Umbilical mass as the sole presenting symptom of pancreatic cancer: a case report

Abstract

Umbilical nodes are rare. The metastatic involvement of the region was first described in 1846. Sister Mary Joseph was the first observer to establish the correlation between carcinomas and umbilical nodes. The umbilical node may be the sole presenting sign of cancer and is usually associated with advanced disease and poor prognosis. A 64-year-old woman, previously healthy, presented vague abdominal discomfort and a hard umbilical nodule for 1 week, which was first diagnosed as an incarcerated umbilical hernia. She underwent a new clinical assessment and biopsy. After immunohistochemical analysis and computerized tomography, she was diagnosed with pancreatic cancer. The clinical staging showed advanced disease with distant metastasis. She received palliative chemotherapy. After 8 months, she was alive in poor clinical condition. Clinical suspicion should lead to a careful additional evaluation whenever an umbilical nodule presents with malignant signs.

Cutaneous metastases secondary to pancreatic cancer

“…Survival time ranged from 1 to 32 mo. The 177 WJGO|www.wjgnet.com July 15, 2012|Volume 4|Issue 7| Hisamoto et al [6] [5] 60 F Present Nodule Umbilicus Tail 2 mo, dead Peritoneum Chemotherapy Yoneda et al [11] 53 F Absent Nodule Umbilicus Tail 7 mo, dead Peritoneum Chemotherapy Yoneda et al [11] 64 F Absent Nodule Umbilicus Body 8 mo, alive Lung Chemotherapy Crescentini et al [12] 75 M Present Nodule Umbilicus Body 6 mo, dead Liver GEM Okazaki et al [13] [22] 50 M Present Nodule Lateral abdomen Body 2 mo, dead Liver, brain GEM, irinotecan Kimura et al [23] 68 M Absent Nodule Umbilicus Body 4 mo, dead Liver, LN GEM, UFT-E, RT Yamashita et al [24] 72 F Present Nodule Umbilicus Tail 32 mo, dead Peritoneum GEM, S-1 Hirahara et al [25] 67 F Present Nodule Lower abdomen Tail 3 mo, dead Liver, LN GEM Pontinen et al [26] 70 F Present Nodule Umbilicus Tail 4 mo, dead Liver, peritoneum GEM Ozaki et al [27] 81 M Present Nodule Umbilicus Tail 7 mo, dead Peritoneum S-1 Ozaki et al [27] 59 M Absent Nodule Umbilicus Body 11 mo, alive Liver, peritoneum GEM, 5-FU Ozaki et al [27] 66 M Absent Nodule Umbilicus Body 18 mo, dead Liver GEM, 5-FU Ozaki et al [27] median survival time (MST) of all patients was 5 mo after diagnosis of cutaneous metastases. The cumulative 1-and 2-year survival rate was 17.5% and 3.5%, respectively ( Figure 1A).…”

Caso para diagnóstico* (Metástase umbilical de carcinoma pancreático "Sister Mary Joseph Nodule")

“…O câncer de pâncreas é o quinto sítio mais frequente, ficando atrás dos tumores de intestino e de origem desconhecida. 4 Esse sinal pode preceder o diagnóstico da lesão primá-ria em até 30% dos casos, como aqui apresentado.…”

Pancreatic cancer presenting as a Sister Mary Joseph's nodule

“…There are many possible mechanisms of the spread to the umbilicus, including direct extension, haematogenous spread and lymphatic spread. The most common from primary sites are intra-abdominal in origin 3. Retrograde flux from superficial and deep lymphatics may also be an important mode of spread 3…”

“…Survival rates are very poor, and there is very little scope for prognosis when a patient presents with tumours at such a late stage 2 3…”