A 44-yo woman had progressive abdominal distension x 1 yr that she believed to be a pregnancy. She did not seek care due to lack of insurance. A growth protruding through the umbilicus oozed serosanguinous fluid. What is it?
Ascites from abdominal pregnancy
Omphalith (umbilical concretion)
Malignancy (Sister Mary Joseph sign)
Umbilical herniation
Hydatidiform mole (molar pregnancy)
You are correct. Debulking surgery revealed a poorly differentiated malignancy involving ovaries and omentum; she succumbed to sepsis post-operatively. Sister Mary Joseph (1856–1939) made the link between intra-abdominal malignancy and umbilical lesions while prepping the skin of patients pre-operatively.