Umbilical Metastasis Research Articles

The umblicus says it all

Abstract Introduction/Objective Umbilical nodules can be divided into benign and malignant. Malignant lesions of the umbilicus are very rare. They can arise from primary tumors or secondary to abdominal and pelvic malignancies. Literature review suggests that these umbilical lesions can present as primary tumor in 38% of the cases, endometriosis in 32%, and metastatic lesions in 30%. Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is known as Sister Mary Joseph’s nodule (SMJN). It is a very rare finding and the incidence of SMJN is 1- 3% in people diagnosed with intra-abdominal or pelvic malignancies. Methods/Case Report A 31-year-old male with no past medical history presented to the emergency room with 3 months history of umbilical nodule and 60 pounds weight loss. He experienced early satiety, abdominal pain, nausea and generalized fatigue. CT abdomen showed hepatomegaly with numerous hypoattenuating lesions throughout the liver with peripheral enhancement, and hypoattenuating mass within the pancreatic tail and body measuring approximately 2.1 x 5.8 cm that appears contiguous with hilar splenic lesion. CT chest showed multiple pulmonary metastases with prominent precarinal and subcarinal lymph nodes. Serologic tests revealed elevated Alpha fetoprotein, ALP, ALT, and CA19-9. Patient underwent umbilical nodule core biopsy and right liver core biopsy. Microscopic evaluation of the specimens revealed pancreatic acinic cell carcinoma with two different morphological variants. Umbilical nodule with glandular pattern and liver lesion with trabecular pattern. Immunohistochemical stains were performed with tumor cells positive for CK 7, Trypsin and BCL-10 and negative for Glypican 3, CK 20, AFP and CD56. The prognosis is poor, with an average survival time of about 19 months. After the diagnosis patient underwent chemotherapy. Results (if a Case Study enter NA) NA Conclusion Umbilical nodules can be diagnosed with careful clinical and histopathological evaluation. The prognosis of patients presenting with SMJN is generally poor as it is a sign of advanced malignancy. Sometimes it may be the first and only sign of an internal neoplasm. Therefore, this is an important differential diagnosis to consider.

Ovarian cancer with umbilical metastasis: A case report and literature review

Ovarian cancer with umbilical metastasis is an extremely rare clinical condition. It presents with subtle symptoms and lacks specific clinical manifestations. Early detection and standardized comprehensive treatment can effectively improve patient prognosis.

Sister Mary Joseph Nodule: A Dermatological Insight into Metastatic Pancreatic Cancer

The Sister Mary Joseph (SMJ) nodule is a metastatic umbilical growth observed in primary tumors originating from the gastrointestinal or genitourinary tract. Commonly, SMJ nodules are associated with gastrointestinal cancers, particularly those affecting the stomach and colon. While the pancreas is an uncommon primary site for umbilical metastasis, pancreatic adenocarcinoma that spreads to the umbilicus typically originates from the body or tail of the pancreas. The presence of an SMJ nodule often indicates a poor prognosis, serving as a straightforward physical indicator of advanced intra-abdominal malignancy. Although pancreatic cancer is a rare cause, it should be considered among the primary sites in such cases. This report details a case of an SMJ nodule unveiling pancreatic adenocarcinoma in a 61-year-old patient. The case underscores the significance of examining the umbilicus, an area frequently overlooked but crucial for diagnosis. Vigilant clinical follow-up and histological evaluation are imperative in such cases, highlighting the importance of not underestimating this infrequently assessed region.

Sister Marie-Joseph’s nodule reveals gynaecological cancer

The Sister Mary Joseph nodule is a rare umbilical metastasis of abdominopelvic cancer, easily accessible on clinical examination, and often correlated with a poor prognosis. Its recognition as a secondary lesion allows early diagnosis and treatment.

Sister Marie-Joseph's Nodule Revealing A Pancreatic Adenocarcinoma: About A Case with Review of the Literature

The Sister Marie-Joseph nodule (SMJ) is an umbilical cutaneous metastasis of a cancer of the gastrointestinal tract or of the gynecological sphere [1]. Stomach and colon are the common gastrointestinal cancers associated with the SMJ nodule. The pancreas is a rare primary site of umbilical metastasis [1]. In pancreatic cancer, the Sister Mary Joseph nodule is a sign of advanced disease associated with a poor prognosis [2].

