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Asymptomatic umbilical lesion in a 76-year-old man
Asymptomatic umbilical lesion in a 76-year-old man Melba Estrella, MD,a Megan Morrison, DO,b and Stuart R. Gildenberg, MDc Santo Domingo, Dominican Republic, and Ypsilanti and Warren, Michigan
A 76-year-old man presented to our clinic with a 6-week history of an asymptomatic lesion of the umbilicus. He reported a decrease in appetite with an 8- to 10-lb weight loss over the previous 6 weeks. He denied any abdominal pain, nausea, vomiting, or bloody stool. He had no significant medical history. The physical examination revealed a 16-mm crusted indurated erythematous nodule within the umbilicus (Fig 1). A punch biopsy specimen of the lesion was obtained (Figs 2 and 3), and a computed tomography scan of the abdomen and pelvis was performed (Fig 4).
From the Universidad Iberoamericana,a Santo Domingo; Department of Dermatology,b St Joseph Mercy Hospital, Ypsilanti; and Midwest Center for Dermatology and Cosmetic Surgery,c Warren. Funding sources: None. Conflicts of interest: None declared.
Correspondence to: Melba Estrella, MD, 537 Stonecrest Parkway, Suite 200, Smyrna TN 37167. E-mail: [email protected]. J Am Acad Dermatol 2017;76:e195-6. 0190-9622/$36.00 ª 2016 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2016.11.060
e195
e196 Estrella, Morrison, and Gildenberg
1.
J AM ACAD DERMATOL
JUNE 2017
This physical examination finding is most likely the result of an underlying pathology of which of the following structures? A. Posterior lobe of prostate gland B. Gallbladder and proximal biliary ducts C. Umbilical region D. Epidermal layer E. Endometrial tissue
2.
Based on the history and images of this patient, which of the following is the most likely diagnosis? A. Sister Mary Joseph nodule B. Prostatic adenocarcinoma C. Omphalith D. Villar nodule E. Bowen disease
3.
Which of the following best describes the possible mechanism of disease spread to the umbilicus? A.
Migration of endometrial cells to the umbilicus through the abdominal cavity, the lymphatic system or through the embryonic remnants in the umbilical fold B. Previous laparoscopic surgery C. Foreign body inclusion D. Poor hygiene E. Direct hematogenous or transperitoneal spread through lymphatics Please visit www.eblueimages.org to answer these questions.
A 76-year-old man presented to our clinic with a 6-week history of an asymptomatic lesion of the umbilicus. He reported a decrease in appetite with an 8- to 10-lb weight loss over the previous 6 weeks. He denied any abdominal pain, nausea, vomiting, or bloody stool. He had no significant medical history. The physical examination revealed a 16-mm crusted indurated erythematous nodule within the umbilicus (Fig 1). A punch biopsy specimen of the lesion was obtained (Figs 2 and 3), and a computed tomography scan of the abdomen and pelvis was performed (Fig 4).
From the Universidad Iberoamericana,a Santo Domingo; Department of Dermatology,b St Joseph Mercy Hospital, Ypsilanti; and Midwest Center for Dermatology and Cosmetic Surgery,c Warren. Funding sources: None. Conflicts of interest: None declared.
Correspondence to: Melba Estrella, MD, 537 Stonecrest Parkway, Suite 200, Smyrna TN 37167. E-mail: [email protected]. J Am Acad Dermatol 2017;76:e195-6. 0190-9622/$36.00 ª 2016 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2016.11.060
e195
e196 Estrella, Morrison, and Gildenberg
1.
J AM ACAD DERMATOL
JUNE 2017
This physical examination finding is most likely the result of an underlying pathology of which of the following structures? A. Posterior lobe of prostate gland B. Gallbladder and proximal biliary ducts C. Umbilical region D. Epidermal layer E. Endometrial tissue
2.
Based on the history and images of this patient, which of the following is the most likely diagnosis? A. Sister Mary Joseph nodule B. Prostatic adenocarcinoma C. Omphalith D. Villar nodule E. Bowen disease
3.
Which of the following best describes the possible mechanism of disease spread to the umbilicus? A.
Migration of endometrial cells to the umbilicus through the abdominal cavity, the lymphatic system or through the embryonic remnants in the umbilical fold B. Previous laparoscopic surgery C. Foreign body inclusion D. Poor hygiene E. Direct hematogenous or transperitoneal spread through lymphatics Please visit www.eblueimages.org to answer these questions.