Unusual Presentation of Appendiceal Adenocarcinoma: Report of a Case

Abstract

Sister Mary Joseph's nodule, which can present as the first sign of internal malignancies, is a rare form of cutaneous umbilical metastases and usually carries a poor prognosis. A case of Sister Mary Joseph’s nodule caused by primary appendiceal adenocarcinoma is presented. A 51-year-old female patient was with umbilical discharge for one month. No other gastrointestinal symptoms was noted. Physical examination revealed a hard, non-tender umbilical nodule with skin discoloration and mucus-like discharge. Histopathologic examination of the umbilical biopsy specimen revealed a mucin-producing, well-differentiated adenocarcinoma. The primary lesion proved to be appendiceal adenocarcinoma with invasion to right adnexa and uterus via further image study and exploratory laparotomy. To the best of our knowledge, the case we present is the first reported appendiceal adenocarcinoma with umbilical metastasis. The authors emphasize the need for careful evaluation of any umbilical lesions and the importance of histologic diagnosis when the origin of the diseases is undetermined.