Pancreatic cancer: Cutaneous metastases, clinical descriptors and outcomes.

Cutaneous metastases in pancreatic cancer (PC) are rare. Herein, we evaluate the clinical, genomic, and other descriptors of patients with PC and cutaneous metastases. Institutional databases were queried, and clinical history, demographics, PC cutaneous metastasis details, and overall survival (OS) from cutaneous metastasis diagnosis were abstracted. OS was estimated using Kaplan-Meier methods. Forty patients were identified, and median age (Q1-Q3, IQR) of PC diagnosis was 66.0 (59.3-72.3, 12.9)years. Most patients had Stage IV disease at diagnosis (n= 26, 65%). The most common location of the primary tumor was the tail of the pancreas (n= 17, 43%). The most common cutaneous metastasis site was the abdomen (n= 31, 78%), with umbilical lesions occurring in 74% (n= 23) of abdominal lesions. The median OS (95% CI) was 11.4months (7.0, 20.4). Twenty-three patients had umbilical metastases (58%), and 17 patients had non-umbilical metastases (43%). The median OS (95% CI) was 13.7 (7.0, 28.7) months in patients with umbilical metastases and 8.9 (4.1, Not reached) months in patients with non-umbilical metastases (p= 0.1). Sixteen of 40 (40%) patients underwent somatic testing, and findings were consistent with known profiles. Germline testing in 12 (30%) patients identified pathogenic variants in patients: CHEK2, BRCA1, and ATM. Cutaneous metastases from PC most frequently arise from a pancreas tail primary site and most frequently occur in the umbilicus. Cutaneous metastases may generally be categorized as umbilical or non-umbilical metastases.

Sister Mary Joseph’s Nodule in Pancreatic Adenocarcinoma

Introduction: Dr. Hamilton Bailey coined the term Sister Mary Joseph’s Nodule in 1949 in recognition of Sister Mary Joseph, a nurse and surgical assistant to Dr. William James Mayo. She was the first to recognize the relationship between firm masses at the umbilicus with underlying intra-abdominal and pelvic malignancy. Metastasis to the umbilicus is seen in only 1-3% of abdominopelvic malignancies and is most commonly seen in gastric and gynecologic cancers. Of cancers that metastasize to the umbilicus, 7-9% are of pancreatic origin. Case report: • 68 year old female with past medical history of diabetes mellitus, presented to the Emergency Room with periumbilical hernia. She had the umbilical hernia for over six years. She recently noticed discoloration of the skin and an inability to reduce the hernia. • CT imaging showed a fat-containing hernia and a 6x5 cm lesion at the pancreatic tail. • Patient taken to the OR for open repair of umbilical hernia • Operative findings included incarcerated fat with large cystic and solid components attached to the underlying omentum Surgical pathology: • Metastatic pancreatic adenocarcinoma • Immunohistochemical staining • positive CK7, • negative CK20, CDX-2, calretinin, PAX-8 and GATA-3 Conclusion: In a patient with no known history of cancer, an umbilical mass may serve as a rare initial presentation of an underlying, and likely advanced, malignant process. The number of case reports describing this phenomenon with a wide range of underlying pathology demonstrates how nonspecific umbilical metastasis is to a particular type of cancer.

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

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.

Sister Mary Joseph's nodule revealing a jejunal adenocarcinoma: A case report.

Introduction and importanceAdenocarcinoma of the jejunum is a diagnostic challenge for the physician because of its extreme rareness and the fact that it classically presents with vague clinical symptoms. On the other hand, the Sister Mary Joseph's nodule is a rare clinical sign that refers to umbilical metastasis of an internal malignancy. We here report a rare case of jejunal adenocarcinoma revealed by a Sister Mary Joseph's nodule.Case presentationA 55-year-old man presented with an ulcerated umbilical tumor, which was found to be a secondary lesion of an advanced jejunal adenocarcinoma invading the transverse colon. He underwent surgical resection of the umbilical tumor and the intestinal primitive.Clinical discussionThe presence of umbilical metastasis usually represents advanced disease but can be its first manifestation. Gastro-intestinal tract tumors such as jejunal adenocarcinomas and gynecologic malignancies are the most common primary sites.ConclusionPracticians must be aware of clinical implication of Sister Mary Joseph nodule. Aggressive surgery when feasible can be beneficial for survival.

