Images in Clinical Practice
Nabar, Kiran; Desai, Chirag1,
Pooja Clinic, Alibag, Raigad, Maharashtra, India
1Divya Sparsh Skin and Hair Clinic, Dadar, Mumbai, Maharashtra, India
Address for correspondence: Dr. Chirag Desai, B21, Krishnalaya Society, 6th Floor, N. S. Mankikar Marg, Chunabhatti-West, Mumbai- 400022, Maharashtra, India. E-mail: [email protected]
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A 68-year-old male patient presented with an asymptomatic hyperpigmented lesion on the umbilicus for the last 2 months. The patient complained of a vague feeling of lower abdominal discomfort and significant weight loss for a few months. On examination, there was a hyperpigmented non-tender, stony hard noduloplaque with peripheral erythema and oozing, crusting on the surface, in the umbilical region. No lymph nodes were palpable [Figure 1]. Biopsy revealed diffuse infiltration of the dermis by neoplastic cells arranged in variable-sized solid cords and at places having an ill-formed glandular pattern with lumina containing necrotic debris, findings consistent with cutaneous metastasis from an adenocarcinoma [Figures 2 and 3]. The CT scan of the abdomen/pelvis revealed primary involvement of the body of the pancreas with metastatic deposits involving the liver, perihepatic soft tissues, mesentery, seminal vesicles with extension into adjacent mesentery abutting the anterior surface of the rectum/rectosigmoid junction and umbilicus/peri-umbilical region. A few enlarged retroperitoneal lymph nodes were seen close to the mass. Similarly, enlarged lymph nodes were also present bilaterally in the inguinal region. The clinicians must keep in mind the possibility of cutaneous metastasis from an internal organ whenever they come across an unusual nodule or a seemingly eczematous plaque in the umbilical region.[1,2]
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Figure 1: Nodular lesion with a hyperpigmented oozy crusted surface and peripheral erythema
Figure 2: Diffuse infiltration of the dermis with solid cords and ill-formed glandular structures [H&E × 40]
Figure 3: Ill-formed glandular structures with cells showing cytological atypia [H&E × 400]
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References
1. Tso S, Brockley J, Recica H, Ilchyshyn A. Sister Mary Joseph's nodule:An unusual but important physical finding characteristic of widespread internal malignancy. Br J Gen Pract 2013;63:551–2
2. Gabriele R, Conte M, Egidi F, Borghese M. Umbilical metastasis:Current viewpoint. World J Surg Oncol 2005;3:13
