Sister Mary Joseph's nodule as primary localized malignant mesothelioma. Report of a case

Our plain-English summary of Sister Mary Joseph's nodule as primary localized malignant mesothelioma. Report of a case, by A. Papalambros, F. Sigala, E.G. Vouza, et al (Zentralblatt Für Chirurgie, 2011).

The study

• Authors: A. Papalambros, F. Sigala, E.G. Vouza, W. Hepp, P. Antonakis
• Journal: Zentralblatt Für Chirurgie
• Published: 2011;136(2):172-4
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

The authors reported a case of primary localized malignant mesothelioma of the umbilicus presenting as a Sister Mary Joseph's nodule. They stated that only one previous report of a primary localized malignant mesothelioma in the umbilical area was known to them. A 78-year-old man had noticed a nodule at the umbilicus 2 months earlier, and it was growing. He had no other symptoms and no history of asbestos exposure. Examination found a firm 2 cm nodule adhering to the skin and underlying structures. Ultrasound showed a solid mass. Frozen sections from an excisional biopsy were positive for malignancy and suggested mesothelioma. A wide local excision was performed that included a 2-cm full-thickness ring of the abdominal wall. Peritoneal fluid cytology was negative. Histopathology showed a 3 cm, moderately differentiated, infiltrating tubulopapillary tumour without asbestos granules. The tumour was positive for calretinin and cytokeratin 5/6 and negative for CEA, CD34 and p53, indicating epithelioid malignant mesothelioma. Diagnostic laparoscopy with multiple serosal biopsies, and CT scans of the chest, abdomen and pelvis, found no further disease. The patient declined further treatment. At 18 months after surgery he was asymptomatic, and CT showed no evidence of disease. The authors concluded that pathologic evidence and accurate staging are essential for diagnosis. They concluded that radical surgery alone can be considered curative in such rare cases, and that aggressive follow-up is mandatory.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a case report describing one patient. A 78-year-old man came to the authors' clinic with a firm 2 cm lump at the navel (umbilicus), called a Sister Mary Joseph's nodule, that had been growing. He had no history of asbestos exposure, and no asbestos granules were seen in the tumor. The lump was removed along with a ring of surrounding abdominal wall. Laboratory examination found a 3 cm tumor, and staining tests indicated an epithelioid malignant mesothelioma. An independent pathologist confirmed the diagnosis. Peritoneal fluid tested negative for cancer cells, and laparoscopy with multiple biopsies and chest, abdominal and pelvic CT scans found no other disease. The authors therefore diagnosed a primary localized malignant mesothelioma of the umbilicus. They wrote that, to their knowledge, only one such case had been reported before. The patient declined further treatment. At his last follow-up, 18 months after surgery, he had no symptoms and no evidence of disease on CT scans. The authors concluded that complete surgical removal could even be considered curative, provided no other disease is found and follow-up is vigorous.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 78-year-old man seen at the authors' outpatient clinic (authors based in Athens, Greece; Solingen, Germany; London, UK) with a growing nodule at the umbilicus
• Exposure: No asbestos exposure reported: the patient had no history of asbestos exposure, and no asbestos granules were seen in the tumor tissue
• Main results:
  • On examination, the patient had a firm 2 cm nodule distorting the umbilicus, adhering to underlying structures and overlying skin
  • A wide local excision was performed, including a 2 cm full-thickness ring of abdominal wall
  • Histopathology showed a 3 cm moderately differentiated infiltrating tubulo-papillary tumor involving the dermis, subcutaneous fat and underlying rectal sheath
  • No asbestos granules were seen in the tumor
  • The tumor was positive for calretinin and cytokeratin 5/6 and negative for CEA, CD34 and P53, indicating an epithelioid malignant mesothelioma
  • An independent pathologist confirmed the diagnosis
  • Peritoneal fluid cytology was negative for malignant cells
  • Diagnostic laparoscopy with multiple serosal biopsies and chest, abdominal and pelvic CT scans excluded further disease
  • The patient declined further treatment. At the last follow-up, 18 months after surgery, he was asymptomatic with no evidence of disease on CT scans
  • The authors stated that, to their knowledge, only one previous report of primary localized malignant mesothelioma in the umbilical area exists
• The authors' conclusion: The authors concluded that, if there is no evidence of other disease and vigorous follow-up is carried out, complete surgical removal could even be considered curative
• Limitations the authors state:
  • The authors noted that diagnostic and staging approaches for such rare cases have not been properly validated

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Localized Malignant Mesothelioma, Asbestos Exposure, Ultrasound, Frozen Section, Biopsy, Mesothelioma, Fluid Cytology, Histopathology.

Related studies

• The sister Mary Joseph nodule — K. Zhang, C. Sankey (2015)
• Lipoblastic differentiation in a primary localized fibrous mesothelioma of the peritoneum — A. Donna, P.G. Betta, et al. (1996)
• Localized mesothelioma tumour arising synchronously with a primary contralateral lung cancer — W. Andrews, S. Paul, et al. (2013)
• Localized biphasic malignant peritoneal mesothelioma presenting as a rectal tumor — K. Saisho, S. Fujiwara, et al. (2020)
• Localized multiple malignant epithelioid peritoneal mesotheliomas arising from the hepatoduodenal ligament and diaphragm: a case report — T. Miyata, Y. Fujiwara, et al. (2019)
• Peritoneal mesothelioma presenting as a skin nodule — C. Abban, M. Viglione (2009)

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