A Sister Mary Joseph Node

Abstract

A 64 year old man with previous medical history of hypertension and cholelithiasis was admitted to the hospital due to a non-healing umbilical ulcer. The ulcer was first noted one month prior to admission, and continued to increase in size despite the use of antibiotics. Our patient described a constant right upper quadrant abdominal pain and a 20 pound weight loss associated to anorexia, sporadic nausea and dizziness. He also noted several episodes of unquantified fever and chills prior to the admission. He denied increased abdominal girth, pruritus, or mental status changes. He also denied dark urine, pale stools or jaundice. Laboratory data showed evidence of leukocytosis with left shifting, high alkaline phosphatase and normal bilirubin and aminotransferase levels. [figure 1]An abdominal ct scan was performed on arrival showing an advanced gallbladder lesion with associated hepatic invasive changes and metastatic implants throughout the abdominopelvic cavity. Small stones were noticed within the gallbladder and a metastatic node was present at the umbilical region. A percutaneous transhepatic biopsy was performed, revealing a poorly differentiated adenocarcinoma with extensive necrosis. Patient's hospital course was complicated with the presence of deep venous thromboses, with subsequent bleeding after anticoagulation and posterior death less than one month after the diagnosis. Gallbladder cancer (GBC) is a rare but highly fatal malignancy with fewer than 5000 newly diagnosed cases each year in the U.S. In this patient, it was found incidentally, the only suspicious findings for malignancy were the presence of a Sister Mary Joseph node, abdominal pain and weight loss. Although a Sister Mary Joseph node has been mainly associated to gastric cancer, GBC should be considered in the differential diagnosis whenever it is identified. [figure 2]FigureFigure