Sister Mary Joseph Nodule and Concomitant Pancreatitis as Initial Presentation of Pancreatic Adenocarcinoma – Case Report and Review of the Literature

Murali Dharan,Courtenay Ryan-Fisher

doi:10.7759/cureus.20069

Abstract

Umbilical metastasis [Sister Mary Joseph Nodule (SMJN)] is a rare presentation of visceral abdominal/pelvic malignancy. It is less commonly seen in metastatic pancreatic adenocarcinoma and there are only over a hundred cases to date in the literature on this topic. This article highlights a case of metastatic pancreatic adenocarcinoma presenting as SMJN and concomitant pancreatitis (which to the best of our knowledge is the first such report to date) with discussions regarding the etiopathogenesis of this phenomenon and presents a brief literature review on pancreatic adenocarcinoma presenting as SMJN.

Highlights

We present a case of a patient presenting with a refractory umbilical rash and generalized abdominal pain
Histopathologic results were consistent with metastatic pancreatic adenocarcinoma presenting at Sister Mary Joseph's nodule (SMJN) and concomitant pancreatitis
In a case series reported by Yendluri et al [11], over 90% of pancreatic cancers associated with SMJN arose from the pancreatic body and tail

Summary

Introduction

We present a case of a patient presenting with a refractory umbilical rash and generalized abdominal pain. Further evaluation revealed elevated lipase, an umbilical nodule, and a large pancreatic cyst on crosssectional imaging. Histopathologic results were consistent with metastatic pancreatic adenocarcinoma presenting at Sister Mary Joseph's nodule (SMJN) and concomitant pancreatitis (this is the first such report to date). A 71-year-old female without any significant past medical history presented with two weeks of nausea, generalized abdominal pain, and a peri-umbilical rash. Core needle biopsy of the umbilical mass revealed malignant cells and immunohistochemistry (IHC) was consistent with pancreatic adenocarcinoma (Figure 4). How to cite this article Dharan M, Ryan-Fisher C (December 01, 2021) Sister Mary Joseph Nodule and Concomitant Pancreatitis as Initial Presentation of Pancreatic Adenocarcinoma – Case Report and Review of the Literature. Immunohistochemistry (IHC) positive for pankeratin, CK 7, CA 19-9, CEA, CDX2, CK 19 and negative for CK 20, TTF-1, Napsin A, PAX8

Discussion

Conclusions

Disclosures

Findings

Galvañ VG

Varani J