Intravascular papillary endothelial hyperplasia mimicking sister Mary Joseph nodule in a patient with ovarian carcinoma

@#Intravascular Papillary Endothelial Hyperplasia (IPEH) is a rare benign vascular lesion of the skin and subcutaneous tissues that results from the proliferation of endothelial cells within a blood vessel. In this article, we present the case of an IPEH mimicking a Sister Mary Joseph Nodule on the umbilicus of a 53-year old female patient with ovarian cancer. A diagnostic workup was performed with a computerized tomography of abdominal cavity and pelvis showing an expansive cystic tumor formation with probable ovarian origin. Two separate histopathologic readings were done on the cutaneous lesion which revealed contradicting findings of benign versus malignant tumors. Immunohistochemical stains done showed that the lesion was positive for ERG and negative for epithelial differentiation markers. No surgical intervention was done at the time of consultation as a cutaneous metastasis was primarily considered initially. It is crucial to rule out a diagnosis of Sister Mary Joseph nodule, especially in a background of ovarian carcinoma as it may mimic vascular lesions occurring on the umbilicus. Immunohistochemical staining is a significant tool to precisely diagnose such lesions so that it is neither inadequately nor aggressively managed.

Nódulo de la hermana Mary Joseph: una manifestación inicial poco usual de adenocarcinoma de páncreas / Sister Mary Joseph nodule: an unusual initial manifestation of pancreas adenocarcinoma

Las metástasis cutáneas representan el 10% de todas las metástasis. El nódulo de la hermana Mary Joseph es una lesión metastásica cutánea umbilical asociada a tumor intraabdominal, que con mayor frecuencia es el carcinoma gástrico. Las metástasis cutáneas de cáncer de páncreas son poco habituales y su localización más frecuente es el ombligo. La mayoría de referencias de la literatura consisten en reportes o series de caso pequeñas. Se reporta el caso de un paciente con lesión metastásica umbilical, nódulo de la hermana Mary Joseph, primaria de adenocarcinoma pancreático, debido a su inusual presentación como manifestación clínica previa al diagnóstico de la neoplasia de origen

Cutaneous metastases represent 10% of all metastatic manifestations. Sister Mary Joseph nodule is a cutaneous umbilical metastatic lesion associated to intraabdominal tumors (most frequently gastric carcinoma). Cutaneous metastases from pancreatic cancer are quite uncommon, and their most frequent location is the umbilicus. Most literature references consist in case reports or small case series. We report the case of a patient with an umbilical metastatic lesion (Sister Mary Joseph nodule) from a pancreatic adenocarcinoma, being this an unusual presentation as a clinical manifestation prior to diagnosing the original malignancy

Sister Mary Joseph Nodule as a Metastasis of Gallbladder Carcinoma / 대한피부과학회지

Cutaneous metastasis into the umbilicus, known as a Sister Mary Joseph nodule, is quite rare. Gastric adenocarcinoma is the most common primary origin overall, whereas gynecologic tumors such as ovarian cancer are the leading cause in women. In most cases, the nodule manifests after the primary tumor had been diagnosed. In rare cases, however, it serves as the first sign of the underlying malignancy. Here, we report the case of a 59-year-old woman who presented with a nodule on the umbilicus and was diagnosed with metastatic adenocarcinoma originating in the gallbladder.

Nódulo de la hermana María José. A propósito de un caso: Metástasis umbilicales de cáncer de colon / Nodule of sister Mary Joseph, associated with a colon cancer and umbilical metastasis

Con el epónimo «nódulo de la hermana María José¼, nos estamos refiriendo a la presencia de una lesión umbilical, generalmente de larga evolución y que en realidad representa una metástasis cutánea umbilical, relacionada habitualmente con una neoplasia intra-abdominal. Se presenta el caso de un paciente, visto en la consulta externa del servicio de Dermatología del Hospital Privado de Córdoba, que presentaba una lesión umbilical indicativa del nódulo de la hermana María José y que era manifestación de un adenocarcinoma primario de colon.

With the eponymous "nodule Sister Mary Joseph" we are referring to the presence of an umbilical lesion, usually of long duration, and it actually represents an umbilical cutaneous metastasis is usually related to intra-abdominal neoplasia. The case of a patient seen in the outpatient dermatology service of Private Hospital of Cordoba, which had umbilical lesion indicative nodule Sister Mary Joseph and was a primary manifestation of colon adenocarcinoma is presented.

Sister Mary Joseph's nodule of the umbilicus: Is it always of gastric origin? A review of eight cases at different sites of origin.

