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LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 4  |  Page : 705-707
 

The unnoticed umbilical nodule of ovarian malignancy with seudomyxomaperitonei: A rare presentation


1 Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
2 Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India

Date of Web Publication10-Mar-2016

Correspondence Address:
K Hari
Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.178394

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How to cite this article:
Hari K, Jena A, Chowhan A K, Patnayak R, Reddy S K, Manilal B. The unnoticed umbilical nodule of ovarian malignancy with seudomyxomaperitonei: A rare presentation. Indian J Cancer 2015;52:705-7

How to cite this URL:
Hari K, Jena A, Chowhan A K, Patnayak R, Reddy S K, Manilal B. The unnoticed umbilical nodule of ovarian malignancy with seudomyxomaperitonei: A rare presentation. Indian J Cancer [serial online] 2015 [cited 2019 Dec 5];52:705-7. Available from: http://www.indianjcancer.com/text.asp?2015/52/4/705/178394


Sir,

A metastatic malignancy of the umbilicus commonly termed as “Sister Mary Joseph Nodule” is a rare occurrence and represent approximately 10% of all secondary tumours which have spread to the skin.[1] The most common primaries of Sister Mary Joseph Nodule are gastrointestinal (52%) tumors followed by gynecologic (28%) malignancies like ovarian and uterine cancers.[2] Ovarian malignancy (Borderline mucinous cystadenocarcinoma and mature teratoma) with Pseudomyxoma Peritonei and umbilical nodule is a rare presentation and has not been described in the literature to the best of our knowledge.

We describe an unusual case of a 40 year old female with abdominal distension and vague abdominal pain of two months duration. She did not have any significant illness in the past. On examination her abdomenwas found to be distended without any clinical evidence of free fluid. A swelling of 1 × 1 cm previously unnoticed by the patient was noted in the umbilical region without any cough impulse. Ultrasonography of the abdomen revealed bilateral adnexal masses and moderate ascites. Aspiration from umbilical nodule and peritoneal fluid cytology result was inconclusive. Serum CA-125 was found to be 5 μg/ml. Contrast Tomography (CT) scan of abdomen revealed heterogeneously enhancing bilateral adnexal masses. Right adnexal mass was 21 × 15 cm and left was 13 × 10 cm in diameter. Both showed presence of solid and cystic components. Based on these data an exploratory laparotomy was undertaken. Large amounts of yellow jelly like semisolid material were seen in the abdomen spreading from pelvis to sub-diagphragmatic region. The capsule of the right adenexal tumor was found to be ruptured. These masses were removed along with uterus. The jelly was present all over the abdomen from pelvis to sub-diaphragmatic region. Debulking was done removing most of the tumor. Appendix was found to be normal. The above mentioned umbilical nodule was excised [Figure 1] and [Figure 2].
Figure 1: Umbilical nodule

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Figure 2: Ovarian tumors (right and left from above downwards) with pseudomyxoma peritone and an umbilical nodule

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Histopathological examination revealed bilateral borderline mucinous cystadenocarcinoma and mature teratomas [Figure 3],[Figure 4],[Figure 5]. The omentum and umbilical nodule showed metastatic deposits in the form of tumor cells suspended in pools of mucin [Figure 6] and [Figure 7].
Figure 3: Borderline mucinous cystadenocarcinoma of ovary (H and E, ×20)

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Figure 4: High power view showing mucin filled vacuolated cytoplasm of the columnar lining cells (H and E, ×40)

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Figure 5: Mature teratomatous components in the form of cartilage, adipose tissue, smooth muscle bundles, columnar cell lined glands and pseudostartified columnar ciliated epithelium (H and E, ×20)

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Figure 6: Mucinous component of the tumour element getting highlighted by ALPAS stain (ALPAS, ×40)

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Figure 7: Microphotograph of umbilical nodule showing stratified squamous epithelium anddeep seated mucinous tumour element (H and E, ×20)

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The term “Sister Mary Joseph Nodule” is used to describe a metastatic umbilical nodule usually associated with advanced intra-abdominal cancer and its presence indicates a poor prognosis.[2] Umbilical metastasis is not a common phenomenon.[3] Though the common belief is that umbilical metastasis originates from abdomen or pelvic malignancies, Powell et al.opined that, in 32% of the cases, primary were benign neoplasms.[4] In the present case the primary was found to be borderline mucinous cystadenocarcinoma with mature teratoma which is quite unique. Moreover in this case the ovarian malignancy was associated with pseudomyxoma peritonei which is a relatively rare condition (1 case/million per year).[5]

Ovarian carcinomas with pseudomyxoma peritonei can present with a wide variety of presentations but an umbilical nodule in such a situation is very rare and has not been widely described in literature. An ovarian carcinoma should always be considered as a differential diagnosis in a case of umbilical nodule showing mucinous deposits.

 
  References Top

1.
Lookingbill D, Spangler N, Sexton FM. Skin involvement as the presenting sign ofinternal carcinoma. A retrospective study of 7316 cancer patients.J Am AcadDermatol 1990;22:19-26.  Back to cited text no. 1
    
2.
FratellonePM, HoloweckiMA. Forgotten node: A case report. World J Gastroenterol2009;15:4974-5.  Back to cited text no. 2
    
3.
Gabriele R, Conte M, Egidi F, Borghese M. Umbilical metastases: Current viewpoint. World J SurgOncol 2005;3:13.  Back to cited text no. 3
    
4.
Powell FC, Cooper AJ, Massa MC, Goellner JR, Su WP. Sister Mary Joseph's nodule: A clinical and histologic study. J Am AcadDermatol 1984;10:610-5.  Back to cited text no. 4
    
5.
GomezPortillaA, DeracoM, SugarbakerPH. Clinical pathway for peritoneal carcinomatosis from colon and rectal cancer: Guidelines for current practice. Tumori 1997;83:725-8  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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