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Reddish, Firm, Asymptomatic Nodules on the Peri-Umbilical Area of a 67-year-old Woman
Chen-Hsi Hung Kuo-Chia Yang Yang-Yuan Chen
Dermatol Sinica 27: 74-75, 2009

A 67-year-old woman presented with abdominal fullness and cramping pain, poor appetite
and hiccup for more than 10 days. Several reddish, fi rm, asymptomatic nodules on the peri-umbilical
area (Fig. 1) were also noted. Biopsy of the umbilical nodule showed that the dermis was
diffusely infi ltrated by ductal and tubular structures. A grenz zone was evident and the epidermis
was relatively spared (Fig. 2A). In higher magnifi cation, many irregularly shaped glandular
structures infiltrate among the collagen bundles. The tubules were composed of pleomorphic,
hyperchromatic cells with high nuclear to cytoplasm ratio. Some lumens shared a common wall
indicating lost of polarity (Fig. 2B). Immunohistochemical staining showed diffuse positive for
cytokeratin 7 (CK7), focally positive for carcinoembryonic antigen (CEA), and negative for cytokeratin
20 (CK20). We also arranged panendoscopy and colonscopy, and both of the biopsies
revealed adenocarcinoma. The abdominal echo revealed multiple heterogenous hypoechoic nodules
over both lobes of liver and spleen. Panendoscopy showed a smooth protrusion into the gastric
mucosa, suggesting compression by a external mass. Computed tomography (CT) scan of the
abdomen revealed an irregular soft tissue mass located in the left upper abdomen with indistinct
borders and multiple metastasis. The largest tumor was located at the pancreatic tail (Fig. 3).

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