Dedifferentiated umbilical metastases from low grade endometrioid endometrial adenocarcinoma complicated by super-obesity: A case report

INTRODUCTION

Umbilical metastases are uncommon and rarely associated with endometrial cancer. In this report we describe a unique case of a patient with low-grade endometrioid adenocarcinoma (EAC) who developed an umbilical metastasis containing dedifferentiated endometrial carcinoma, in the context of super-morbid obesity with a body mass index (BMI) of 80 kg/m².

PRESENTATION OF CASE

A 55-year-old female with atypical endometrial hyperplasia was treated with progestogens whilst attempting weight loss prior to definitive surgery, given the impact of her obesity on surgical risk. She progressed to grade 1 EAC of the uterus and then to metastatic disease in the umbilicus and inguinal lymph nodes. After adequate weight loss, cytoreductive surgery was completed via robotic hysterectomy and bilateral salpingoophorectomy (BSO) and resection of metastatic disease. Differing histological grades were seen across all disease sites with dedifferentiated endometrial carcinoma at the umbilicus. Immunohistochemistry suggested a common uterine origin due to loss of MLH1 and PMS2 proteins.

DISCUSSION

There are no clear management pathways for the rare umbilical metastases related to endometrial cancer. Our patient's significant obesity complicated their clinical course and highlights the risks of progestogen therapy whilst attempting weight loss prior to definitive surgery for low-grade EAC. Differing grades of disease across metastatic sites in EAC is rare and may reflect the recently recognized intratumoral genetic heterogeneity in endometrial cancers.

CONCLUSION

Management of umbilical metastases should be individualized to patient factors and local resources. More research is needed into pathways of care for women with low grade EAC with obesity preventing routine surgical management.

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 in endometrial carcinoma: A case report

BACKGROUND

Sister Mary Joseph’s nodule (SMJN) is rare and may occur independently or simultaneously with malignant tumors in the abdominal cavity. It has a poor prognosis. Endometrial carcinoma is the most common malignant tumor in the upper segment of the female reproductive tract; however, it rarely occurs with SMJN. We here report a case of endometrial carcinoma with SMJN.

CASE SUMMARY

A 75-year-old woman was diagnosed with endometrial cancer > 2 years ago. After multiple cycles of chemotherapy, an obvious but painless umbilical mass was detected 2 wk before admission. The patient did not undergo surgical treatment but received chemotherapy, which was different from previous chemotherapy, for three consecutive cycles after discovery of umbilical metastases. Currently, the umbilical metastatic tumor has reduced, and the quality of life of the patient has significantly improved.

CONCLUSION

Once the umbilical mass is found, the possibility of SMJN should be considered. We should also take into account the poor prognosis of endometrial carcinoma complicated with umbilical metastasis, especially in patients with advanced tumors, and it is important to choose an appropriate treatment.

Umbilical metastasis mimicking symptomatic hernia: Report of a case of Sister Mary Joseph Syndrome

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Underline the possibility that a complicated umbilical hernia can be a metastasis.

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All complicated umbilical hernia in THE adult population should represent a suspicion of advanced metastatic neoplasm.

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An umbilical biopsy and abdomen CT SCAN should be mandatory in all case of complicated umbilical hernia in THE adult population.

Introduction

An umbilical mass can be the first symptom of an intra-abdominal neoplasia, and this condition is also defined as Sister Mary Joseph Syndrome.

Case presentation

An eighty-year-old patient presented with a complicated umbilical hernia. CT scan abdomen revealed a pancreatic neoplasm and an umbilical biopsy confirmed diagnosis of metastasis. Patient started chemotherapy by Oncologists.

Conclusions

In this paper the Authors suggest a histopathological evaluation of umbilical fat in all cases of newly emerging umbilical hernia in the adult population.

Primary peritoneal carcinoma presenting as a Sister Mary Joseph's nodule: A case report and review of the literature

Sister Mary Joseph's nodule is sometimes the first sign of an internal malignancy, including gastrointestinal, gynecological, or malignancy of unknown primary. It is rarely the sole presentation of a primary peritoneal cancer. In this report, we present the case of a 70-year-old female with umbilical drainage and a computed tomography scan consistent with solitary umbilical nodule. Excision of the nodule revealed adenocarcinoma of likely müllerian origin. Surgical staging did not show any evidence of malignancy with the exception of pelvic washings. She was considered to have primary peritoneal adenocarcinoma and was treated with adjuvant chemotherapy.

Umbilical metastasis as primary manifestation of cancer: a small series and review of the literature

Umbilical metastasis is a rare manifestation of intra-abdominal cancer. It appears either as the first sign of a primary malignancy or as metastatic site of an already diagnosed cancer, representing an ominous prognostic finding. We report three cases of umbilical metastasis as the first sign of an underlying malignancy. Hypotheses about pathophysiology of umbilical metastasis are based on the embryological origin of the umbilicus and its residual communication with systematic, portal and lymphatic circulation.

Sister Mary Joseph's nodule from rectal cancer: A case report

Umbilical metastasis of malignant tumor is seldom reported worldwide and it is more rarely in colorectal cancer. This paper reported a case of umbilical metastasis from a rectal carcinoma postoperatively. We discussed possible mechanism and prognosis in patients with umbilical metastasis and introduced a view that the interaction of tumor cells and microenvironment determines the destination of tumor metastasis. We think that further research in tumor micrometastases and tumor microenvironment may discover new mechanism of umbilical metastasis from malignant tumor.

Malignant peritoneal mesothelioma presenting umbilical hernia and Sister Mary Joseph’s nodule

Malignant peritoneal mesothelioma is a rare aggressive tumor of the peritoneum. An increasing number of malignant mesothelioma cases have been reported in recent years. We report here a very rare case of malignant peritoneal mesothelioma with both umbilical hernia and umbilical metastasis which is also called Sister Mary Joseph’s nodule. We performed laparoscopy which showed specific laparoscopic findings, and the pathological findings of the biopsy specimen led to the diagnosis. This case was associated with umbilical hernia which could be induced by massive ascites. A newly developed abdominal hernia should be noted as a primary symptom of malignant peritoneal mesothelioma, as shown in the present case.

Sister Mary Joseph’s nodule as a first sign of pancreatic cancer

Sister Mary Joseph’s nodule (SMJN) refers to a metastatic tumor of the umbilicus. It is a rare entity which arises from a malignancy in the intra-abdominal cavity. We herein describe a patient who presented with SMJN as his first sign of pancreatic cancer. It is an even more unusual case of SMJN. We therefore, suggest that pancreatic cancer should be included in the differential diagnosis when an umbilical mass is found. With the progress made in surgical procedures and other modalities, an early diagnosis will dramatically improve the prognosis of the patients.