Nódulo de la hermana María José y linfoma difuso de células grandes B

A 38-year-old patient presented with abdominal distention, anorexia and a weight loss of 7 kg over the previous two months. Physical examination revealed a solid abdominal mass and a 3 cm umbilical nodule. He had raised lactate dehydrogenase and beta-2 microglobulin levels, as well as hypogammaglobulinemia. An abdominal CT showed a solid retroperitoneal mass invading the left kidney and displacing the aorta, splenomegaly and an umbilical nodule. Histopathology revealed a diffuse large b cell lymphoma germinal center type. Umbilical metastases, also known as Sister Mary Joseph's nodule, are uncommon and usually associated with disseminated gastrointestinal and gynecological malignancies; indeed only a few cases of lymphomas with this presentation have been reported, most of which have a much better prognosis.