Umbilicus as the Only Site of Metastasis in Recurrent Ovarian Cancer

We present 2 rare cases of umbilical metastases (Sister Mary Joseph's nodule) as the first sign of late recurrent ovarian cancer. Two patients with ovarian cancer treated with optimal debulking surgery plus chemotherapy were regularly followed up postoperatively. An isolated umbilical nodule was noted accidentally 8 years and 3 years, respectively, after the initial operation. Abdominal computed tomography (CT) for both patients showed a 1.8-cm mass and a 2.3-cm mass with negative peritoneal tumor seeding. Other tumor surveys, including CA125, showed negative findings. Both patients had exploratory laparotomy and complete excision of the umbilical tumor. The pathology showed an isolated metastatic adenocarcinoma without evidence of other metastases. Both patients were treated with 4-course postoperative adjuvant chemotherapy of carboplatin and paclitaxel. Both patients have been in complete clinical remission for 22 months and 12 months, respectively. In addition to tumor marker CA125, a careful and thorough physical examination, assisted by modern imaging evaluation, is the best method for detecting early recurrence in patients with previously treated ovarian cancer. Although an umbilical metastasis usually indicates advanced disease with disseminating peritoneal spread, it does not always imply inoperable or incurable disease. Intensive treatment can improve the outcome.

Key Words:  recurrent ovarian cancer , Sister Mary Joseph's nodule , umbilical metastasis

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