Malignant umbilical nodule as the presenting symptom of underlying Krukenberg tumour

A 27-year-old woman presented with a 2-month history of a lump around the umbilicus. Initially measuring 0.5 cm, the nodule gradually increased in size, with no relationship to position or her menstrual cycle. She reported unintentional weight loss of 5 kg over the past month but denied fever, abdominal pain, menstrual irregularities, or changes in bowel habits. She had no personal or family history of congenital disorders or cancer. Physical examination showed a pink, firm, nonreducible umbilical nodule of about 1.5 cm in diameter (Figure 1A). Skin biopsy revealed a diffuse dermal infiltrate of hyperchromatic tumour cells with dispersed signet ring cells (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.250584/tab-related-content). Immunohistochemical analysis showed that the tumour cells were positive for cytokeratin 7 (CK7) but negative for paired box protein 8 (PAX8), thyroid transcription factor 1 (TTF-1), and GATA-binding protein 3 (GATA3), suggesting a gastrointestinal origin. The tumour markers showed elevated cancer antigen 125 (CA-125) at 47.9 (reference range < 35) U/mL. Computed tomography showed a heterogeneous gastric mass and tumours involving both ovaries (Figure 1B). Endoscopic biopsy of gastric tissue confirmed adenocarcinoma, leading to the final diagnosis of Krukenberg tumour, an ovarian malignancy arising from primary gastrointestinal cancer. Given the advanced stage of her gastric cancer (pT3N2M1, stage IV), the patient began chemotherapy with capecitabine and oxaliplatin every 2 weeks and continues to be monitored with stable disease. Krukenberg tumour is a rare metastatic ovarian cancer that often arises from the gastrointestinal tract.1 Metastatic umbilical nodules, also known as Sister Mary Joseph nodules, are found in about 1% to 3% of advanced abdominal–pelvic adenocarcinomas, most commonly originating from gastrointestinal (35% to 65%) and genitourinary (12% to 35%) sites.2 Although more typical in older patients, this case highlights that younger individuals can also present with this condition.3 The presence of Krukenberg tumour and a malignant umbilical nodule indicates poor prognosis. Differential diagnosis of umbilical nodules includes cutaneous endometriosis, umbilical hernia, primary umbilical malignancy, and benign tumours (e.g., dermoid cyst, epidermoid cyst). Footnotes Competing interests: None declared. This article has been peer reviewed. The authors have obtained patient consent. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/ References - 1↵BaziIBigiSChahbiZ. Krukenberg tumor secondary to gallbladder adenocarcinoma: a case report. Radiol Case Rep 2025;20:2048–53. - 2↵TsoSBrockleyJRecicaH. Sister Mary Joseph’s nodule: an unusual but important physical finding characteristic of widespread internal malignancy. Br J Gen Pract 2013;63:551–2. - 3↵O’Connor-ByrneNGlaveySde FreitasD. Sister Mary Joseph nodule in mantle cell lymphoma. Lancet Oncol 2020;21:e337.