Sister Mary Joseph nodule associated with pancreatic adenocarcinoma

Abstract

A 64-year-old man presented with a 1-month history of painless nodule on the umbilicus (Fig. 1A). He had no history of abdominal pain, poor appetite, bowel habit change, or body weight loss. The skin biopsy of the umbilical nodule revealed dermal infiltration of tubuloglandular neoplastic cells, which were stained strongly positive for cytokeratin 7 and weakly positive for cytokeratin 20. All laboratory test results were within normal ranges, except a remarkable elevation in the tumor marker CA19-9 level of 12000 U/mL (normal: 37 U/mL). The abdominal computed tomography confirmed a 3.8 cm mass at the pancreatic tail (Fig. 1B, arrow), with pancreatic duct dilatation, multiple foci of liver metastasis, and peritoneal carcinomatosis. Gastrointestinal endoscopy, chest X-ray, and whole-body bone scan showed negative results for tumor surveillance. Under the diagnosis of pancreatic adenocarcinoma with multiple metastases, the patient was transferred to the oncology department for chemotherapy. Cutaneous metastases from an internal malignancy have been reported in 0.7e10.4% of patients. Sister Mary Joseph nodule (SMJN) is a cutaneous nodule resulting from metastasis of malignant tumors affecting the umbilicus. SMJN is commonly associated with a primary adenocarcinoma of the gastrointestinal or genitourinary tract. Umbilical involvement in an internal malignancy may result from lymphatic or hematogenous spread, direct invasion into the