Umbilical metastasis of intraabdominal malignancy in Aba, southeastern Nigeria: a case report, review of the literature, and a reminder for increased awareness of the problem

Abstract

Background: Whatever the classifica on and variant, virtually all intraabdominal malignancies without interven on, eventually spread to regional and/or distant lymph nodes or sites.

Observation: The first clinical manifesta ons of occult neoplasia, which are  sually intraabdominal malignancies, are frequent metastases to the mesenteric, supraclavicular sentinel [Virchow] nodes, and/or the umbilical region to form a subcutaneous nodule. This subcutaneous umbilical lesion is referred to as Sister May Joseph's nodule [SMJN]. The reason for this pa ern of metastasis is obscured. Ours is a mildly tender, hyper pigmented, periumbilical subcutaneous nodule of 3x2cm in dimension, in an elderly man of 84years old.

Method: Case note of the pa ent was retrieved for relevant informa on. The age, sex and date of first contact of the pa ent, his presen ng complaints, clinical findings and laboratory inves ga ons for diagnosis were the informa on extracted from the case file.

Result: Pa ent had a 3x2cm, mildly tender, variegated, periumbiliccal subcutaneous nodule. To the best of our knowledge, this is the first case of periumbilical metastasis of an intrabdominal malignancy [gastric carcinoma in this case] in our se ng, Abia State University Teaching Hospital, Aba, Southeastern Nigeria.

Conclusion: Non-tender, or mildly tender periumbilical nodule[s] may be the first clinical sign of the presence of an occult intraabdominal malignancy, and it is of poor prognostic value. Not all nodular lesions of the skin are melanocarcinoma: endometriosis, metastatic ovarian and pancrea c carcinomas, may be found at the umbilical region or laparotomy scars in females; but in males gastric, colonic, and rectal metasta c carcinomas may be the case. Ours is a metasta c gastric adenocarcinoma to the periumbilical region in an 84years old man.There is need for increased awareness, and hence, accurate diagnosis of all nodular lesions of the skin.

Keywords: Malignancy, Occult, Periumbilical, Sen nel, Intraabdominal