Journal of the Chinese Medical Association
Volume 69, Issue 5 , Pages 233-235, May 2006

Umbilicus as the Only Site of Metastasis in Recurrent Ovarian Cancer

  • Hsiao-Wen Tsai

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Chiou-Chung Yuan

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine
    • ,
  • Peng-Hui Wang

      Affiliations

    • Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine
    • Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr. Peng-Hui Wang, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 12 August 2005; accepted 28 December 2005.

Article Outline

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

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Brustman L , Seltzer V . Sister Joseph's nodule: seven cases of umbilical metastases from gynecologic malignancies . Gynecol Oncol . 1984;19:155–162
  2. Storer HR . Cases illustrative of obstetric disease . Boston Med Surg J . 1864;70:9
  3. Zhang Y , Selvaggi SM . Metastatic islet cell carcinoma to the umbilicus: diagnosis by fine-needle aspiration . Diagn Cytopathol . 2003;29:91–94
  4. Majmudar B , Wiskind AK , Croft BN , Dudley AG . The Sister (Mary) Joseph nodule: its significance in gynecology . Gynecol Oncol . 1991;40:152–159
  5. Albano EA , Kanter J . Images in clinical medicine. Sister Mary Joseph's nodule . N Engl J Med. . 2005;352:1913
  6. 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
  7. Heatley MK . Sister Mary Joseph's nodule in malignant mesothelioma . Histopathology . 2004;45:299–300
  8. Gabriele R , Conte M , Egidi F , Borghese M . Umbilical metastases: current viewpoint . World J Surg Oncol . 2005;3:13
  9. Ching ASC , Lai CW . Sonography of umbilical metastasis (Sister Mary Joseph's nodule): from embryology to imaging . Abdom Imaging . 2002;27:746–749
  10. Boyde AM , Attanoos RL . Sister Mary Joseph's nodule in malignant mesothelioma . Histopathology . 2003;43:300–308
  11. Wang PH , Yuan CC , Lin G , Ng HT , Chao HT . Risk factors contributing to early occurrence of port site metastases of laparoscopic surgery for malignancy . Gynecol Oncol . 1999;72:38–44
  12. Wang PH, Yen MS, Yuan CC, Chao KC, Ng HT, Lee WL, et al. Port site metastasis after laparoscopic-assisted vaginal hysterectomy for endometrial cancer: possible mechanisms and prevention . Gynecol Oncol . 1997;66:151–155
  13. Brasanac D , Boricic I , Todorovic V , Basta-Jovanovic G . Umbilical metastasis (Sister Joseph's nodule) as a first sign of a disseminated ovarian carcinoma: comparative immunohistochemical analysis of primary tumor and its metastases . Int J Gynecol Cancer . 2005;15:377–381
  14. Khan AJ , Cook B . Metastatic carcinoma of umbilicus. “Sister Mary Joseph's nodule.” . Cutis . 1997;60:297–298
  15. Gabriele R , Borghese M , Conte M , Basso L . Sister Mary Joseph's nodule as a first sign of cancer of the cecum: report of a case . Dis Colon Rectum . 2004;47:115–117

PII: S1726-4901(09)70225-4

doi:10.1016/S1726-4901(09)70225-4

Journal of the Chinese Medical Association
Volume 69, Issue 5 , Pages 233-235, May 2006

Article Tools