RESUMEN
Sister Mary Joseph's nodule (SMJN) is an umbilical mass referring to an intraabdominal and/or pelvic tumor's metastasis. SMJN is frequently associated with gynecological malignancies, but only 30 cases of SMJN originated from endometrial cancer have been described in the literature. We reported a case of SMJN detected within the primary diagnosis of endometrial cancer, in which a 1-year vaginal relapse occurs. A robotic single-site total hysterectomy and a bilateral salpingo-oophorectomy were performed to treat the primary tumor, followed by an adjuvant radiotherapy. The SMJN was resected during the surgical procedure. The relapse was treated by a partial colpectomy. No evidence of disease has been observed to date, and an overall survival of 31 months has been achieved. Due to the rare occurrence of an umbilical metastasis from an endometrial carcinoma, SMJN is difficult to recognize in this contest; nevertheless, its diagnosis is becoming increasingly important in relation to the choice of a proper treatment.
RESUMEN
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.
RESUMEN
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.