Sister Mary Joseph's Nodule

Abstract

A 12-year-old girl presented with a one-month history of decreased appetite, vomiting, and weight loss. The patient had had no fevers or night sweats. Physical examination revealed a distended abdomen with a fluid wave, a palpable pelvic mass, and a tumor protruding through the umbilicus (Panel A). Computed tomographic scanning showed a large pelvic mass probably originating from the ovary, omental and hepatic metastases, ascites, and a mass through the umbilicus (Panel B). Pathological evaluation of a biopsy specimen showed a desmoplastic small round-cell tumor. The patient received vincristine, doxorubicin, and cyclophosphamide alternating with etoposide and ifosfamide. After two courses . . .