Umbilical mass as the sole presenting symptom of pancreatic cancer: a case report. E-mail: sobrado iconet. Umbilical nodes are rare. The metastatic involvement of the region was first described in Sister Mary Joseph was the first observer to establish the correlation between carcinomas and umbilical nodes.
If a person is experiencing pain or discomfort from a hernia, medication can help. Umbilical deposits from internal malignancy. Stomach Cancer Gastric Adenocarcinoma. Umbilical lump laparoscopic surgeryor keyhole, surgery, mesh and sutures will be pass through small incisions. If the doctor wants Umbilical lump screen for Umbliical, they may request an abdominal ultrasoundX-ray, or blood tests.
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Umbilical hernia An umbilical hernia creates a soft swelling or bulge near the navel. It is usually described as a painful nodule with irregular margins and a mean diameter of 2 to 3 cm. About About Drugs. The application of pressure to a point of weakness in a muscle can lead to the emergence of hernias. Hematomas typically resolve without needing Umbiliacl. Subscribe to our newsletters. Stomach Cancer Gastric Adenocarcinoma. Other natural phenomena Umbilical lump constipation, diarrhea, and persistent coughing can also lead to hernias. An umbilical hernia creates a soft swelling or bulge near the Umbilical lump umbilicus. You can lessen this symptom by eating foods that produce less acid.
An abdominal lump is a swelling or bulge that emerges from any area of the abdomen.
- An abdominal lump is a swelling or bulge that emerges from any area of the abdomen.
- Daneshbod Laboratory, Shiraz, Iran.
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Umbilical mass as the sole presenting symptom of pancreatic cancer: a case report. E-mail: sobrado iconet. Umbilical nodes are rare. The metastatic involvement of the region was first described in Sister Mary Joseph was the first observer to establish the correlation between carcinomas and umbilical nodes. The umbilical node may be the sole presenting sign of cancer and is usually associated with advanced disease and poor prognosis.
A year-old woman, previously healthy, presented vague abdominal discomfort and a hard umbilical nodule for 1 week, which was first diagnosed as an incarcerated umbilical hernia. She underwent a new clinical assessment and biopsy. After immunohistochemical analysis and computerized tomography, she was diagnosed with pancreatic cancer. The clinical staging showed advanced disease with distant metastasis. She received palliative chemotherapy. After 8 months, she was alive in poor clinical condition.
Clinical suspicion should lead to a careful additional evaluation whenever an umbilical nodule presents with malignant signs. Key words: Sister Mary Joseph's nodule. Umbilical mass. Unknown primary site. A paciente foi submetida a quimioterapia paliativa. Massa umbilical. Tumors of the umbilicus are rare. The metastatic involvement of the region due to visceral carcinomas is even less frequent.
The author found only 2 cases of umbilical involvement among deaths from cancer in the period of to Her name was attributed to this clinical feature, which was designated as "Sister Mary Joseph's" sign. Even though it is a rare clinical finding, an umbilical mass may be the sole presentation of malignant tumors. This review found a total of cases and 85 nodules from unknown primary tumors.
Concerning pancreatic tumors, only 12 cases had been reported. We undertook this bibliographic research using the PubMed database and the following keywords: "Sister Mary Joseph's nodule", unknown primary tumor, pancreatic cancer, umbilical metastasis. A careful clinical examination and extensive diagnostic procedures should be performed for all patients presenting with umbilical nodules.
To illustrate and emphasize this point, we report a case of an umbilical mass as the only presenting sign of adenocarcinoma of the pancreas. A year-old woman presented with a 3-month history of vague abdominal discomfort in the epigastric region, with no irradiation sites, slowly progressive, and not related to food intake. She had noticed an umbilical nodule the previous week. She did not present with weight loss, fever, or other systemic symptoms.
