Pancreatic Cancer with Umbilical Metastasis (Sister Mary Joseph\u27s Nodule)

A 60-year-old woman was admitted to Nagasaki Prefectural Shimabara Hospital, with a painful tumor in her umbilical region. The tumor was about 1×1 cm in size. Histological examination of biopsied specimens revealed it to be a metastatic adenocarcinoma. Abdominal computed tomography and ultrasonography revealed a cystic tumor of about 23 mm in diameter in the pancreatic body. In addition, serum levels of cancer antigen 19-9 were elevated. With a tentative diagnosis of pancreatic tumor, she underwent surgery. When we opened her peritoneal cavity, there was no evidence of intra-abdominal disseminations, liver metastases or ascites. At that time, distal pancreatectomy accompanied by splenectomy was the procedure of choice. Histological examination revealed a moderately differentiated adenocarcinoma in the pancreatic body along with fatty replacement of the pancreatic tail. The umbilical tumor was a metastatic adenocarcinoma, which is referred to as a Sister Mary Joseph\u27s nodule