Hepatocellular adenoma (HCA) is an uncommon benign liver neoplasm usually solitary and identified incidentally on imaging. We report a case of a 50-year old female who was diagnosed with multiple hepatic adenomas of the inflammatory subtype. After discontinuation of oral contraception a decrease of both the number and size of the liver lesions was seen on magnetic resonance imaging (MRI) without the need of further intervention. The major challenge in the clinical management of patients with multiple HCAs resides in the risk assessment for future complications. In the case of multiple HCAs subtype seemed to be more relevant than the actual number of lesions. Because little is known about the natural evolution in patients with multiple HCAs, we performed a review of the current literature with focus on the different subtypes and their clinical relevance.

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Background: Umbilical metastasis, also known as Sister Mary Joseph nodule, is a rare pathognomonic clinical sign suggesting the presence of an internal cancer. Case Presentation: We describe two female patients with Sister Mary Joseph nodule. In one case, there was a relapse of cancer. In the other patient, the Sister Mary Joseph nodule was the first and only clinical sign of an abdominal malignancy. We will briefly discuss the association with various internal malignancies as well as the pathogenesis and differential diagnosis. Conclusion: We conclude that Sister Mary Joseph nodule is a sign of intra-abdominal malignancy most frequently associated with gastro-intestinal or gynecological cancer. It can be the first and only clinical sign of abdominal malignancy in an otherwise healthy appearing patient or it can be an indication of oncological progressive disease, tumor relapse. Umbilical lesions should raise suspicion of a Sister Mary Joseph nodule, but a differential diagnosis must be made with other primary umbilical malignancies as well as with benign conditions involving the umbilicus.