Case Report/Review: Sister Mary Joseph Nodule as a First Manifestation of a Metastatic Ovarian Cancer

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 3. Discussion
Umbilical tumors are rare and can be classified as benign or malignant. Benign causes include umbilical hernia, granuloma, abscess, mycosis, and eczema. Malignant tumors can be either primary or metastatic [2, 6].....In this case the final pathological diagnosis was an ovarian serous adenocarcinoma with intra-abdominal and thoracic metastases.....

Abstract

A 76-year-old female presented to our hospital with a 2 cm firm, nontender, protuberant umbilical nodule. She received treatment with antibiotics for suspected granuloma, with no improvement after two months. High levels of CA125 as well as an ovarian cyst and intrathoracic and intra-abdominal lesions on imaging studies made us suspect an ovarian cancer with a Sister Mary Joseph nodule (SMJN) and other metastases. A bilateral salpingo-oophorectomy and umbilical and omentum tumor resections were performed and a metastatic ovarian serous adenocarcinoma was diagnosed by histopathology. After surgery, the patient received chemotherapy with paclitaxel, carboplatin, and bevacizumab; however paclitaxel allergy was observed. As a result, chemotherapy continued with carboplatin and bevacizumab every three weeks for a total of 6 courses. Currently, she is still undergoing treatment with bevacizumab and CA125 levels have been progressively decreasing. SMJN is a rare umbilical metastasis which needs to be considered as a differential diagnosis in the presence of an umbilical tumor for prompt treatment initiation.

1. Introduction

Sister Mary Joseph nodule (SMJN) is a rare umbilical lesion resulting from an intra-abdominal and/or pelvic malignancy. It was named after Sister Mary Joseph, a surgical assistant to Dr. William J. Mayo, who noted the association between the presence of an umbilical nodule and an intra-abdominal malignancy [1]. Its incidence is 1%–3% of all intra-abdominal or pelvic malignancies [2]. Gastrointestinal malignancies, most commonly gastric, colon, and pancreatic, account for about 52% of cases and gynecological cancers, most commonly ovarian and uterine, account for about 28% of the underlying sources [3]. Also, 15–29% of all cases have an unknown origin [4]. The mechanism of tumor spread to the umbilicus is poorly understand as it seems to be lymphatic, vascular, contiguous, or via embryologic remnants in the abdominal wall [5].

Here, we present a case of SMJN as an ovarian cancer metastasis, its diagnosis, treatment and follow-up.....

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