| A case of Sister Mary Joseph's nodule In the patient with gastric cancer |
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울산대학교 의과대학 서울아산병원 호흡기내과 |
| A case of Sister Mary Joseph's nodule In the patient with gastric cancer |
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Chang Kyun Lee, Young Woon Chang, Sung Hoon Jung, Jae Young Jang, Seok Ho Dong, Hyo Jong Kim, Byung Ho Kim, and Rin Chang |
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| Abstract |
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Background A cutaneous metastatic nodule of visceral malignancy to the umbilicus is called Sister Mary Joseph's nodule. It
is a very rare condition as a first sign of primary cancer, and rarely leads to the diagnosis of primary cancer. It usually signifies
advanced, metastasizing cancer and therefore is considered as a sign of poor prognosis for the patient. Case We recently
encountered a 48 year old man presented with an umbilical lump. The lesion was a firm, relatively well-delineated, painful nodule
with regular surface in the umbilicus. The Abdomen CT scan showed about 2.2 cm sized, ill-defined, delayed enhanced mass
at the umbilical area of midline abdominal wall accounting for palpable mass, diffuse irregular thickening of peritoneum, and
diffuse wall thickening of stomach implies gastric cancer. Routine laboratory data were within normal limits. The
esophagogastroduodenoscopy revealed diffuse ulcerative lesion at the lesser curvature and posterior wall from cardia through
body, compatible with Borrmann type 4 advanced gastric cancer. It was confirmed as signet ring cell adenocarcinoma from
biopsy specimens. Summing up, these findings supported the umbilical mass is a metastatic nodule from gastric cancer, and it
was thought that direct extension of tumor through the peritoneum is the route for umbilical metastasis. Conclusion This case
is described of an umbilical metastasis as the first presenting sign of a gastric adenocarcinoma, and highlights the importance
of careful examination of all umbilical lesions for the diagnosis of internal malignancy. |
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