Sister Mary Joseph's Nodule: A case of umbilical metastasis
The present case has been reported in NEJM.

A 12-year-old girl presented with a one-month history of decreased appetite, vomiting, and weight loss. The patient had had no fevers or night sweats. Physical examination revealed a distended abdomen with a fluid wave, a palpable pelvic mass, and a tumor protruding through the umbilicus (Panel A).

Computed tomographic scanning showed a large pelvic mass probably originating from the ovary, omental and hepatic metastases, ascites, and a mass through the umbilicus (Panel B). Pathological evaluation of a biopsy specimen revealed a desmoplastic small round-cell tumor. The patient received vincristine, doxorubicin, and cyclophosphamide alternating with etoposide and ifosfamide.

After two courses of therapy, the primary tumor and metastatic lesions remained unchanged, but the amount of ascites was decreased. Eight months after diagnosis, the patient was clinically well with stable disease.

Metastatic cancer of the umbilicus, known as Sister Mary Joseph's nodule, is typically associated with adult cancers of the gastrointestinal tract and ovary.

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