Diagnosis of carcinosarcoma metastatic to the umbilicus by fine needle aspiration biopsy: a case report.
BACKGROUND
Metastasis to the umbilicus, known as Sister Mary Joseph's nodule, sometimes represents the first clinical manifestation of an internal malignancy. These nodules are infrequent, and their discovery has prognostic implications.


METHODS
An 86-year-old woman presented with an ultrasound diagnosis of peritoneal carcinomatosis and the presence of a round lesion in the umbilical area. A fine needle aspiration biopsy was performed. The cytologic smears showed a biphasic neoplasm composed of malignant epithelial cells with a glandular appearance and randomly scattered spindle cells in a necrotic base. Immunohistochemical staining was performed to confirm the diagnosis.


CONCLUSIONS
After an extensive search of the literature, we discovered that this is the first report of a metastatic carcinosarcoma diagnosed by fine needle aspiration biopsy. The diagnosis of carcinosarcoma requires a clear definition of the 2 components, which is why immunohistochemical staining is very useful. The presence of an umbilical nodule should raise suspicion of an underlying malignant neoplasm. Needle aspiration biopsy should be considered as the most effective, simple, uncomplicated method of diagnosing these lesions.
Department of Anatomic Pathology, University Hospital, Autonomous University of Nuevo León, Fco. I Madero and Gonzalitos, C.P. 64460 Monterrey, Neuvo León, Mexico.
Oralia
O
Barboza-Quintana
Yuridia L
YL
Alvarado-Bernal
Juan Pablo
JP
Flores-Gutiérrez
Jesús
J
Ancer-Rodríguez
Raquel
R
Garza-Guajardo
D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle; D002296:Carcinosarcoma / Q000175:diagnosis* / Q000473:pathology; D002454:Cell Differentiation; D002467:Cell Nucleus / Q000473:pathology; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D007633:Keratins / Q000378:metabolism; D009362:Neoplasm Metastasis / Q000473:pathology*; D014472:Umbilicus / Q000473:pathology*; D014746:Vimentin / Q000378:metabolism
D014746:Vimentin; D007633:Keratins