Sister Mary Joseph nodule as a first manifestation of ovarian carcinoma
- PDF / 823,863 Bytes
- 4 Pages / 595.276 x 793.701 pts Page_size
- 80 Downloads / 161 Views
209 Hellenic Journal of Surgery 2010; 82: 2
Sister Mary Joseph Νodule as a First Manifestation of Ovarian Carcinoma Case Report A. Klimis, E. Karvounis Received 07/12/2009 Accepted 27/01/2010
Abstract A 46-year-old woman presented with a progressively growing umbilical tumour, draining pus-like material. Wedge biopsy of the lesion showed metastatic adenocarcinoma, involving the dermis and subcutis. The immunohistochemical staining results of the tumour cells were consistent with an ovarian origin, and subsequent evaluation of the patient with imaging studies confirmed the diagnosis of ovarian carcinoma. Cutaneous (umbilical) metastasis, as the initial manifestation of ovarian carcinoma, is rare. Such cases are inoperable and have very poor prognosis.
Keywords
Umbilical metastasis, Ovarian carcinoma, Immunohistochemistry
ule had gradually enlarged, but it was not until foulsmelling purulent discharge drained from the lesion that the patient consulted her surgeon. There were no other relevant features in the history. Examination revealed a well-looking woman, with a 3.2 cm hard infiltrating lesion with a scalloped edge overlying the umbilicus, in the centre of which was a small area of ulceration (Fig 1). The clinical impression was suggestive of pyogenic granuloma or benign tumour. Wedge biopsy of the nodule showed invasive adenocarcinoma of the dermis and subcutis. (Fig 2). Immunohistochemistry was performed on formalinfixed, paraffin- embedded tissue of the tumour using the immunoperoxydase method. The neoplastic cells were positive for Ca- 125 at their apical surface of the cytoplasm (Fig 3A), cytokeratin (CK) 7 in the
Introduction The metastatic umbilical nodule is often referred to as Sister Joseph’s nodule, in recognition of Sister Joseph, who first alerted William Mayo to this sign of abdominal metastatic malignancy [1]. Umbilical metastasis may represent the first clinical presentation of disseminated malignancy or indicate a recurrence in a patient with a previous internal cancer [1, 2]. Whereas in men these tumour nodules are often related to the gastrointestinal tract [3, 4], in women the main primary tumour is located in the genital tract, especially in the ovary [1, 2, 5, 6, 7, 8]. This report emphasizes the need for careful examination of any umbilical lesion and the importance of histological examination and immunohistochemical analysis in case of doubt.
Case report A 46-year-old woman, with a six-month history of umbilical nodule, presented to a surgeon. The nod-
Department of Pathology, 3rd Hospital of Social Insurance Institute, Athens, Greece Department of Pathology, Aretaieon Hospital, Athens University School of Medicine, Athens, Greece
Fig. 1 A 3.2 cm nodular lesion, proven to be a cutaneous umbilical metastasis of ovarian origin
cytoplasm (Fig 3B) and for oestrogen and progesterone receptor (nuclear staining). They were negative for CK20 and Carcinoembryonic antigen (C.E.A.). The morphology along with the immunophenotype of the tumour was in keeping with metastatic carcinoma, most li
Data Loading...
