[A Case of Successful Curative Treatment Following Chemotherapy for Gastric Cancer with Sister Mary Joseph's Nodule]

A woman in her 50s presented to our department of plastic surgery with a complaint of a nodule in the umbilical region. CT revealed an umbilical tumor and thickening of the anterior wall of the stomach, raising suspicion of gastric cancer with umbilical metastasis. She was referred to surgery. Upper endoscopy identified advanced gastric cancer(type 2)in the greater curvature of the gastric body. PET-CT showed abnormal uptake in the greater curvature of the gastric body, umbilical region, right ovary, and lymph nodes. She was diagnosed with gastric cancer(T4aN3aM1, cStage ⅣB)and underwent chemotherapy. A CT scan after the fourth course showed significant tumor shrinkage, making identification difficult. After 9 months of chemotherapy, upper endoscopy showed marked tumor shrinkage, and CT and PET-CT scans showed that the primary and metastatic lesions were indistinguishable. Exploratory laparoscopy and umbilical biopsy revealed no gross dissemination, and histologically, no tumor cells were found in the umbilical area or ascites. Conversion surgery was deemed appropriate and performed, including distal gastrectomy with bilateral salpingo-oophorectomy. No metastases were found in the lymph nodes or adnexa, and she was diagnosed with ypStage ⅠB(T2N0M0). Adjuvant chemotherapy was administered, and she remains recurrence-free 14 months post-surgery.