[Umbilical cutaneous metastasis (or Sister Mary Joseph's nodule) disclosing an ovarian adenocarcinoma]

Abstract

In this study, the case is described of an umbilical metastasis as the presenting symptom of an ovarian adenosarcoma. The overall frequency of cutaneous metastases has been estimated at between 5 and 9%. Umbilical metastases are a rare occurrence: it is estimated that between 1 and 3% of patients with abdomino-pelvic disease present with an umbilical nodule. Epidemiological studies have shown the female predominance of this disease. The clinical characteristics of umbilical metastases cannot be visually distinguished from those of primary lesions. The clinical appearance is often that of a nodule of varying size, more or less painful, and sometimes ulcerated or suppurating as in the present case. The nodule may be indicative of cancer, or of cancer recurrence. The most frequently encountered histological type is adenocarcinoma (about 75% of cases), and is more rarely epidermoid, undifferentiated, or carcinoid. Etiological findings have indicated a digestive origin in over 55% of cases (stomach, colon, rectum, pancreas, in decreasing order of frequency), with a clear male predominance; cancers of gynecological origin are the second most frequent etiology, with ovarian cancers being the most common (34% of cases). Sister Mary Joseph nodule accounts for 60% of all malignant umbilical tumors (primary or secondary), and is usually associated with a poor prognosis (mean survival: 10-12 months). However, patient survival time could be lengthened by aggressive therapy, i.e., surgery combined with chemotherapy.