Abstract: Sister Mary Joseph's nodule (SMJN) involving the umbilicus can often be a clinical sign of metastatic cancer, but rarely cancer originating from the breast. We report a rare case of umbilical metastases from breast cancer and reviewed the literature. A 54-year-old woman was referred to a pre-surgery clinic for an examination of an umbilical nodule. The patient had a history of ductal breast carcinoma. Cytological smear from fine needle aspiration showed epithelial neoplastic cells resembling those of breast carcinoma. Neoplastic cells from tissue were positive for cytokeratin 8-18, estrogen and progesterone receptor and negative for E-cadherin and had a low proliferative index. Her-2/neu immunodetection showed a 2+ equivocal positive rate, but Her-2/neu gene amplification was found on the cytological smear by fluorescence in situ hybridization analysis. Similar results were obtained within a tissue section. Concordant findings have been obtained when comparing the recent American Society of Clinical Oncology/College of American Pathologists scoring system. Fine needle aspiration from the SMJN is a useful tool for the diagnosis of metastatic breast cancer. Furthermore, the predictive biomarkers for tumors of the breast, hormonal receptors and Her-2/neu not only assist with the identification of the source of the metastatic disease but also provide clinical information for patient management.
Her-2/neu evaluation in Sister Mary Joseph's nodule from breast carcinoma: a case report and review of the literature / Brunelli, Matteo; Manfrin, Erminia; Miller, K; Eccher, Albino; Gobbo, Stefano; Reghellin, Daniela; Chilosi, Marco; Remo, Andrea; Martignoni, Guido; Menestrina, Fabio; Bonetti, Franco. - In: JOURNAL OF CUTANEOUS PATHOLOGY. - ISSN 0303-6987. - 36:6(2009), pp. 702-705. [10.1111/j.1600-0560.2008.01114.x]