title: Hematogenous umbilical metastasis from colon cancer treated by palliative single-incision laparoscopic surgery.
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.
authors.affiliation: Tomohide Hori, Noriyuki Okada, Masaya Nakauchi, Fumitaka Oike, Takahiro Tanaka, Daigo Gunji, Department of Surgery, Mitsubishi Kyoto Hospital, Kyoto 615-8507, Japan.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hori
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Okada
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakauchi
authors.forename: Shuji
authors.initials: S
authors.lastname: Hiramoto
authors.forename: Ayako
authors.initials: A
authors.lastname: Kikuchi-Mizota
authors.forename: Masahisa
authors.initials: M
authors.lastname: Kyogoku
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Oike
authors.forename: Hidemitsu
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Junya
authors.initials: J
authors.lastname: Tanaka
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Morikami
authors.forename: Kaori
authors.initials: K
authors.lastname: Shigemoto
authors.forename: Toyotsugu
authors.initials: T
authors.lastname: Ota
authors.forename: Masanobu
authors.initials: M
authors.lastname: Kaneko
authors.forename: Masato
authors.initials: M
authors.lastname: Nakatsuji
authors.forename: Shunji
authors.initials: S
authors.lastname: Okae
authors.forename: Takahiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Daigo
authors.initials: D
authors.lastname: Gunji
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshioka
keywords: Hematogenous metastasis; Palliative operation; Single-incision laparoscopic surgery; Sister Mary Joseph; Umbilicus