Kirshtein Boris, Meirovitz Mihai, Okon Elimelech, Piura Benjamin
Department of Surgery A, Soroka University Medical Center and Faculty of the Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
J Minim Invasive Gynecol. 2006 May-Jun;13(3):234-6. doi: 10.1016/j.jmig.2006.01.009.
Umbilical metastasis (Sister Mary Joseph's nodule) is often the first sign of intraabdominal and/or pelvic carcinoma. We describe the fourth case reported in the literature of Sister Mary Joseph's nodule originating from fallopian tube carcinoma. In a 54-year-old woman, Sister Mary Joseph's nodule was unexpectedly detected during umbilical hernia repair. Subsequent laparoscopy revealed a 2-cm friable tumor located at the fimbriated end of right fallopian tube and 1-cm peritoneal implant in the pouch of Douglas. Laparoscopic bilateral adnexectomy and resection of the peritoneal implant were performed. Because frozen section examination revealed fallopian tube carcinoma, the procedure was continued with laparotomy including total abdominal hysterectomy, omentectomy, and pelvic lymph node sampling. Final diagnosis was stage IIIB fallopian tube carcinoma. The patient received postoperative adjuvant chemotherapy with single-agent carboplatin and has remained alive and with no evidence of disease. It is concluded that in cases of Sister Mary Joseph's nodule, laparoscopy can be a useful tool in the search of the primary tumor in the abdomen and/or pelvis. Laparoscopy can provide crucial information with respect to the location, size, and feasibility of optimal surgical resection of the intraabdominal and/or pelvic tumors.
脐部转移（玛丽·约瑟夫修女结节）通常是腹内和/或盆腔癌的首个体征。我们描述了文献中报道的第四例起源于输卵管癌的玛丽·约瑟夫修女结节。在一名54岁女性患者中，在脐疝修补术中意外发现了玛丽·约瑟夫修女结节。随后的腹腔镜检查显示，在右侧输卵管伞端有一个2厘米易碎肿瘤，在Douglas窝有一个1厘米的腹膜种植灶。进行了腹腔镜双侧附件切除术和腹膜种植灶切除术。由于冰冻切片检查显示为输卵管癌，手术继续进行剖腹术，包括全腹子宫切除术、大网膜切除术和盆腔淋巴结取样。最终诊断为IIIB期输卵管癌。患者接受了单药卡铂术后辅助化疗，目前仍存活且无疾病证据。结论是，对于玛丽·约瑟夫修女结节病例，腹腔镜检查可作为寻找腹内和/或盆腔原发性肿瘤的有用工具。腹腔镜检查可提供有关腹内和/或盆腔肿瘤的位置、大小以及最佳手术切除可行性的关键信息。
