A Case of Umbilical Metastasis as the Presenting Sign of Pancreatic Adenocarcinoma

Chang, Woo Im; Han, Sok Won; Yoon, Jong Goo; Lee, Dae Hoon; Sung, Yong Jik; Kim, Bung Wook; Kim, Jin Il; Park, Soo Hun; Oh, Soo Hyuk; Song, Ho Jin; Choi, Kyu Yong; Sun, Hee Shik

Abstract

Metastatic cancer of the umbilicus is very rare and is called Sister Mary Joseph's nodule. The most common primary site of umbilical metastasis is an adenocarcinoma of the stomach and the incidence of pancreatic carcinoma is less than 10% of umbilical metastases. Metastasis to the umbilicus usually presents as diffuse spreading of primary cancer or recurrence after treatment of primary cancer, resulting in inoperability and poor prognosis. However, umbilical metastasis presents rarely as a first sign of primary cancer and leads to its diagnosis. We report a case of umbilical metastasis as a presenting sign of pancreatic adenocarcinoma. The patient was a 38-year-old woman who had a nodule in the umbilicus and suffered from abdominal pain around the umbilicus. Histologic findings of the umbilical nodule showed poorly differentiated adenocarcinoma. Abdominal computed tomography showed a pancreatic tail mass. Ultrasonography-guided aspiration biopsy of the pancreas also revealed poorly differentiated adenocarcinoma almost identical to the pathologic finding of the umbilicus.