UMBILICAL METASTASIS MIMICKING SYMPTOMATIC UMBILICAL HERNIA - A RARE CASE REPORT AND REVIEW OF THE LITERATURE

Umbilical metastases, also termed Sister Mary Joseph's nodule, are reported rarely in medical literature and they are associated with advanced metastatic intra-abdominal and pelvic cancers. The purpose of this publication is to report a rare case of umbilical metastasis misdiagnosed as acomplicated umbilical hernia. Case presentation. A 74-years-old woman with nausea and painful umbilical swelling was misdiagnosed as incarcerated umbilical hernia оn the initial examination. Abdominal computed tomography revealed a huge pelvic cystic-solid mass, probably originates from right ovary. Conclusion. In conclusion, the presented case demonstrated that due to the lack of understanding Sister Mary Joseph’s nodule could be easily mistaken for incarcerated umbilical hernia.

Scalp Metastasis as the First Presentation of an Underlying Aggressive Pancreatic Cancer

Pancreatic ductal adenocarcinoma, an extremely aggressive cancer, has high metastatic potential. Cutaneous metastasis is very uncommon, representing only <10% of all cases, presenting mostly around the umbilical region. Non-umbilical metastasis is even rarer, and the significance remains unknown. In this article, we describe a case of a 76-year-old gentleman who initially presented with an asymptomatic scalp lesion, which on biopsy revealed metastatic adenocarcinoma of pancreatic origin. Detailed workup revealed extremely high tumor burden with metastases involving muscles, subcutaneous tissues, bone, lung, spleen, liver, and colon. Cutaneous involvement in pancreatic cancer represents poor survival with widespread dissemination of the disease. The involvement of some sites and not others and the extreme degree of aggressiveness might reflect subgroups of this cancer with different molecular biology. Identifying these groups may have utility in determining prognosis and stratifying treatment for patients. This will hopefully translate into better diagnostic tests and therapies in the near future.

Pancreatic tumor metastasis to the navel in a case with three primary tumors – case report and review of the literature

Introduction. Sister Mary Joseph nodule (SMJN) is a metastasis that can occur in the umbilical region due to many tumors in the abdomen. Most of the cases are of gastrointestinal system origin and are often an indicator of poor prognosis. It can be seen in 1-3% of intraabdominal and pelvic malignancies. In the literature, around 300 studies are presented, mostly in the form of case reports. Very few (7-9%) of the cases with SMJN are from pancreatic origin. In our literature review, we found that in the majority (>90%) of SMJN cases due to pancreatic tumors, the lesions originated from the pancreatic tail and/or body, and tumor marker Ca-19.9 was very high in most cases (>90%). Aim. Here, the case of SMJN seen in a patient with three different primary tumors was discussed in the light of the literature data. Description of the case. Here, our case, whose third primary malignancy was detected in the pancreas in the PET/CT examination performed to investigate the origin of SMJN in a 68-year-old female patient who had undergone surgery due to breast in 2011 and endometrium cancers in 2018 and came with umbilical metastasis, is presented in the light of the literature data. Conclusion. As a result, in our case, which was followed up due to two primary tumors, it became important to know the origin of the SMJN that occurred due to the third primary tumor detected during the CT and PET/CT examination due to the newly emerging SMJN. It is important to know the origin and histopathological features of the SMJN in order to determine the treatment to the patient.

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

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.