She denied having cardiorespiratory discomfort or gastrointestinal complaints. Her referral doctor general practice first diagnosed the mass as an incarcerated umbilical mass. A surgeon re-examined and re-evaluated the patient. She presented in good general condition, well nourished, no palpable masses at the cervical, abdominal, or thoracic regions. On physical examination, a peri-umbilical nodule of 2 by 2 cm was noted, which was hyper-pigmented, indurated, discretely painful, and produced a fetid discharge.
Routine laboratory investigation showed normal results. The sonographic scan of the abdomen showed no abnormalities. At the first physical and laboratory investigation, the patient presented evidence of tumoral disease, with unknown primary tumor. Therefore, the umbilical nodule was resected for diagnostic purposes and an anatomic-pathologic analysis was performed Figure 1 , which showed a mucinous, poorly differentiated metastatic adenocarcinoma, suggestive of a GI tract stomach or pancreas or ovarian cancer.
Immunohistochemical analysis was positive for cytokeratin 7 and negative for cytokeratin This finding suggested a primary site at stomach or pancreas. Due to the anatomic-pathologic findings, an abdominal CT scan was performed. The exam showed a cystic and solid tumor of 6 cm in the pancreatic body Figure 2.
For staging purposes, a thoracic CT scan was also performed, and several pulmonary nodules, diagnosed as metastases, were encountered Figure 3. The brain CT scan showed no abnormalities.
The patient was referred to the medical oncology service for palliative chemotherapy because of advanced pancreatic cancer with peritoneal dissemination and lung metastases.
Even though the patient was alive 8 months after the diagnosis, she progressively deteriorated and presented in poor clinical condition. She had undergone thoracocentesis 3 times for relief of severe dyspnea. The finding of an umbilical nodule as the only clinical manifestation of a disease leads to several possible diagnoses including umbilical hernia, granuloma, attachments of the urachus, pilonidal sinus, omphalomesenteric duct abnormalities, endometriosis, and benign and malignant tumors.
Several modes of spreading to the umbilicus have been discussed. Metastasis to the umbilicus may occur due to proximity to the tumor, hematogenic and lymphatic dissemination, or via umbilical ligaments.
The most prevalent form of umbilical involvement is related to direct invasion of peritoneal metastasis. The retrograde flux from superficial and deep lymphatic systems originated at axillary, inguinal, and para-aortic nodes may lead to umbilical involvement.
Another possible form involves venous communication between the lateral thoracic veins and internal mammary vein with the portal circulation. However, the most prevalent primary sites are from intra-abdominal origin.
However, this data should be analyzed cautiously since it was partially obtained before modern radiological techniques. The metastatic umbilical nodule, known as Sister Mary Joseph's nodule, is morphologically firm, an indurated plaque or nodule with a vascular appearance, and may be fissured and ulcerated with some fetid discharge. However, it may also present as an uncharacteristic diffuse hardening of the umbilical region or as a profound node.
This figure demonstrates the importance of an evaluation of all umbilical lesions, especially in patients after the fifth decade of life. For diagnostic purposes, radiological methods and the anatomic-pathological analysis are extremely important. The microscopic analysis is especially attractive in such cases due to the favorable localization of umbilical nodes.
The usual evaluation with hematoxylin-eosin may differentiate primary and metastatic tumors. Edoute et al. Analyzed the cytologic material of 14 patients using fine-needle aspiration. The method had a sensitivity as high as Only 1 case was diagnosed as a false negative, since na inflammatory cell-containing aspiration was obtained. Moreover, radiological exams, such as ultrasound imaging, CT scan, or MRI have a poor cost-benefit relationship due to their low diagnostic power.
Those methods should be preserved for staging purposes or for special cases when the pathologist evaluation is not possible. The metastatic spread to the umbilical region representnaan advanced stage of the primary disease and worsened prognosis.
Consequently, palliative treatment is usually the only remaining therapeutic option. However, as previously discussna, an umbilical nodule may be the only presenting sign of cancer, enhancing the diagnosis before the appearance of more exuberant features, such as ascites, pulmonary masses, and bone metastasis, which are responsible for decreased quality of life and overall survival even after the administration of palliative treatment.
