Umbilical metastasis of unknown primary presenting as umbilical hernia: a case report

Ibrahim W Adamu¹, Noubar Kevorkian¹, Genato Romulo¹, Stephen S Carryl¹, Armand Asarian¹, Philip Q Xiao^2
1Department of Surgery, ²Department of Pathology, The Brooklyn Hospital Center, Brooklyn, NY, USA

Abstract: Umbilical metastasis is well known to be a late stage of malignancy and is associated with a poor prognosis. The majority of such cases are associated with primary gastrointestinal and gynecologic malignancies, and fewer cases are noted to derive from the thoracic cavity and the urinary tract. In this report, we describe a rare case of metastasis that presented as incarcerated umbilical hernia with no primary sites found. Extensive work-up, including tumor markers, imaging studies, endoscopies, and immunohistochemical analysis, failed to identify the primary source of this malignancy; this was a rare case of Sister Mary Joseph’s nodule with unknown primary. Therefore, it is very important for a surgeon to consider metastasis among the differential diagnosis of umbilical hernia.

Keywords: umbilical metastasis, Sister Mary Joseph’s Nodule, hernia