Abdominal Malignancy with Skin Manifestation and Thromboembolic Disease: An Unusual Presentation

A 55-year-old male presented to our hospital with shortness of breath and leg swelling. Imaging studies revealed deep vein thrombosis and bilateral pulmonary embolism. The patient was placed on anticoagulation. A palpable umbilical nodule consistent with the appearance of Sister Mary Joseph's nodule (SMJN) raised the possibility of an underlying gastrointestinal malignancy. The patient also had significant ascites and underwent paracentesis with cytology, upper gastrointestinal and lower gastrointestinal endoscopy with the biopsy. Gastric lesion histology revealed gastric adenocarcinoma with peritoneal and colonic metastases. The patient was started on chemotherapy with 5‐fluorouracil, leucovorin, oxaliplatin (FOLFOX) for disseminated gastric malignancy. SMJN is a rare cutaneous metastatic manifestation which needs to be considered as a differential diagnosis of an umbilical tumor for prompt diagnosis and initiation of treatment.