Uyama Takuto, Matoba Yusuke, Nakahara Hikaru, Ishikawa Akira, Niitsu Hiroaki, Nakamoto Kosuke, Koh Iemasa, Mii Shinji, Hinoi Takao, Banno Kouji
Department of Obstetrics and Gynecology, Hiroshima University Hospital, Kasumi 1-2-3 Minami-ku, Hiroshima, 734-8551, Japan.
Department of Clinical and Molecular Genetics, Hiroshima University Hospital, Hiroshima, Japan.
J Med Case Rep. 2025 Aug 22;19(1):425. doi: 10.1186/s13256-025-05432-7.
A Sister Mary Joseph's nodule is an umbilical metastasis from an intra-abdominal or pelvic malignancy, associated with a poor prognosis. Three possible metastatic pathways for Sister Mary Joseph's nodule have been postulated: hematogenous spread, lymphatic dissemination, and direct invasion. However, detailed analyses of these metastatic pathways, particularly those involving gene expression profiling, are lacking in literature. We investigated the metastatic patterns of Sister Mary Joseph's nodule by performing RNA microarray analysis of the primary tumor and each metastatic site in a case of fallopian tube cancer presenting with Sister Mary Joseph's nodule and inguinal lymph node metastases.
A 48-year-old Japanese woman presented with swelling in an inguinal lymph node. Positron emission tomography-computed tomography imaging revealed multiple lymph node metastases, right ovarian tumor, umbilical metastasis, and peritoneal dissemination. The patient underwent a laparoscopic right adnexal resection, left inguinal lymph node biopsy, and umbilical resection. Pathological examination confirmed the diagnosis of primary high-grade serous carcinoma of the right fallopian tube. Metastatic high-grade serous carcinoma was identified in the lymph nodes and umbilical tissue. Tumor tissue samples were collected from the primary lesion, umbilical metastasis, and inguinal lymph node metastasis for RNA microarray analysis. The results showed that genes involved in cell adhesion, migration, and stromal remodeling associated with the metastatic processes were more highly expressed in both inguinal lymph node metastasis and Sister Mary Joseph's nodule than in the primary lesion. Interestingly, distinct differences in gene expression profiles were observed between umbilical and lymph node metastases, suggesting different metastatic mechanisms.
Our findings suggest differences in the RNA expression patterns between Sister Mary Joseph's nodule and lymph node metastases in fallopian tube cancer, indicating the possibility of distinct metastatic mechanisms. Further examination of similar cases and longitudinal studies are necessary to elucidate the metastatic patterns of Sister Mary Joseph's nodule. This case highlights the potential value of molecular profiling for understanding the complex metastatic processes in gynecological malignancies.
玛丽·约瑟夫修女结节是腹内或盆腔恶性肿瘤的脐部转移灶，与预后不良相关。关于玛丽·约瑟夫修女结节有三种可能的转移途径被提出：血行播散、淋巴道转移和直接侵犯。然而，文献中缺乏对这些转移途径的详细分析，尤其是涉及基因表达谱分析的内容。我们通过对一例伴有玛丽·约瑟夫修女结节和腹股沟淋巴结转移的输卵管癌患者的原发肿瘤及每个转移部位进行RNA微阵列分析，研究了玛丽·约瑟夫修女结节的转移模式。
一名48岁日本女性因腹股沟淋巴结肿大就诊。正电子发射断层扫描-计算机断层扫描成像显示多处淋巴结转移、右侧卵巢肿瘤、脐部转移和腹膜播散。患者接受了腹腔镜下右侧附件切除术、左侧腹股沟淋巴结活检和脐部切除术。病理检查确诊为右侧输卵管原发性高级别浆液性癌。在淋巴结和脐部组织中发现了转移性高级别浆液性癌。从原发灶、脐部转移灶和腹股沟淋巴结转移灶采集肿瘤组织样本进行RNA微阵列分析。结果显示，与转移过程相关的细胞黏附、迁移和基质重塑相关基因在腹股沟淋巴结转移灶和玛丽·约瑟夫修女结节中的表达均高于原发灶。有趣的是，脐部转移和淋巴结转移之间观察到基因表达谱的明显差异，提示不同的转移机制。
我们的研究结果表明，输卵管癌中玛丽·约瑟夫修女结节和淋巴结转移的RNA表达模式存在差异，提示可能存在不同的转移机制。有必要进一步检查类似病例并进行纵向研究，以阐明玛丽·约瑟夫修女结节的转移模式。本病例突出了分子谱分析在理解妇科恶性肿瘤复杂转移过程中的潜在价值。
