- 期刊
Sister Mary Joseph Nodules Associated with Colorectal Cancer: A Case Series and Literature Review
原發於大腸直腸癌之肚臍轉移－案例分析與文獻回顧
摘要
Introduction. Sister Mary Joseph's nodule is an umbilical metastatic tumor often originating from intra-abdominal and/or pelvic malignancies. It is an indicator of a poor prognosis. However, few studies in the past have correlated its clinical role among malignant diseases. Published case series are rare. Methods. Cases in which umbilical nodules were documented were retrospectively included in this study. These cases were all treated and followed up at Mackay Memorial Hospital (including the Taipei main hospital and the Tamsui branch hospital) from December 2013 to July 2019. Results. A total of 12 patients were enrolled in this study. The male-to-female ratio was 1:1.4. Patient ages ranged from 38 to 87 years, with a median age of 62.5 years. Nine (75%) of the 12 patients presented with stage IV disease initially. The histopathological type of most of the primary tumors and umbilical nodules was adenocarcinoma. The histological grade of 36.4% of the patients was poorly differentiated. Surgical treatment with a curative or palliative intent was performed for all patients. Eleven (91.7%) of the 12 patients received adjuvant chemotherapy. Nine patients (75%) died 2 years after diagnosis and initial treatment. All mortality cases were documented with disease progression. The patients were followed up at least 6 months. Patients who received aggressive treatment had an average survival of 21.5 months and a median survival of 16.5 months. Conclusion. Umbilical nodule is rare, but is an indicator of intra-abdomino-pelvic advanced malignancy. It is usually associated with peritoneal carcinomatosis, and has a very poor prognosis. During follow-up, an umbilical nodule could be an initial symptom of recurrence, so physical examinations are important.
並列摘要
介紹：肚臍的轉移性腫瘤又稱做Sister Mary Joseph's nodule（SMJN），它與腹腔、骨盆腔內的癌症有著很大的相關性，並代表著原發癌症的遠處轉移與較差的預後。在文獻上只有零星的案例報告，系統性的案例分析更是少見。方法：收集自2013年至2019年七月在馬偕醫院診斷或接受治療並在病歷上記載肚臍轉移之大腸直腸癌病患。我們統計及分析病人的年齡、性別、臨床表現、大腸直腸癌位置、疾病嚴重度、疾病進程、接受之手術、病理種類及分期以及死亡日期。所有病人資料皆從馬偕醫院資料庫取得並使用回溯式分析進行研究。結果：在我們的研究中收集了12位病患，男女比例為1:1.4。年齡範圍從38歲到87歲不等，年齡中位數為62.5歲。九位（75%）病人在診斷時已是第四期疾病。大多數病人的原發腫瘤及肚臍腫瘤的病理型態為腺瘤。全部的病人均有接受術治療。十一位（91.7%）病人有接受化學治療。九位（75%）病人在診斷後兩年內死亡。有接受積極治療的病人平均存活為21.5個月，中位數為16.5個月。結論：肚臍的腫瘤跟腹腔、骨盆腔內的癌症有很大的關聯。它也是一個可以預測病人有晚期癌病的臨床表徵 （無論是腹膜轉移或是遠端轉移）。在病人追蹤上，它的出現也可能是病人疾病有所變化時。同時它也是一個不好的預後因子。