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Indian Journal of Surgery, Vol. 66, No. 4, July-August, 2004, pp. 243 Images in Surgery A case of umblical secondaries from ovarian carcinoma Augustine AlfredJ, Joshua CC, Pai ManoharV, Khar Anuradha, Gaurav Maheshwari Department of General Surgery, Kasturba Medical College and Hospital, Attavar, Mangalore Code Number: is04061 A 39-year-old woman came with a swelling in the umbilical area since last 2 months with minimal blood like discharge. On examination, there was a shiny, cystic swelling in the umbilicus measuring 5x5 cms [Figure - 1]. Ultrasonography suggested an umbilical mass with hypo echoic cystic area and large cystic lesion with mixed echogenecity in right adnexal region. Fine Needle Aspiration Cytology from the umbilical mass suggested secondaries from adeno carcinoma. Intraoperatively right ovarian mass was seen in right ovary with pelvic lymph nodes. Total abdominal hysterectomy with bilateral salphingoophorectomy and total omentectomy was done. Histopathological examination reported as bilaterally moderately differentiated papillary serous cystadenocarcinoma ovary with metastasis to umbilicus. Sister Joseph′s nodule is a common term for any metastatic deposit at the umbilicus originating from an intraabdominal malignancy.[1] Several mechanisms have been suggested for the pathogenesis of umbilical metastasis. The tumor cells shed from the hepatic secondaries or nodes in the porta hepatis traverse along the ligamentum teres and reach the umbilicus. Even though the normal flow of lymphatics is away from the umbilicus, in the presence of lymph nodes metastasis retrograde passage of tumor cells can promote umbilical metastasis. Another mechanism is possibly by arterial or venous embolisation.[2] REFERENCES
Copyright 2004 - Indian Journal of Surgery The following images related to this document are available:Photo images[is04061f1.jpg] |
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