title: Sister Joseph's nodule in a liver transplant recipient: Case report and mini-review of literature.
abstract: BACKGROUND: Umbilical metastasis is one of the main characteristic signs of extensive neoplastic disease and is universally referred to as Sister Mary Joseph's nodule. CASE PRESENTATION: A 59-years-old Caucasian female underwent liver transplant for end stage liver disease due to hepatitis C with whole graft from cadaveric donor in 2003. After transplantation the patient developed multiple subcutaneous nodules in the umbilical region and bilateral inguinal lymphadenopathy. The excision biopsy of the umbilical mass showed the features of a poorly differentiated papillary serous cystadenocarcinoma. Computed tomographic scan and transvaginal ultrasonography were unable to demonstrate any primary lesion. Chemotherapy was start and the dosage of the immunosuppressive drugs was reduced. To date the patient is doing well and liver function is normal. CONCLUSIONS: The umbilical metastasis can arise from many sites. In some cases, primary tumor may be not identified; nonetheless chemotherapy must be administrated based on patient's history, anatomical and histological findings.
authors.affiliation: Department of Transplant Surgery, St, Martino Hospital-University of Genoa, Genoa, Italy. fabriziopanaro@hotmail.com.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Panaro
authors.forename: Enzo
authors.initials: E
authors.lastname: Andorno
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Domenico
authors.forename: Nicola
authors.initials: N
authors.lastname: Morelli
authors.forename: Giuliano
authors.initials: G
authors.lastname: Bottino
authors.forename: Rosalia
authors.initials: R
authors.lastname: Mondello
authors.forename: Marco
authors.initials: M
authors.lastname: Miggino
authors.forename: Tomasz M
authors.initials: TM
authors.lastname: Jarzembowski
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Ravazzoni
authors.forename: Marco
authors.initials: M
authors.lastname: Casaccia
authors.forename: Umberto
authors.initials: U
authors.lastname: Valente