Even though it is a rare finnang, an umbilical mass may be the first manifestation of neoplastic disease, as was observed in the present case. Therefore, the clinical suspicion and diagnostic evaluation are extremely important for therapeutic and prognostic purposes. Shetty MR. Metastatic tumors of the umbilicus: a review J Surg Oncol ; Umbilical metastasis diagnosed by fine needle aspiration.
J Surg Oncol ; Barrow MV. Metastatic tumors of the umbilicus. J Chron Dis ; Umbilical mass as a presenting symptom of endometrial adenocarcinoma. Gynecol Obstet Invest ; Umbilical metastasis as the presenting sign of pancreatic adenocarcinoma. Cutis ; Tumors of the umbilicus. Mt Sinai J Med ; Visceral neoplasia presenting at the umbilicus.
Umbilical metastasis from carcinoma of the pancreas. Arch Dermatol ; Sharaki M, Abdel-Kadner M. Umbilical deposits from internal malignancy.
Clin Oncol ; Sister Mary Joseph's nodule: a study of the incidence of biopsied umbilical secondary tumors in a defined population. Br J Surg ; Sister Mary Joseph's sign from metastatic disease of the pancreas. J Am Coll Surg ; Image of the month.
During gestation, the umbilical cord passes through a small opening in the baby's abdominal muscles. Cameron JL, et al. Usually, these benign masses come up thanks to the cells in the region dividing without any inhibitions in a confined region of the anatomy. In adults, too much abdominal pressure contributes to umbilical hernias. Advertising revenue supports our not-for-profit mission.
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Lump in the abdomen: MedlinePlus Medical Encyclopedia
A lump in the abdomen is a small area of swelling or bulge of tissue in the belly. Most often, a lump in the abdomen is caused by a hernia. An abdominal hernia occurs when there is a weak spot in the abdominal wall. This allows the internal organs to bulge through the muscles of the abdomen. A hernia may appear after you strain, or lift something heavy, or after a long period of coughing. Call your health care provider if you have a lump in your abdomen, especially if it becomes larger, changes color, or is painful.
The blood supply may be cut off to the organs that stick out through the hernia. This is called a strangulated hernia. This condition is very rare, but it is a medical emergency when it occurs. The provider will examine you and ask questions about your medical history and symptoms, such as:.
Surgery may be needed to correct hernias that do not go away or cause symptoms. The surgery may be done through a large surgical cut, or through a smaller cut into which the surgeon inserts a camera and other instruments. Abdominal hernia; Hernia - abdominal; Abdominal wall defects; Lump in the abdominal wall; Abdominal wall mass. Siedel's Guide to Physical Examination. Abdominal wall, umbilicus, peritoneum, mesenteries, omentum, and retroperitoneum.
Sabiston Textbook of Surgery. Philadelphia, PA: Elsevier; chap Updated by: Debra G. Editorial team. Lump in the abdomen. There are several types of hernias, based on where they occur: Inguinal hernia appears as a bulge in the groin or scrotum.
This type is more common in men than women. Incisional hernia can occur through a scar if you have had abdominal surgery. Umbilical hernia appears as a bulge around the belly button. It occurs when the muscle around the navel does not close completely.
Other causes of a lump in the abdominal wall include: Hematoma collection of blood under the skin after injury Lipoma collection of fatty tissue under the skin Lymph nodes Tumor of the skin or muscles. When to Contact a Medical Professional. If you have a hernia, call your provider if: Your hernia changes in appearance.
Your hernia is causing more pain. You have stopped passing gas or feel bloated. You have a fever. There is pain or tenderness around the hernia. You have vomiting or nausea. What to Expect at Your Office Visit. The provider will examine you and ask questions about your medical history and symptoms, such as: Where is the lump located?
When did you first notice the lump in your abdomen? Is it always there, or does it come and go? Does anything make the lump bigger or smaller? What other symptoms do you have? During the physical exam, you may be asked to cough or strain. Alternative Names. Infant abdominal hernia gastroschisis.
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