Sister Mary Jospeh's nodule as metastasis of colorectal cancer. Systematic review of the literature and meta-analysis.

INTRODUCTION AND IMPORTANCE

Metastatic cancer of the umbilicus is an uncommon and rare presentation.

CASE PRESENTATION

Our interest for the clinical outcomes of umbilical metastases from colon cancer arose after a 60-years old lady with ulcerated umbilical lesion came to our clinic. She was seen in several other clinics, and the diagnoses of infection of the umbilical region and/or of umbilical hernia were made. She was asymptomatic and in good clinical conditions. A complete evaluation led to the diagnosis of adenocarcinoma in the caecum with umbilical metastasis. During the hospital admission she underwent emergency colectomy for acute obstruction. An uneventful right colectomy was performed, but the lady died 21 months after surgery for diffuse metastases.

CLINICAL DISCUSSION

We performed a literature review of reports describing patients with umbilical metastases. Median survival rate was 7 months from the time of diagnosis of the umbilical metastasis (5 months in clinical reports and 8 months in autopsy studies). Observed survival rates were higher for patients with primary ovarian cancer (18 months), and endometrium (9 months). Median survival rate was 8 months in case of primary colon cancer. Chemotherapy and surgery allowed acceptable survival and quality of life in 8 patients with umbilical metastasis from colon cancer.

CONCLUSION

Clinical experience suggests that an aggressive approach may offer to selected groups of patients with umbilical metastasis from abdominal cancer acceptable quality of life and improved survival probabilities.