Peritoneal Metastases: Their Associated Imaging Features

Peritoneal Metastases (PM) detection remains a challenge even with modern imaging. Knowing imaging features of abnormal findings frequently associated with PM is of interest to improve PM detection. Although ascites is a common imaging finding of PM, the presence of ascites alone, even in patients with known cancer, is not enough to diagnose PM. The peritoneum should be read as an own organ with careful analysis of the ligament (e.g. falciform and hepatoduodenal ligament), the mesos and the omenta. Indirect manifestations of visceral peritoneal involvement is a segment of small bowel fixed to the parietal peritoneum, the appearance of blockage of free circulation of ascites, plurisegmental bowel obstruction and clumped bowel that is a strong predictor of diffuse involvement of the visceral peritoneum by a high grade tumor. Ovarian and umbilical metastases are frequently associated with PM in particular in digestive cancers. Moreover, ovarian metastases has been shown to be less responsive to chemotherapy than other metastases and should not be chosen as a target lesion for RECIST assessment. The presence of cardiophrenic angle lymph nodes also increases the possibility of metastatic spread in peritoneum. Finally, the most common PM mimickers include colonic diverticulum, mesenteric lymph nodes, splenosis implants, fat necrosis and postoperative changes after cytoreductive surgery and HIPEC.

Sister Mary Joseph’s Nodule: A Rare Cytological Presentation Post Gallbladder Surgery

Umbilicus is a rare focus of cutaneous metastasis. It is called as Sister Mary Joseph’s nodule (SMJN), and is associated with critical prognosis. The most frequent primary malignancies are stomach, colon and pancreas in males, ovaries and endometrium in females. Neoplasm of gallbladder with SMJN is a rare presentation. We present a case report of an elderly male, who presented with umbilical metastasis (SMJN) on non-guided fine needle aspiration cytology (FNAC). On subsequent work-up through previous slides and further radiological studies, this case was later diagnosed as primary gallbladder adenocarcinoma, which is now presenting with multiple liver metastasis and SMJN. This case report suggests the poor prognosis of gallbladder carcinoma and the unusual presentation of SMJN in gallbladder cancer.

Umbilical metastases: Real-world data shows abysmal outcome.

Umbilical metastases form a clinical challenge, especially when they represent the first sign of malignant disease and the primary tumor is unknown. Our study aims to generate insight into the origin and timing of umbilical metastasis, as well as patient survival, using population‐based data. A nationwide review of pathology records of patients diagnosed with an umbilical metastasis between 1979 and 2015 was performed. Data was collected from the Nationwide Network and Registry of Histopathology and Cytopathology (PALGA) and the Netherlands Cancer Registry. Kaplan‐Meier analyses and log‐rank testing were used to estimate overall survival and a Cox proportional hazard model was used to determine multivariable hazard ratios. A total of 806 patients with an umbilical metastasis were included. There were 210 male (26.1%) and 596 female (73.9%) patients. Distribution of umbilical metastases was different between male and female patients due to the high incidence of umbilical metastases originating from the ovaries in females. They most frequently originated from the ovaries in female patients (38.8%) and from the colon in male patients (43.8%). In 18% of cases no primary tumor could be identified. Prognosis after diagnosis of an umbilical metastasis was dismal with a median survival of 7.9 months (95% confidence interval 6.7‐9.1). The origin of the primary tumor was an independent prognostic factor for overall survival. In conclusion, umbilical metastases relatively rare, mainly originating from intraabdominal primary tumors. Survival is dependent on the origin of the primary tumor and poor overall survival rates warrant early recognition.

