Sister Mary Joseph's nodule: a rare cytologic presentation

Area of Science:

• Oncology
• Cytopathology
• Surgical Pathology

Background:

• Umbilical metastasis, known as Sister Mary Joseph's nodule, is a recognized sign of advanced malignancy, typically originating from gastrointestinal or pelvic cancers.
• While often indicative of widespread disease, the primary tumor remains occult in 15-30% of cases.
• This nodule can be an early or sole clinical manifestation of an underlying neoplasm.

Observation:

• A case presenting with an umbilical nodule was evaluated.
• Fine needle aspiration (FNA) cytology was performed for diagnostic purposes.
• The cytologic findings were analyzed to determine the nature of the umbilical lesion.

Findings:

• The fine needle aspiration (FNA) cytologic examination revealed metastatic ovarian carcinoma.
• This represents a rare diagnosis of an umbilical metastasis originating from ovarian cancer.
• The cytologic features were consistent with adenocarcinoma, necessitating further investigation for the primary ovarian tumor.

Implications:

• This case underscores the importance of considering gynecologic malignancies, particularly ovarian cancer, in the differential diagnosis of Sister Mary Joseph's nodule, even when the primary site is not immediately apparent.
• Fine needle aspiration (FNA) cytology is a valuable tool for the initial diagnosis of umbilical metastases, guiding subsequent clinical management.
• Increased awareness of this rare presentation can improve diagnostic yield and facilitate timely treatment for patients with occult primary ovarian cancer.