An ominous sign from Sister Mary Joseph: LANCET case report
A 39-year-old man presented with a 2-month history of painful nodules in his umbilicus. He had been diagnosed with gastric ring cell carcinoma of the stomach with extensive metastasis 9 months earlier. An ill-defined, firm, indurated plaque, with multiple nodules in and around the umbilicus, was found on examination.

A skin biopsy sample showed extensive infiltration of the dermis by signet ring cells. A diagnosis of Sister Mary Joseph's nodule was made: the lesion in the umbilicus was caused by metastases from the gastric carcinoma. A CT scan of his abdomen revealed thickening of the gastric wall and a mass forming posteriorly.

He was given intravenous chemotherapy every 2 weeks: fluorouracil 2400 mg/m2, oxaliplatin 70 mg/m2, and docetaxel 50 mg/m2, for eight cycles. He was then given one cycle of the combined oral treatment, 25 mg/m2 twice a day, of tegafur, gimeracil, and oteracil for 28 consecutive days; this was followed by 14 days of rest.

However, the primary tumour remained unchanged. The patient decided not to continue with chemotherapy and died of multiorgan metastasis 4 months later.

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