Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2023; 11(34): 8205-8211
Published online Dec 6, 2023. doi: 10.12998/wjcc.v11.i34.8205
Long-term survival of the Sister Mary Joseph nodule originating from breast cancer: A case report
Koji Kanayama, Maki Tanioka, Yoshitsugu Hattori, Takuya Iida, Mutsumi Okazaki
Koji Kanayama, Yoshitsugu Hattori, Takuya Iida, Mutsumi Okazaki, Department of Plastic and Reconstructive Surgery, The University of Tokyo, Tokyo 113-8655, Japan
Maki Tanioka, Department of Medical Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
Author contributions: Kanayama K designed the case report and drafted the manuscript; Tanioka M, Hattori Y, and Iida T collected patient data; Okazaki M provided the administrative support; The final version of the manuscript was approved by all authors.
Informed consent statement: Informed consent for publication was obtained from the patient in this case report.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest, financial or otherwise.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Koji Kanayama, MD, PhD, Assistant Professor, Department of Plastic and Reconstructive Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. kanayama-tky@umin.ac.jp
Received: September 28, 2023
Peer-review started: September 28, 2023
First decision: November 13, 2023
Revised: November 14, 2023
Accepted: November 24, 2023
Article in press: November 24, 2023
Published online: December 6, 2023
Processing time: 69 Days and 4.1 Hours
Abstract
BACKGROUND

A Sister Mary Joseph nodule (SMJN) is an uncommon cutaneous metastasis found in the umbilicus, indicating an advanced malignancy. SMJNs typically originate from intra-abdominal sources, rarely from breast cancer. Diagnosis suggests a poor prognosis with a median survival of approximately 8 mo after detection. Managing patients with SMJNs is challenging, as most receive limited palliative care only. The optimal strategy for long-term survival of these patients remains unclear.

CASE SUMMARY

A 58-year-old female, previously diagnosed with right breast cancer 17 years ago and underwent breast-conserving surgery, adjuvant radiotherapy, and endocrine therapy, presented with a 2-cm umbilical nodule. Thirteen years previously, metastases were detected in the right supraclavicular, infraclavicular, hilar, and mediastinal lymph nodes. An umbilical nodule emerged four years before the date of presentation, confirmed as a skin metastasis of primary breast cancer upon excisional biopsy. Despite initial removal, the nodule recurred and grew, leading to her referral to our hospital. The patient underwent extensive excision of the umbilical tumor and immediate abdominal wall reconstruction. Endocrine therapy was continued postoperatively. Five years later, no local recurrence was observed, and the patient continued to work full-time, achieving over 9 years of survival following SMJN diagnosis.

CONCLUSION

This case study aimed to identify the optimal strategy for achieving extended survival outcomes in patients with SMJN through comprehensive treatment. We presented a case of the longest survival in a patient after undergoing a multidisciplinary treatment regimen. Our findings underscore the significance of adopting a multimodal treatment approach comprising timely and wide excision along with adjunctive therapy. This approach can control the disease, prolong survival, and improve the quality of life in patients with SMJN.

Keywords: Sister Mary Joseph nodule; Breast cancer; Cutaneous metastasis; Long-term survival; Abdominal wall reconstruction; Case report

Core Tip: Sister Mary Joseph nodules (SMJN) typically present as firm, irregular periumbilical nodules, which are uncommon yet significant symptoms that indicate an advanced stage of malignancy with a poor prognosis. Although most patients receive limited treatment, the optimal systemic treatment strategy for long-term survival remains controversial. While treatment decisions should be based on the patient's overall health and condition, a multimodal treatment approach comprising timely and wide excision along with adjunctive therapy has the potential to control the disease, prolong survival, and improve the quality of life of patients with SMJNs without peritoneal dissemination.