Teaching Case

The patient, with a history of peptic ulcer disease, complained of epigastric pain.Clinical examination revealed a small intra-umbilical mass. Ultrasonography of this lesion was performed followed by a CT scan of the abdomen.

History of peptic ulcer disease. Actually complains of epigastric pain.Clinical examination revealed a small intra-umbilical mass. Ultrasonography and CT scan were performed.

Umbilical tumors are rare. About 30% of these tumors are metastases, mostly of unknown origin (29%), or caused by primary tumors of the stomach (25%), ovary (12%), colon (10%), or pancreas (7%). The clinical features are characteristic: a firm indurated plaque or nodule, usually with a vascular appearance. However, a number of other tumors (e.g. (lymph) angioma, epidermoid cyst), and congenital malformations of the urachus must be excluded, as well as endometriosis. There are different ways of spread of malignancy to the umbilicus. Hematogeneous spread may be arterial as well as venous. Lymphatic spread may occur through the subserosal lymphatic network, communicating with para-aortic, inguinal and axillary node. The most common way probably is contiguous extension from the peritoneal surface. Finally, metastasis to the umbilicus can occur through embryological connections. Although the umbilicus may be the unique metastatic location, umbilical metastases generally indicate an advanced tumor spread and poor overall prognosis.