Rais Ghizlane, Bourhafour Mouna, Nafidi Fatima Zahra, Rais Fadoua
Medical Oncology Department, Faculty of Medicine and Pharmacy of Agadir, University Ibn Zohr , Agadir, CHU Souss Massa, Morocco.
Medical Oncology Department, Faculty of Medicine and Pharmacy of Casablanca, University Hassan II, CHU Ibn Rochd, Casablanca, Morocco.
J Med Cases. 2022 Mar;13(3):115-118. doi: 10.14740/jmc3895. Epub 2022 Mar 5.
Metastatic involvement of the umbilicus as a result of a visceral carcinoma is a rare entity known as Sister Mary Joseph's nodule (SMJN). The most common primary sites are the gastrointestinal and gynecological tract. The occurrence of SMJN is commonly associated with advanced peritoneal disease and poor prognosis. The average survival time at the appearance of an umbilical metastasis is estimated at 10 months, and only 13% of patient will be alive at 2 years. Treatment usually involves systemic chemotherapy and palliative care, but the possibility of surgical resection should be considered especially if good response to systemic treatment is achieved in selected patients to maintain or to improve the quality of life. We describe here an unusual case of a 60-year-old man referred with enlarging umbilical lesion, identified as SMJN, that was metastasized from advanced signet ring cell carcinoma of the stomach with generalized peritoneal carcinomatosis. The nodule had rapid progression, and in a few days had reached 15 cm. Chemotherapy was started immediately and patient achieved good clinical and radiological response. A resection of the umbilical nodule was discussed but the patient unfortunately died following a massive pulmonary embolism. This case is unique in view of the unusual size of the SMJN in our patient and the good response to chemotherapy. We present this case to increase physician's awareness for careful evaluation of the umbilical area and encourage them to look for a primary digestive tumor if an umbilical nodule is observed. Therapeutic response to primary chemotherapy may encourage a multimodal approach allowing resectability of the metastatic umbilical nodule.
内脏癌转移累及脐部是一种罕见情况，称为玛丽·约瑟夫修女结节（SMJN）。最常见的原发部位是胃肠道和生殖道。SMJN的出现通常与晚期腹膜疾病及预后不良相关。出现脐部转移时的平均生存时间估计为10个月，仅有13%的患者能存活2年。治疗通常包括全身化疗和姑息治疗，但应考虑手术切除的可能性，特别是在部分对全身治疗反应良好的患者中，以维持或改善生活质量。我们在此描述一例不同寻常的病例，一名60岁男性因脐部肿物增大前来就诊，被确诊为SMJN，其由晚期胃印戒细胞癌伴广泛腹膜转移瘤转移而来。该结节进展迅速，数天内直径就达到了15厘米。立即开始化疗，患者取得了良好的临床和影像学反应。曾讨论过切除脐部结节，但不幸的是，患者在发生大面积肺栓塞后死亡。鉴于我们患者的SMJN大小异常且对化疗反应良好，此病例较为独特。我们呈现该病例以提高医生对仔细评估脐部区域的认识，并鼓励他们在观察到脐部结节时寻找原发性消化肿瘤。对原发性化疗的治疗反应可能会促使采取多模式方法，使转移性脐部结节能够被切除。
