Sister Mary Joseph's nodule: report of five cases

Case 1 A 54‐year‐old woman presented with a 5‐month history of an asymptomatic, 2.5‐cm, erythematous, ulcerated nodule involving the umbilicus ( Fig. 1). Biopsy demonstrated metastatic adenocarcinoma ( Fig. 2) and abdominal ultrasound showed a large ovarian tumor ( Table 1). Further evaluation revealed pleural metastases. 1Erythematous nodule of the umbilicus2Proliferation of glandular structures composed of tumor cells with prominent nucleoli and numerous mitoses (hematoxylin and eosin, ×4000)1 Primary malignancy in five patients with Sister Mary Joseph's noduleCaseAge (years)GenderPrimary malignancy1 54 Female Ovarian adenocarcinoma 2 58 Male Colorectal adenocarcinoma 3 42 Male Pancreatic adenocarcinoma 4 58 Male Ileocecal sarcoma 5 58 Female CholangiocarcinomaCase 2  A 58‐year‐old man was hospitalized with a 6‐month history of diffuse abdominal pain, a 2‐week history of a cutaneous nodule, and a 5‐day history of bloody diarrhea. Cutaneous examination revealed a 1.5‐cm, erythematous to violaceous, infiltrative, and verrucous nodule of the umbilicus ( Fig. 3). Colonoscopy showed a pedunculated polyp of the right colon and a loss of substance in the anal area; histologic examination demonstrated well‐differentiated adenocarcinoma. Abdominal ultrasound showed moderate ascites. A diagnosis of colorectal adenocarcinoma ( Table 1) with umbilical metastasis and peritoneal carcinomatosis was made. 3Irregular, infiltrative, verrucous nodule of the umbilicusCase 3  A 42‐year‐old man, with a history of surgery 5 months earlier for a perforated gastric ulcer, was hospitalized with a 2‐month history of abdominal pain and general deterioration. Clinical examination showed a 15‐cm infiltrative area at the central abdomen with coalescing ulcerated papules at the umbilicus ( Fig. 4), which developed during the onset of abdominal pain. Histologic evaluation revealed metastatic adenocarcinoma to the skin. Further evaluation supported a diagnosis of pancreatic cancer with peritoneal carcinomatosis ( Table 1). 4Tumor infiltrating the central abdomen, with overlying umbilical noduleCase 4  A 58‐year‐old man presented with a 3‐month history of abdominal pain and a 1‐month history of a painful, bilobed nodular lesion involving the umbilicus. Clinical examination showed a nontender, uniform, and fixed abdominal mass. Colonoscopy revealed a cecal mass. Histologic examination of the cecal mass and umbilical lesion confirmed a diagnosis of ileocecal sarcoma ( Table 1). Further evaluation demonstrated peritoneal metastases. Case 5  A 58‐year‐old woman was hospitalized with a 1‐year history of an umbilical lesion, abdominal pain, vomiting, and general deterioration. Examination revealed a 2‐cm hard, fixed, nontender, umbilical tumor and hepatomegaly. Endoscopy showed a gastric ulcer without histologic evidence of malignancy. Additional evaluation demonstrated a gallbladder tumor, hepatic metastases, and peritoneal carcinomatosis ( Table 1). Biopsy of the umbilical lesion revealed poorly differentiated adenocarcinoma.