0.79 Images of memorable cases: cases 87, 88 & 89

87, 88&89. umbilical metastases

From carcinomas of the pancreas (top), stomach (middle), and ovary (bottom). Umbilical metastases ordinarily occur late in thecourse 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 maybe only thickening and inflammation of the subcutaneous tissue simulating cellulitis or abscess of the umbilicus. Correct diagnosis requires biopsy of theumbilical lesion. The results may spare the patient time, money, and physical and emotional stress.