Two case reports of umbilical metastasis: the enigmatic Sister Mary Joseph nodule

Background: Umbilical metastasis, also known as Sister Mary Joseph nodule, is a rare pathognomonic clinical sign suggesting the presence of an internal cancer. Case Presentation: We describe two female patients with Sister Mary Joseph nodule. In one case, there was a relapse of cancer. In the other patient, the Sister Mary Joseph nodule was the first and only clinical sign of an abdominal malignancy. We will briefly discuss the association with various internal malignancies as well as the pathogenesis and differential diagnosis. Conclusion: We conclude that Sister Mary Joseph nodule is a sign of intra-abdominal malignancy most frequently associated with gastro-intestinal or gynecological cancer. It can be the first and only clinical sign of abdominal malignancy in an otherwise healthy appearing patient or it can be an indication of oncological progressive disease, tumor relapse. Umbilical lesions should raise suspicion of a Sister Mary Joseph nodule, but a differential diagnosis must be made with other primary umbilical malignancies as well as with benign conditions involving the umbilicus.

A Case of Ascending Colon Cancer with Umbilical Metastasis and a Markedly Reduced Quality of Life Because of an Extensive Skin Disorder

A Case of Ascending Colon Cancer with Umbilical Metastasis and a Markedly Reduced Quality of Life Because of an Extensive Skin Disorder

The coincidence of testicular and umbilical metastasis of colon cancer: a case report and literature review

: The liver and lungs are prone to be the metastatic sites of colorectal cancer. Testicular metastasis is uncommon, as is umbilical metastasis, both of them are associated with advanced disease, when they appear at the same time, it is often associated with multiple metastases and indicates poor prognosis. Here we report a 56-year-old man complained intermittent right testicular mass with scrotal pain initially. In the view of image inspection and pathological examination, he was diagnosed as stage IV transverse colon cancer with widespread metastasis according to the gastrointestinal multidisciplinary team meeting. He had received Oxaliplatin plus Capecitabine for 12 cycles, he failed to use bevacizumab for anti-angiogenesis therapy because of his economic conditions. However, revaluation for the primary and metastatic tumors were partial remission, then he received Capecitabine as maintenance therapy. The coincidence of testicular and umbilical metastasis from colorectal cancer is uncommon, and the prognosis is poor, with appropriate regimen developed by a multidisciplinary medical team used, patients with metastatic colon cancer may achieve significant benefit. We also conduct a review of the literature, the purpose is to summarize the clinical features of colon cancer metastasis to the testis and umbilical area, it is speculate that this case of metastasis may be related to transperitoneal seeding on the basis.

Neuroendocrine Carcinoma of the Cervix with Sister Mary Joseph's Nodule: About a Case and Literature Review

Neuroendocrine tumors are a rare and aggressive histological variant of the cervix, and they have several differences compared to other types of cervical cancer, in prognosis, diagnosis and treatment. In this paper we report the case of a 39-year-old patient that was taken care of in the medical oncology department at the Hassan II University Hospital Center, for an advanced neuroendocrine carcinoma of the cervix with a Sister Mary Joseph’s nodule. The aim of this work is to highlight this rare location of neuroendocrine tumors and their very aggressive character; by describing the different clinical, radiological and anatomopathological aspects of the primary tumor as well as umbilical metastasis.

Pancreatic tumor metastasis to the navel in a case with three primary tumors – case report and review of the literature

Introduction. Sister Mary Joseph nodule (SMJN) is a metastasis that can occur in the umbilical region due to many tumors in the abdomen. Most of the cases are of gastrointestinal system origin and are often an indicator of poor prognosis. It can be seen in 1-3% of intraabdominal and pelvic malignancies. In the literature, around 300 studies are presented, mostly in the form of case reports. Very few (7-9%) of the cases with SMJN are from pancreatic origin. In our literature review, we found that in the majority (>90%) of SMJN cases due to pancreatic tumors, the lesions originated from the pancreatic tail and/or body, and tumor marker Ca-19.9 was very high in most cases (>90%). Aim. Here, the case of SMJN seen in a patient with three different primary tumors was discussed in the light of the literature data. Description of the case. Here, our case, whose third primary malignancy was detected in the pancreas in the PET/CT examination performed to investigate the origin of SMJN in a 68-year-old female patient who had undergone surgery due to breast in 2011 and endometrium cancers in 2018 and came with umbilical metastasis, is presented in the light of the literature data. Conclusion. As a result, in our case, which was followed up due to two primary tumors, it became important to know the origin of the SMJN that occurred due to the third primary tumor detected during the CT and PET/CT examination due to the newly emerging SMJN. It is important to know the origin and histopathological features of the SMJN in order to determine the treatment to the patient.

