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LETTER TO THE EDITOR
Year : 2016  |  Volume : 12  |  Issue : 1  |  Page : 428-430

Sister Mary Joseph's nodule: Unusual case


Department of Oncology and Radiotherapy, University Hospital Center Ibn Rochd, Casablanca, Morocco

Date of Web Publication13-Apr-2016

Correspondence Address:
Fatima Safini
Radiotherapy Oncology Service, Hospital Ibn Rochd, Casablanca 1 District Hospitals, 20360, Casablanca
Morocco
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.172712

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How to cite this article:
Safini F, Naqos N, Sahraoui S, Benider A. Sister Mary Joseph's nodule: Unusual case. J Can Res Ther 2016;12:428-30

How to cite this URL:
Safini F, Naqos N, Sahraoui S, Benider A. Sister Mary Joseph's nodule: Unusual case. J Can Res Ther [serial online] 2016 [cited 2019 Nov 13];12:428-30. Available from: http://www.cancerjournal.net/text.asp?2016/12/1/428/172712



Sir,

Sister Mary Joseph's nodule (SMJN) is a rare umbilical cutaneous metastasis of abdominopelvic visceral malignancies. The frequency of abdominopelvic cancers with umbilical metastasis is estimated between 1% and 3%.[1],[2],[3] Here, we report an umbilical metastasis of an advanced ovarian carcinoma with an excellent evolution after chemotherapy.

A 53-year-old woman, nulligeste, reported to us with a family background of cancer. Her case manifested in pelvic pain, average bleeding per vagina, and urinary disorders. On physical examination, a cutaneous nodule was noted on the umbilical region. It was purplish, firm consistency, and measuring 3 cm [Figure 1]. Computed tomography (CT) scan showed two multilobular mass within the pelvis; the first mass was on the left ovary measuring 7 cm and the second was on the right ovary measuring 6 cm, associated with ascites [Figure 2]. Abdominal CT scan showed an umbilical nodule measuring 3 cm [Figure 3]. Laboratory investigation showed increased serum CA125 levels of 385 UI/l. Exploratory laparotomy objectified a left ovarian tumor with peritoneal carcinomatosis and pelvic shielding. Lumpectomy and biopsy of the omentum and ascites fluid sampling were completed. Histological study found an invasive ovarian carcinoma undifferentiated with epiploic location. The immunocytochemical profile demonstrated marker positivity for cytokeratin 7 (100%) and CA125 (60%). The diagnosis confirmed was a primitive ovarian carcinoma. Neoadjuvant chemotherapy was initiated using carboplatin AUC5 every 21 days and weekly paclitaxel 80 mg/m 2 was given. Evolution has been marked by a regression of the umbilical nodule's size more than 50% after 6 cycles of chemotherapy [Figure 4] and a radiological response of ovarian tumor up to 70%. The patient was addressed to the surgery department, but she refused any treatment and had been lost to follow-up. We received the patient after 1 year and an a half. The clinical examination brought into view that there was an increase in the umbilical nodule's size, fistulized on the skin [Figure 5]. She underwent chemotherapy with platamine. She is still in good performance status with excellent response, but she still refuses surgery.
Figure 1: Gross photograph showing a cutaneous nodule on the umbilicus measuring 3 cm in diameter

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Figure 2: Contrast-enhanced computed tomography scan of the pelvis in axial view demonstrates two cystic mass, on the left ovary measuring 7 cm and on the right ovary measuring 6 cm, associated with ascites

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Figure 3: Abdominal computed tomography of umbilical nodule

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Figure 4: Umbilical nodule's response to chemotherapy, (a) after 2 courses, (b) after 4 courses, (c) after 6 courses

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Figure 5: Umbilical nodule after relapse

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Mechanism of SMJN remains unclear, and several hypotheses have been stated. This entity can be the first symptom of an underlying cancer or a recurrence's sign in a patient with a previous visceral cancer.[1],[3],[4] The size of the nodule usually ranges from 0.5 to 2 cm; however, some nodules may reach up to 10 cm in size. It is described as a firm irregular nodule. It can be ulcerated either with bloody, purulent, or serous discharge.[2]

The therapeutic approach is multidisciplinary and not codified. Dermatologists, surgeons, gynecologists, and oncologists should be aware of such a relatively rare entity. Treatment usually involves palliative care. However, an aggressive treatment combining chemotherapy and surgery may provide better long-term survival for ovarian cancer.[3],[5]

Umbilical metastasis is usually associated with advanced neoplastic diseases, with a poor prognosis. Fewer than 15% patients survive in 2 years' time.[3],[5]

This case needs to be taken into consideration because it is the first one which illustrated the response of SMJN to chemotherapy. The other particularity of our observation lies in its exceptional outcome. The survival exceeded the limit of 2 years without surgery.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.





 
 > References Top

1.
Dubreuil A, Dompmartin A, Barjot P, Louvet S, Leroy D. Umbilical metastasis or Sister Mary Joseph's nodule. Int J Dermatol 1998;37:7-13.  Back to cited text no. 1
    
2.
Tso S, Brockley J, Recica H, Ilchyshyn A. Sister Mary Joseph's nodule: An unusual but important physical finding characteristic of widespread internal malignancy. Br J Gen Pract 2013;63:551-2.  Back to cited text no. 2
    
3.
Deb P, Rai RS, Rai R, Gupta E, Chander Y. Sister Mary Joseph nodule as the presenting sign of disseminated prostate carcinoma. J Cancer Res Ther 2009;5:127-9.  Back to cited text no. 3
    
4.
José RJ, Hawley L. Sister Mary Joseph's nodule. QJM 2013;106:779.  Back to cited text no. 4
    
5.
Pereira WA, Humaire CR, Silva CS, Fernandes LH. Sister Mary Joseph's nodule: A sign of internal malignancy. An Bras Dermatol 2011;86 4 Suppl 1:S118-20.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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