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Unusual presentation of more common disease/injury
CASE REPORT
Sister Mary Joseph nodule: an unusual site for endometrioid cancer metastasis
  1. Sarah Petch1,
  2. Aleksandra Sobota2 and
  3. Feras Abu Saadeh3
  1. 1 Department of Gynaecology, Tallaght Hospital, Dublin, Ireland
  2. 2 Department of Obstetrics & Gynaecology, Coombe Women and Infants University Hospital, Dublin, Ireland
  3. 3 Department of Gynaecology-Oncology, St James’s Hospital, Dublin, Ireland
  1. Correspondence to Dr Sarah Petch, petchs{at}tcd.ie

Abstract

Sister Mary Joseph (SMJ) nodules are rare malignant metastatic umbilical nodules, indicating disseminated disease and associated with a poor prognosis. This is the case of an 80-year-old woman who presented with umbilical discomfort and an ulcerated umbilical nodule. She was noted to have a bulky uterus and vaginal bleeding. CT abdomen-pelvis showed an enlarged uterus and right-sided lymphadenopathy, extending from the groin to the para-aortic area. Upper and lower endoscopies were normal. Biopsy of the umbilical nodule revealed metastatic endometrioid adenocarcinoma grade 1–2 with the endometrium and the ovary suggested as potential primary sites. The patient had cytoreductive surgery including en bloc resection of the umbilical tumour. Final histology confirmed Stage IVb endometrioid adenocarcinoma of the uterus. This unusual case highlights the diagnostic challenges faced with the presentation of an umbilical nodule. Gynaecological malignancy should always be considered within the initial differential diagnosis of an SMJ nodule.

  • gynaecological cancer
  • surgical oncology

https://doi.org/10.1136/bcr-2019-229187

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    Footnotes

    • Contributors SP was involved in the care of patients, assisted with patients' surgery, took photographs, obtained consent from patients and writing patients' cases. AS was involved in the care of patients, assisted with patients' surgery, and was involved in the writing of discussions. FAS was the supervising consultant for patients under his care, and was involved in the planning of patients' care and surgery, and in the planning of case reports and approval reports for submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.