UMBILICAL METASTASIS MIMICKING SYMPTOMATIC UMBILICAL HERNIA - A RARE CASE REPORT AND REVIEW OF THE LITERATURE

Umbilical metastases, also termed Sister Mary Joseph's nodule, are reported rarely in medical literature and they are associated with advanced metastatic intra-abdominal and pelvic cancers. The purpose of this publication is to report a rare case of umbilical metastasis misdiagnosed as acomplicated umbilical hernia. Case presentation. A 74-years-old woman with nausea and painful umbilical swelling was misdiagnosed as incarcerated umbilical hernia оn the initial examination. Abdominal computed tomography revealed a huge pelvic cystic-solid mass, probably originates from right ovary. Conclusion. In conclusion, the presented case demonstrated that due to the lack of understanding Sister Mary Joseph’s nodule could be easily mistaken for incarcerated umbilical hernia.

Cutaneous Metastases in Ovarian Cancer.

Skin metastases in ovarian cancer are uncommon, but their incidence may be increasing due to improved survival rates. Skin metastases can be divided into umbilical metastases, which are known as Sister Joseph nodules (SJNs) and are associated with peritoneal metastasis, and non-SJN skin metastases, which usually develop within surgical scars and in the vicinity of superficial lymphadenopathy. As most skin metastases develop after specific conditions, recognition of preceding metastatic diseases and prior treatments is necessary for early diagnosis of skin lesions. The prognosis of skin metastases in ovarian cancer varies widely since they are heterogeneous in the site of lesion and the time of appearance. Patients with SJNs at initial diagnosis and patients with surgical scar recurrences without concomitant metastases may have prolonged survival with a combination of surgery and chemotherapy. In patients who developed skin recurrences as a late manifestation, symptoms should be treated with external beam radiotherapy and immune response modifiers. Immune checkpoint blockade can enhance anti-tumor immunity and induce durable clinical responses in multiple tumor types, including advanced chemoresistant ovarian cancer. With the use of radiation therapy, which enhances the systemic anti-tumor immune response, immune checkpoint blockade may be a promising therapeutic strategy for distant metastasis, including skin metastasis.

Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms.

Cutaneous metastases from internal malignancies are uncommon. Umbilical metastasis, also known as Sister Joseph nodule (SJN), develops in patients with carcinomatous peritonitis or superficial lymphadenopathy, while non-SJN skin metastases develop after surgery, injury, and lymphadenopathy. In this review, the possible mechanisms of skin metastases are discussed. SJNs develop by the contiguous or lymphatic spread of tumor cells. After surgery and injury, tumor cells spread by direct implantation or hematogenous metastasis, and after lymphadenopathy, they spread by extranodal extension. The inflammatory response occurring during wound healing is exploited by tumor cells and facilitates tumor growth. Macrophages are crucial drivers of tumor-promoting inflammation, which is a source of survival, growth and angiogenic factors. Angiogenesis is promoted by the vascular endothelial growth factor (VEGF), which also mediates tumor-associated immunodeficiency. In the subcutaneous tissues that surround metastatic lymph nodes, adipocytes promote tumor growth. In the elderly, age-associated immunosuppression may facilitate hematogenous metastasis. Anti-VEGF therapy affects recurrence patterns but at the same time, may increase the risk of skin metastases. Immune suppression associated with inflammation may play a key role in skin metastasis development. Thus, immune therapies, including immune checkpoint inhibitors reactivating cytotoxic T-cell function and inhibiting tumor-associated macrophage function, appear promising.