Sister Mary Joseph nodule revealing an ovarian carcinoma: a case report and review of the literature

Abstract

BACKGROUND: The Sister Mary Joseph's nodule (SMJN) is an umbilical skin metastasis observed in the advanced stages of abdominopelvic malignancies. It is rare and is typically associated with a poor prognosis. The appearance of the skin lesions is non-specific, often leading to misdiagnosis. Early detection and diagnosis of the primary lesion are essential for prompt management and improved patient survival. CASE PRESENTATION: In this report, we present the case of a 68-year-old North African woman with a hypertensive disorder who was referred to our oncology center for an umbilical mass that had been present for 3 months. Abdominopelvic MRI revealed a cystic mass with endocystic vegetations, bilobed within the right ovary. A second cystic lesion with a solid component was also identified in the abdominopelvic region, extending into the umbilicus. Following biopsy, the immunohistochemical profile was consistent with adenocarcinoma of ovarian origin. The patient was treated with neoadjuvant chemotherapy and subsequently underwent surgery, and is currently undergoing maintenance therapy with bevacizumab, achieving excellent clinical, biological, and radiological response. CONCLUSION: Umbilical metastasis, although uncommon, constitutes a diagnostic challenge due to its non-specific clinical and radiological presentation, which may resemble benign lesions. Timely recognition of a Sister Mary Joseph's nodule is critical, as it may represent the initial manifestation of an underlying advanced malignancy, thereby enabling prompt diagnostic evaluation and initiation of appropriate oncologic management.