Sister Mary Joseph Nodule in a Patient With Advanced Prostate Cancer

Abstract

Prostate cancer is the second most common cause of cancer death among US men. Metastasis typically occurs in the bone, lymph nodes, liver, and thorax. This case highlights a patient who was suspected of having prostate cancer several years before presenting to the emergency department with back pain and an umbilical hernia of increasing size. Gross examination revealed fixed masses on the abdominal wall that appeared malignant on computed tomographic imaging. The umbilical mass was a Sister Mary Joseph nodule (SMJN), which is sometimes found in patients with advanced, metastatic abdominal cancer. An SMJN is most commonly suggestive of gastrointestinal or gynecologic cancer, but it is a rarely reported finding in the context of prostate cancer. SMJN is a frequently missed finding that may delay further investigation for malignant neoplasms. This case reinforces the importance of this physical examination finding and provides evidence for adding prostate cancer to the list of possible diagnoses for patients who have an SMJN.

Untitled

“…In women, the most frequent primary locations are ovarian cancer (34%), endometrial cancer (12%), and colorectal cancer (12%) [1]. Other rare causes have also been reported, such as lymphoma [6] and metastatic prostate cancer [7]. Not all umbilical nodules represent malignant tumors.…”

Uncommon Manifestation of Oligometastatic Prostate Cancer

“…7 Histopathology is vital in confirming the diagnosis and suggesting a possible primary tumor location. [8][9][10] In contemporary patients, the most common sites of metastatic involvement from PC are iliac lymph nodes, skeleton, and lungs, and rarely the bladder, liver, testis, and brain. 11 Skin is an uncommon site, with PC accounting for less than 1% of all skin metastases.…”

“…Only a few case reports have described the prostate as a primary site 7. Histopathology is vital in confirming the diagnosis and suggesting a possible primary tumor location [8][9][10]. In contemporary patients, the most common sites of metastatic involvement from PC are iliac lymph nodes, skeleton, and lungs, and rarely the bladder, liver, testis, and brain 11.…”