Sister Mary Joseph Nodule as a Cutaneous Manifestation of Metastatic Appendiceal Adenocarcinoma: Case Report and Literature Review

Girijala, Raghavendra L; Riahi, Ryan R; Cohen, Philip R.

doi:10.7759/cureus.2244

Cited by 4 publications

(6 citation statements)

References 9 publications

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“…SJNs usually develop in patients with gastrointestinal and gynecological cancers [4,5,6,7,8,9,10]. SJN refers to a metastatic cancer of the umbilicus and is named after Sister Joseph, a nurse who frequently assisted Dr. William Mayo at St. Mary’s Hospital in Rochester, Minnesota, USA.…”

Section: Patterns Of Skin Metastasesmentioning

confidence: 99%

“…Skin metastases usually develop at the umbilicus, surgical scars, including laparoscopic port sites, and in the vicinity of metastatic lymph nodes [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46]. Skin metastases are often a late manifestation of the disease; however, in certain cases they may sometimes be the first sign of internal malignancies such as lung, renal, and ovarian cancers [47].…”

Section: Introductionmentioning

confidence: 99%

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Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms

Otsuka

2019

IJMS

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Cutaneous metastases from internal malignancies are uncommon. Umbilical metastasis, also known as Sister Joseph nodule (SJN), develops in patients with carcinomatous peritonitis or superficial lymphadenopathy, while non-SJN skin metastases develop after surgery, injury, and lymphadenopathy. In this review, the possible mechanisms of skin metastases are discussed. SJNs develop by the contiguous or lymphatic spread of tumor cells. After surgery and injury, tumor cells spread by direct implantation or hematogenous metastasis, and after lymphadenopathy, they spread by extranodal extension. The inflammatory response occurring during wound healing is exploited by tumor cells and facilitates tumor growth. Macrophages are crucial drivers of tumor-promoting inflammation, which is a source of survival, growth and angiogenic factors. Angiogenesis is promoted by the vascular endothelial growth factor (VEGF), which also mediates tumor-associated immunodeficiency. In the subcutaneous tissues that surround metastatic lymph nodes, adipocytes promote tumor growth. In the elderly, age-associated immunosuppression may facilitate hematogenous metastasis. Anti-VEGF therapy affects recurrence patterns but at the same time, may increase the risk of skin metastases. Immune suppression associated with inflammation may play a key role in skin metastasis development. Thus, immune therapies, including immune checkpoint inhibitors reactivating cytotoxic T-cell function and inhibiting tumor-associated macrophage function, appear promising.

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Section: Patterns Of Skin Metastasesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms

Otsuka

2019

IJMS

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“…Metastasis to the umbilicus from GC is a rare condition, and only few cases have been previously reported [7][8][9][10][11][12][13][14][15]. SMJN is the term commonly used to refer to cutaneous metastasis from internal malignancies.…”

Section: Discussionmentioning

confidence: 99%

“…Metastasis to the umbilicus may be the only presenting symptom. However, solitary umbilical metastases are extremely rare, and most patients present in a poor clinical state with several physical signs such as ascites and pleural effusion [9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

A Huge Sister Mary Joseph’s Nodule From Signet Ring Cell Gastric Carcinoma Showing Good Response to FOLFOX-Based Chemotherapy Regimen

et al. 2022

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Metastatic involvement of the umbilicus as a result of a visceral carcinoma is a rare entity known as Sister Mary Joseph's nodule (SMJN). The most common primary sites are the gastrointestinal and gynecological tract. The occurrence of SMJN is commonly associated with advanced peritoneal disease and poor prognosis. The average survival time at the appearance of an umbilical metastasis is estimated at 10 months, and only 13% of patient will be alive at 2 years. Treatment usually involves systemic chemotherapy and palliative care, but the possibility of surgical resection should be considered especially if good response to systemic treatment is achieved in selected patients to maintain or to improve the quality of life. We describe here an unusual case of a 60-year-old man referred with enlarging umbilical lesion, identified as SMJN, that was metastasized from advanced signet ring cell carcinoma of the stomach with generalized peritoneal carcinomatosis. The nodule had rapid progression, and in a few days had reached 15 cm. Chemotherapy was started immediately and patient achieved good clinical and radiological response. A resection of the umbilical nodule was discussed but the patient unfortunately died following a massive pulmonary embolism. This case is unique in view of the unusual size of the SMJN in our patient and the good response to chemotherapy. We present this case to increase physician's awareness for careful evaluation of the umbilical area and encourage them to look for a primary digestive tumor if an umbilical nodule is observed. Therapeutic response to primary chemotherapy may encourage a multimodal approach allowing resectability of the metastatic umbilical nodule.

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“…Upon discovery of umbilical lesion in our patient, she was also promptly evaluated with biopsy to determine metastasis. Biopsy is also helpful in differentiating these nodules from benign swellings in the umbilicus, such as hernia, fibroma, cyst, keloids, abscess, and benign nodules (pseudo-SMJN) [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Sister Mary Joseph’s Nodule: Where Umbilicus Holds the Truth!

Dhruv

Anwar

Polavarapu

et al. 2021

Cureus

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An umbilical metastasis from an internal visceral malignancy is defined as Sister Mary Joseph's nodule (SMJN), and, although a rare finding, it is a very poor prognostic indicator. We describe an interesting case of metastatic colon cancer with SMJN, emphasizing the significance of this classic finding. A 64-year-old female with a history of stage IV colon cancer with palliative right hemicolectomy and left hepatectomy presented to the hospital with nausea and abdominal discomfort. A computed tomography (CT) scan of the abdomen was performed, which showed small bowel obstruction secondary to metastatic tumor mass compressing the duodenum. She refused to undergo any chemotherapy or endoscopic intervention and was eventually discharged on hospice care. During the hospital stay an umbilical ulcerative lesion was also noted, which was violaceous, measuring 4.5 x 4 cm in size, firm in consistency with irregular borders, and tender to touch. Therefore, further history was obtained from the patient about it. Several months ago, she had developed localized swelling around the umbilicus, which gradually enlarged and ulcerated later. She eventually underwent the biopsy of that umbilical lesion, which confirmed it as SMJN with metastasis from the colonic primary. However, the patient refrained from the surgical intervention of the umbilical lesion. SMJN presents as a palpable periumbilical metastatic mass with diameter usually not exceeding 5 cm in size. It can be variable in color from violaceous to reddish brown. Once discovered, such lesions should be worked up with biopsy and imaging studies such as CT scan of the abdomen, as the nodule may be indicative of underlying malignancy or cancer recurrence. Its presence indicates a poor prognosis, with average survival time after diagnosis of SMJN of 10 months.

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Sister Mary Joseph Nodule as a Cutaneous Manifestation of Metastatic Appendiceal Adenocarcinoma: Case Report and Literature Review

Cited by 4 publications

References 9 publications

Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms

Cutaneous Metastasis after Surgery, Injury, Lymphadenopathy, and Peritonitis: Possible Mechanisms

A Huge Sister Mary Joseph’s Nodule From Signet Ring Cell Gastric Carcinoma Showing Good Response to FOLFOX-Based Chemotherapy Regimen

Sister Mary Joseph’s Nodule: Where Umbilicus Holds the Truth!

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