nodule (SMJN), which is known as a malignant tumor metastasized to the umbilicus, is a rare condition. We report ultrasonic findings of SMJN secondary to ovarian cancer in a 66-year-old woman. The umbilical tumor was observed as a hypoechoic mass with punctate hyperechoic foci. A pathological specimen obtained by needle biopsy confirmed adenocarcinoma with psammoma bodies. A comparison of the ultrasonographic findings with the pathological findings of the resected specimen suggested that the hyperechoic foci corresponded to psammoma bodies. When hyperechoic foci are observed inside SMJN by ultrasonography, adenocarcinoma from ovarian cancer should be included in the differential diagnosis.

Umbilical concretion

Umbilical concretion is a rarely encountered benign entity. Concretions typically form within an umbilical cleft which is unusually deep and consist of keratinaceous and sebaceous material. Lack of attention to umbilical hygiene usually plays a role in their formation. Concretions are generally asymptomatic and may only present clinically when complicated by inflammation or infection. Their appearance on imaging studies may be problematic for the radiologist given their rarity, particularly in the setting of a known or suspected intra-abdominal malignancy.

Her-2/neu evaluation in Sister Mary Joseph's nodule from breast carcinoma: a case report and review of the literature

Sister Mary Joseph's nodule (SMJN) involving the umbilicus can often be a clinical sign of metastatic cancer, but rarely cancer originating from the breast. We report a rare case of umbilical metastases from breast cancer and reviewed the literature. A 54-year-old woman was referred to a pre-surgery clinic for an examination of an umbilical nodule. The patient had a history of ductal breast carcinoma. Cytological smear from fine needle aspiration showed epithelial neoplastic cells resembling those of breast carcinoma. Neoplastic cells from tissue were positive for cytokeratin 8-18, estrogen and progesterone receptor and negative for E-cadherin and had a low proliferative index. Her-2/neu immunodetection showed a 2+ equivocal positive rate, but Her-2/neu gene amplification was found on the cytological smear by fluorescence in situ hybridization analysis. Similar results were obtained within a tissue section. Concordant findings have been obtained when comparing the recent American Society of Clinical Oncology/College of American Pathologists scoring system. Fine needle aspiration from the SMJN is a useful tool for the diagnosis of metastatic breast cancer. Furthermore, the predictive biomarkers for tumors of the breast, hormonal receptors and Her-2/neu not only assist with the identification of the source of the metastatic disease but also provide clinical information for patient management.

Terra Firma forme dermatosis. Case series and review of the literature

Terra Firma forme dermatosis (TFFD) is an infrequently described disorder which features dirt-like lesions that clear after rubbing with alcohol. We describe a series of four patients with the disorder, discuss differential diagnostic considerations and review the literature.

Laparoscopic scar: A mimicker of Sister Mary Joseph's nodule on positron emission tomography/CT

Positron emission tomography/CT is an established imaging method in the diagnosis and staging of cancers. (18)F-fluoro-2-deoxy-d-glucose (FDG) is the most commonly used radiotracer in positron emission tomography/CT. It is a tumour viability agent and usually its uptake within a lesion reflects the presence of a viable tumour tissue. However, false-positive FDG uptake is known to occur in benign processes of either inflammatory or infectious aetiology. We describe FDG uptake at the site of laparoscopic scar that mimicked Sister Mary Joseph's nodule in a patient with gastric adenocarcinoma. Here, the knowledge of the patient's history and subtle imaging findings helped in accurate staging of the patient. In this case report, we emphasize the value of the knowledge of the patient history and awareness of different pitfalls of FDG to achieve a correct diagnosis on positron emission tomography/CT.

Case report: MR imaging features of endometriosis at the umbilicus

The radiological features of extrapelvic endometriosis at the umbilicus with large ovarian endometriomas are described. In this patient, the umbilical lesion appears as hypointense on T(1) weighted and T(2) weighted MR images. The MR characteristics of endometriosis at the umbilicus are compared with those found within the pelvis.

Metastatic Tumors of the Umbilicus: Report of Two Cases and Review of the Literature

An umbilical nodule may be an early or late sign of metastatic spread from an internal malignancy. Usually it appears when the internal malignancy is widely disseminated and has been previously diagnosed. More rarely, such a nodule is the first sign of disease and eventually results in the diagnosis of the primary tumor. We present two cases which document examples of both events, in order to focus on the most relevant aspects of this condition.

[Umbilical metastasis (Sister Mary Joseph's nodule) diagnosed by fine-needle aspiration]

Sister Mary Joseph's nodule is the eponym for metastatic involvement of the umbilicus. This less common entity is the sign of disseminated malignant disease, mainly of digestive and gynecologic origin, and is associated with a poor prognosis. A case of Sister Mary Joseph's nodule in a 76-year-old woman in whom the umbilical metastasis was the first sign of malignant disease in presented. The diagnosis of metastatic adenocarcinoma was established by fine needle aspiration cytology of the umbilical nodule. Radiological and ultrasonographic investigation disclosed carcinoma of the gallbladder with pancreas, stomach, and colon invasion as well as peritoneal dissemination. The diagnosis was confirmed by exploratory laparatomy and histological examination of the excised umbilical nodule.

Metastatic islet cell carcinoma to the umbilicus: diagnosis by fine-needle aspiration

Internal malignancies rarely metastasize to the umbilical region. The gastrointestinal tract and female genital tract are the most common primary sites. Although the pancreas is frequently involved, the majority of these metastases are adenocarcinoma. Here, we present a case of umbilical metastasis from an islet cell carcinoma diagnosed by fine-needle aspiration in a young woman 2 yr after distal pancreatectomy. This finding led to further radiological studies and surgical intervention, which revealed intraabdominal tumor spread. Neuroendocrine tumors represent a rare tumor type that can give rise to umbilical metastases. Only two cases of carcinoid tumor metastasizing to the umbilicus have been reported.