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Images of Memorable Cases: Cases 87, 88 & 89

Module by: Herbert L. Fred, MD, Hendrik A. van Dijk

http://rup.rice.edu/memcases-button.jpg

Cases_87_88_89-pres1-1.jpg

Cases_87_88_89-pres1-2.jpg

Cases_87_88_89-pres1-3.jpg

87, 88 & 89. Umbilical metastases

From carcinomas of the pancreas (top), stomach (middle), and ovary (bottom). Umbilical metastases ordinarily occur late in the course of fatal neoplastic disease. Nevertheless, they can be the presenting symptom, earliest sign, or only physical finding of neoplasm arising elsewhere. Although the primary tumor can originate anywhere below the diaphragm, the most commonly reported sites are the stomach and ovary.

Umbilical metastases usually appear as small, irregular, firm, and sometimes painful nodules. Occasionally, however, there may be only thickening and inflammation of the subcutaneous tissue simulating cellulitis or abscess of the umbilicus. Correct diagnosis requires biopsy of the umbilical lesion. The results may spare the patient time, money, and physical and emotional stress.

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