Publication

Abstract : An 85-year-old woman was admitted with vomiting and loss of appetite. Clinical examination revealed the presence of multiple nodular lesions in and around the umbilicus (Figures 1 and 2). She also had a mildly enlarged liver, which was firm and nodular. On further evaluation she was found to have mild renal failure (serum creatinine: 2.5 mg/dL; normal range: 0.5-1.2 mg/dL). Alkaline phosphatase also was mildly elevated (215 U/L; normal range: 38-126 U/L). Ultrasound study of the abdomen revealed the presence of ascites, with an enlarged liver with enhanced echoes and minimal intrahepatic biliary radical dilatation. CA 125 levels were elevated in both blood and ascites. Fine-needle aspiration cytology of the umbilical nodule was reported as papillary adenocarcinoma; however, the primary could not be identified. A contrast-enhanced computed tomography scan of the abdomen was deferred due to the renal failure. Besides, considering her age and advanced stage of malignancy, the family opted for palliative care. The periumbilical lesions described above are suggestive of Sister Mary Joseph's node.