University of Pittsburgh Medical Center Pittsburgh, PA
Muaz Aijazi, MD1, Ashish Ahuja, MD2, Rao M. Afzal, MD1, Abdelrhman Abo Zed, MD1, Mohamed Yassin, MD, PhD1; 1University of Pittsburgh Medical Center, Pittsburgh, PA; 2University of Maryland Medical Center, Baltimore, MD
Introduction: The incidence of umbilical skin metastasis secondary to intra-abdominal tumors is extremely low, and very rarely an initial manifestation of pancreatic cancer (1). Stomach and colon cancers are the most common sources of the condition in men, while for women it is the ovaries. Pancreatic cancer accounts for 7-9% of Sister Mary Joseph’s nodules (2,3). We present a case of a woman with umbilical metastasis as the initial presentation for abdominal visceral adenocarcinoma.
Methods: A 75-year-old female with a past medical history of hypertension and Hashimoto's thyroiditis presents to clinic complaining of a lesion and drainage from her umbilicus for the last 3 months. She denies any local trauma. She has a reduced appetite and fatigue, saying she does not have enough energy to cook at home. She has occasional abdominal pain which improves after she eats. Her PCP evaluated this lesion, and on cultures it grew prevotella and peptostreptococcus. She denies fevers, chills, or sweats over the 3-month time period. She is referred her for a CT scan of her abdomen at this time which shows a pancreatic tail lesion representing pancreatic adenocarcinoma, enlarged peripancreatic and gastrohepatic lymph nodes, and extensive peritoneal and omental metastases. Two hypodense lesions in the liver as well as a 2.1 cm periumbilical mass were also seen. After these findings, her and her PCP ultimately decided to pursue hospice care. Discussion: Traditionally, the presence of SMJN remains unnoticed in most cases until the malignant tumor is advanced and has thus been considered as a sign of poor prognosis. Based on one investigation the authors studied, the survival time without treatment ranged from 2 months to 11 months (average 10 months). Only 13.5% of patients with SMJN stayed alive after 2 years of umbilical metastasis. (4) To conclude, SMJN is a characteristic but easily overlooked dermatological sign of metastatic intra-abdominal tumors. Awareness of this specific manifestation enables physicians to properly assess the underlying malignancy.
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Gross image of umbilical lesion
Pancreatic body lesion with distal ductal dilatation concerning for pancreatic neoplasm seen on coronal view
Distal pancreatic body lesion with distal ductal dilatation concerning for PDAC
Disclosures: Muaz Aijazi indicated no relevant financial relationships. Ashish Ahuja indicated no relevant financial relationships. Rao Afzal indicated no relevant financial relationships. Abdelrhman Abo Zed indicated no relevant financial relationships. Mohamed Yassin indicated no relevant financial relationships.