MULTIMEDIA ARTICLE- Clinical Imaging Metastatic Mucinous Cystic Adenocarcinoma of the Pancreas Presenting as Sister Mary Joseph’s Nodule

Context Sister Mary Joseph’s nodule usually represents metastatic cancers from gastro-intestinal malignancy including adeno-carcinoma of the pancreas. Mucinous cyst-adenocarcinoma is a rare malignancy of the pancreas. However, pancreatic mucinous cystadenocarcinoma metastasized to Sister Mary Joseph’s nodule is much rarer and has never been reported before. Case report A 73-year-old Thai woman presented with progressive epigastric discomfort, severe back pain and significant weight loss over a 3 month period. Physical examination revealed right supraclavicular lymphadenopathy and Sister Mary Joseph’s nodule at the umbilicus. A CT scan showed a large cystic lesion with internal septation at the pancreatic tail. Cyst fluid analysis revealed a brown mucoid fluid having high carcinoembryonic antigen and carbohydrate antigen 19-9 levels. Skin biopsy from the nodule confirmed the presence of metastatic mucinous cystadenocarcinoma. Conclusion To our knowledge, this is the first report of pancreatic mucinous cystadenocarcinoma metastasized as Sister Mary Joseph’s nodule