Abstract
Umbilical metastasis of malignant tumor which is known as Sister Mary Joseph's nodule (SMJN) is rare, especially from biliary cancer. Here, we report a case of metachronous SMJN after resection of a cancer of the ampulla of Vater. A 64-year-old woman underwent pancreatoduodenectomy for a cancer of the ampulla of Vater. 1-year and 3-months later, she had the elevation of serum Ca19-9 level, and celiac lymph node metastasis was detected by CT. After systemic chemotherapies, CT demonstrated umbilical mass in a diameter of 1cm in addition to the celiac lymph node metastasis. FDG-PET showed a positive finding in the umbilical mass. We diagnosed the mass as SMJN. She could not continue the chemotherapy due to pancytopenia, and then she underwent radiotherapy for the celiac lymph node metastasis. SMJN increased in size and a pain of the umbilical part developed. We performed resection of SMJN for palliative therapy 2-years and 4-months after the initial surgery. After the resection, the pain disappeared and her quality of life was improved.
