[Umbilical metastasis - "Sister Joseph's nodule" of an endometrial adenocarcinoma: a case report and review of the literature].

The umbilical metastatic lesions have been termed the "Sister Joseph nodule" by Sir Hamilton Bailey in 1949. SJN is an important diagnostic finding, as it often is the first clue and sometimes the only physical indication of an advanced intra-abdominal malignancy. SJN is most often associated with malignancy of the stomach or ovary. It usually appears late in the course of neoplastic disease and suggests a poor prognosis. In our review of English language medical literature we could find only 27 reports of SJN in endometrial adenocarcinoma. We offer a case of SJN, presenting as umbilical hernia, in a female patient, who, 12 years previously, had undergone laparotomy with total hysterectomy and bilateral salpingo-oophorectomy for endometrial adenocarcinoma. Three years after the surgical excision of the umbilical lesion, the patient underwent surgery for a tumor located subcutaneously in the suprapubic area. Histologically, in the samples obtained with both surgical interventions, endometrioid adenocarcinoma with squamous differentiation was found. The clinical examination and imaging studies found no evidence of other metastases. On the basis of clinico-pathological analysis we offer a hypothesis about development of metastases and discuss their prognostic significance.