Objective : The aim of this analysis was to evaluate our management and outcome of eight cases of Sister Mary Joseph's Nodule of the umbilicus (SMJN). Methods : Between 2002 and 2009, we collected eight cases of SMJN and their clinical data were studied in a retrospective manner. Results : The mean age of the patients was 50.6 years (range, 34-58). There were three males and five females. Five cases were discovered preoperatively during an abdominal examination and in the remaining three patients, the umbilical nodule was noticed during surgery. Most patients presented with abdominal pain. Various signs were discovered during clinical examination. Exhaustive investigations done included ultrasound, computed tomography, magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, gastrointestinal endoscopy, mammogram, bone scan, and a panel of tumor markers. The primary tumors were gastric adenocarcinoma (two patients), ovarian adenocarcinoma (two patients), pancreatic carcinoma (one patient), colonic adenocarcinoma (one patient), gallbladder adenocarcinoma (one patient), and cholangiocarcinoma (one patient). As the disease was advanced and metastatic in all patients, only palliative therapy was offered. All patients died within a short period after clinical presentation, ranging from four to 58 weeks (mean, 20 weeks). Conclusion : SMJN is a rare manifestation of a variety of advanced malignancies, usually of gastrointestinal origin. A majority of the patients present at a late stage and many harbor distant metastases. The patient's survival is very short (mean, 20 weeks) leading to a poor outcome. We believe that if the primary cancer is discovered at an early stage, the prognosis may improve.

Sister mary joseph's nodule: A case of umbilical cutaneous metastasis with signet ring cell histology.

The metastasis of a visceral malignancy to the umbilicus is known as "Sister Mary Joseph's nodule". It is a rare clinical sign indicating advanced, metastasizing intraabdominal cancer. We report a 50-year-old man who developed metastatic skin cancer in the form of semicircular indurated plaque on top of which was a firm mobile rounded nodule at the umbilical area. Histopathological examination demonstrated diastase-resistant periodic acid-Schiff and mucicarmine positive signet ring cells, suggesting gastric carcinoma. Immunohistochemical staining showed that these cells were positive for cytokeratins and epithelial membrane antigen, suggesting epithelial origin.

A Case of Sister Mary Joseph's Nodule / 대한피부과학회지

Metastatic cancer of the umbilicus is very rare and is called Sister Mary Joseph's nodule. Metastasis to the umbilicus usually presents as diffuse spreading of primary cancer or recurrence after treatment of primary cancer, carries very poor prognosis, and is generally inoperable. However, umbilical metastasis presents rarely as a first sign of primary cancer and can lead to its diagnosis. The diagnosis is usually made with the histologic examination and the most common primary cancer is an adenocarcinoma of the stomach. We report a case of umbilical metastasis as a first sign of gastric cancer which leads to its diagnosis. This report emphasizes the need for careful evaluation of any umbilical lesion.

Sister Mary Joseph's nodule from advanced ovarian carcinoma / 대한산부인과학회지

Umbilical metastasis may be the first presenting sign of the disease, or an indication of a recurrence from a previous malignancy. We recently encountered a 19-year-old woman with advanced ovarian adenocarcinoma whose first sign was having a Sister Mary Joseph's nodule. This patient only presented an umbilical nodule with slight lower abdominal discomfort, without any other subjective symptom. The lesion was fresh red, firm, ulcerating and has 1.5 cm in diameter. A punch biopsy from the lesion revealed metastatic adenocarcinoma and a PET-CT scan showed hypermetabolism on the umbilicus. After a systemic evaluation, she had a laparotomy including right salpingo-oophorectomy, total omentectomy, pelvic and paraaortic lymphadenectomy, appendectomy, and extirpation of the umbilicus. The patient received a postoperative combination of chemotherapy with paclitaxel and carboplatin, and still remains alive. This case demonstrates the importance of careful evaluation of any umbilical lesion and pathologic examination.

A Case of Sister Mary Joseph's Nodule as a Presenting Sign of Gastric Cancer / 대한소화기학회지

The cutaneous metastasis of a visceral malignancy to the umbilicus is known as "Sister Mary Joseph's nodule (SMJN)". It is considered to be a predictor of poor prognosis because it mostly occurs in advanced, metastasizing cancer. However, it is a very rare condition as an initial presenting sign of primary cancer. We recently encountered a 48-year-old man presented with an umbilical lump. The lesion was a firm, ill-delineated, painful nodule with regular surface in the umbilicus. Abdominal computed tomography showed a 2.2 cm sized, ill-defined, delayed enhancing mass at the periumbilical area accounting for umbilical nodule. Diffuse irregular thickening of peritoneum and diffuse wall thickening of stomach implied the diagnosis of gastric cancer. Esophagogastroduodenoscopy revealed diffuse nodular infiltrative lesion from cardia through body of the stomach, compatible with Bormann type 4 advanced gastric cancer. Later, histopathologic confirmation showed a presence of signet ring cell adenocarcinoma from biopsy specimens. We experiened a case presenting with an umbilical metastasis as the first sign of gastric adenocarcinoma. It is thought that direct extension of tumor through the peritoneum might be the route for umbilical metastasis. Careful examination of all umbilical lesions must be needed for the early diagnosis of internal malignancy.

A Case of Sister Mary Joseph's Nodule / 대한피부과학회지

A metastatic umbilical carcinoma from internal malignancy is known as Sister Mary Joseph's nodule. A 56-year-old man presented with a progressively enlarging umbilical nodule. Skin biopsy was done and the patient was diagnosed as metastatic adenocarcinoma of umbilicus. Search for the primary tumor revealed gastric adenocarcinoma with metastasis to perigastric lymph node, portal vein and intrahepatic duct. Sister Mary Joseph's nodule, a rare form of cutaneous metastasis, generally carries very poor prognosis. We describe a case of Sister Mary Joseph's nodule preceding a diagnosis of gastric cancer with review of the literature, and emphasize the importance of careful evaluation of any umbilical nodule.