Case Report
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World J Gastrointest Surg. Oct 27, 2013; 5(10): 272-277
Published online Oct 27, 2013. doi: 10.4240/wjgs.v5.i10.272
Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery
Tomohide Hori, Noriyuki Okada, Masaya Nakauchi, Shuji Hiramoto, Ayako Kikuchi-Mizota, Masahisa Kyogoku, Fumitaka Oike, Hidemitsu Sugimoto, Junya Tanaka, Yoshiki Morikami, Kaori Shigemoto, Toyotsugu Ota, Masanobu Kaneko, Masato Nakatsuji, Shunji Okae, Takahiro Tanaka, Daigo Gunji, Akira Yoshioka
Tomohide Hori, Noriyuki Okada, Masaya Nakauchi, Fumitaka Oike, Takahiro Tanaka, Daigo Gunji, Department of Surgery, Mitsubishi Kyoto Hospital, Kyoto 615-8507, Japan
Shuji Hiramoto, Ayako Kikuchi-Mizota, Akira Yoshioka, Department of Medical Oncology, Mitsubishi Kyoto Hospital, Kyoto 615-8507, Japan
Masahisa Kyogoku, Department of Histopathology, Mitsubishi Kyoto Hospital, Kyoto 615-8507, Japan
Hidemitsu Sugimoto, Junya Tanaka, Yoshiki Morikami, Kaori Shigemoto, Masato Nakatsuji, Department of Gastroenterology, Mitsubishi Kyoto Hospital, Kyoto 615-8507, Japan
Toyotsugu Ota, Masanobu Kaneko, Department of Radiology, Mitsubishi Kyoto Hospital, Kyoto 615-8507, Japan
Shunji Okae, Department of Internal Medicine, Mitsubishi Kyoto Hospital, Kyoto 615-8507, Japan
Author contributions: Hori T and Okada N perform this surgery; Nakauchi M provided the opinion of SILS in this case; Yoshioka A, Hiramoto S and Kikuchi-Mizota A evaluated the meaning of protein assays; Kyogoku T performed histopathological assessments; Oike F, Tanaka T and Gunji D helped to discuss this surgery; Sugimoto H, Tanaka J, Morikami Y, Shigemoto K, Nakatsuji M and Okae S performed preoperative studies including endoscopic investigations, and provided informative opinions; Ota T and Kaneko M made detailed radiological studies; Hori T wrote this paper.
Correspondence to: Tomohide Hori, MD, PhD, Department of Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto 615-8507, Japan. horit@kuhp.kyoto-u.ac.jp
Telephone: +81-75-3812111 Fax: +81-75-3927952
Received: August 13, 2013
Revised: September 15, 2013
Accepted: October 16, 2013
Published online: October 27, 2013
Abstract

Sister Mary Joseph’s nodule (SMJN) is a rare umbilical nodule that develops secondary to metastatic cancer. Primary malignancies are located in the abdomen or pelvis. Patients with SMJN have a poor prognosis. An 83-year-old woman presented to our hospital with a 1-month history of a rapidly enlarging umbilical mass. Endoscopic findings revealed advanced transverse colon cancer. computer tomography and fluorodeoxyglucose-positron emission tomography revealed tumors of the transverse colon, umbilicus, right inguinal lymph nodes, and left lung. The feeding arteries and drainage veins for the SMJN were the inferior epigastric vessels. Imaging findings of the left lung tumor allowed for identification of the primary lung cancer, and a diagnosis of advanced transverse colon cancer with SMJN and primary lung cancer was made. The patient underwent local resection of the SMNJ and subsequent single-site laparoscopic surgery involving right hemicolectomy and paracolic lymph node dissection. Intra-abdominal dissemination to the mesocolon was confirmed during surgery. Histopathologically, the transverse colon cancer was confirmed to be moderately differentiated tubular adenocarcinoma. We suspect that SMJN may occur via a hematogenous pathway. Although chemotherapy for colon cancer and thoracoscopic surgery for the primary lung cancer were scheduled, the patient and her family desired home hospice. Seven months after surgery, she died of rapidly growing lung cancer.

Keywords: Umbilicus, Sister Mary Joseph, Single-incision laparoscopic surgery, Palliative operation, Hematogenous metastasis

Core tip: Cutaneous metastasis localized to the umbilicus is termed “Sister Mary Joseph’s nodule” (SMJN). SMJN is a rare nodule that originates from tumors in the abdomen or pelvis, and patients with SMJN show a poor prognosis. Previous reports of SMJN described direct disseminative or lymphogenous pathways. To our knowledge, SMJN via the hematogenous pathway is very rare. We herein report a case of advanced colon cancer with SMJN via a hematogenous metastatic pathway treated by palliative single-incision laparoscopic surgery.