Scientific letter
Primary Adenocarcinoma of the Navel: An Uncommon Entity
Adenocarcinoma primario del ombligo: una entidad poco frecuente
Beatriz Febreroa,
, David Ruiz de Anguloa, M. Ángeles Ortiza, M. José Lópezb, Pascual Parrillaa
Corresponding author
a Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, Murcia, España, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD)
b Servicio de Anatomía Patológica, Hospital Universitario Virgen de la Arrixaca, Murcia, España, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD)
Read
5593
Timeswas read the article
975
Total PDF
4618
Total HTML
Share statistics
array:24 [ "pii" => "S2173507714002907" "issn" => "21735077" "doi" => "10.1016/j.cireng.2012.06.002" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "952" "copyright" => "AEC" "copyrightAnyo" => "2012" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Cir Esp. 2014;92:436-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2180 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 1624 "PDF" => 546 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0009739X12002679" "issn" => "0009739X" "doi" => "10.1016/j.ciresp.2012.06.002" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "952" "copyright" => "AEC" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Cir Esp. 2014;92:436-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 14752 "formatos" => array:3 [ "EPUB" => 13 "HTML" => 9710 "PDF" => 5029 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Adenocarcinoma primario del ombligo: una entidad poco frecuente" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "436" "paginaFinal" => "438" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Primary adenocarcinoma of the navel: an uncommon entity" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 795 "Ancho" => 2167 "Tamanyo" => 559274 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio microscópico de la pieza quirúrgica. a) se observa una neoplasia compuesta por estructuras glandulares con tendencia a la quistificación y sin signos significativos de complejidad, tapizadas en su mayoría por un epitelio monocapa cúbico o cilíndrico, y, con menos frecuencia, aplanado. Las células muestran atipia citológica leve con escaso número de mitosis. En la luz de las glándulas se observa la presencia de un material con contenido proteináceo (asterisco). El estroma que rodea a las estructuras glandulares es intensamente desmoplásico (flecha), observándose además algunos infiltrados inflamatorios linfoides, a veces con formación de centros claros (dos flechas) (HE, ×50); b) el índice de proliferación (ki-67) era aproximadamente de 30%.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Beatriz Febrero, David Ruiz de Angulo, M. Ángeles Ortiz, M. José López, Pascual Parrilla" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Febrero" ] 1 => array:2 [ "nombre" => "David" "apellidos" => "Ruiz de Angulo" ] 2 => array:2 [ "nombre" => "M. Ángeles" "apellidos" => "Ortiz" ] 3 => array:2 [ "nombre" => "M. José" "apellidos" => "López" ] 4 => array:2 [ "nombre" => "Pascual" "apellidos" => "Parrilla" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173507714002907" "doi" => "10.1016/j.cireng.2012.06.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507714002907?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X12002679?idApp=UINPBA00004N" "url" => "/0009739X/0000009200000006/v1_201406080133/S0009739X12002679/v1_201406080133/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173507714002671" "issn" => "21735077" "doi" => "10.1016/j.cireng.2012.04.008" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "935" "copyright" => "AEC" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Cir Esp. 2014;92:438-41" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1579 "formatos" => array:3 [ "EPUB" => 14 "HTML" => 1183 "PDF" => 382 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Liver and Pancreatic Metastasis of a Solitary Fibrous Tumour" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "438" "paginaFinal" => "441" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metástasis hepática y pancreáticas de un tumor fibroso solitario" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1964 "Ancho" => 1446 "Tamanyo" => 378435 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal CT: (a) cross-sectional image showing metastases in the liver and head and body of the pancreas; (b) cross-sectional image with metastasis in the liver and tail of the pancreas; (c) sagittal slice of the liver metastasis and the proximity of the metastasis in the head/body of the pancreas with the portal vein; (d and e) follow-up abdominal CT showing no evidence of recurrence or metastasis in the abdominal region.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Beatriz Febrero, Ricardo Robles, Roberto Brusadin, Caridad Marín, Asunción López-Conesa, Cristina Martínez, Pascual Parrilla" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Febrero" ] 1 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Robles" ] 2 => array:2 [ "nombre" => "Roberto" "apellidos" => "Brusadin" ] 3 => array:2 [ "nombre" => "Caridad" "apellidos" => "Marín" ] 4 => array:2 [ "nombre" => "Asunción" "apellidos" => "López-Conesa" ] 5 => array:2 [ "nombre" => "Cristina" "apellidos" => "Martínez" ] 6 => array:2 [ "nombre" => "Pascual" "apellidos" => "Parrilla" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X12002291" "doi" => "10.1016/j.ciresp.2012.04.024" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X12002291?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507714002671?idApp=UINPBA00004N" "url" => "/21735077/0000009200000006/v1_201406190027/S2173507714002671/v1_201406190027/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173507714002919" "issn" => "21735077" "doi" => "10.1016/j.cireng.2012.07.006" "estado" => "S300" "fechaPublicacion" => "2014-06-01" "aid" => "955" "copyright" => "AEC" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "cor" "cita" => "Cir Esp. 2014;92:434-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2829 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 2380 "PDF" => 439 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Intestinal Obstruction Caused by Recurrent Phytobezoar: Resolved With Non-surgical Treatment With Cellulase" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "434" "paginaFinal" => "435" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Oclusión intestinal por fitobezoar recidivante: resolución con tratamiento no operatorio mediante celulasa" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 697 "Ancho" => 793 "Tamanyo" => 109342 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Abdominal CT: bowel obstruction due to a voluminous bezoar impact in the distal ileum; important distension of the small bowel loops.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manuel Carreira Delgado, Elvira Fernández Rodríguez, José Manuel Nuño Vázquez-Garza, Carlos Gil Llorens, Cristina Vázquez López" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Manuel" "apellidos" => "Carreira Delgado" ] 1 => array:2 [ "nombre" => "Elvira" "apellidos" => "Fernández Rodríguez" ] 2 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Nuño Vázquez-Garza" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "Gil Llorens" ] 4 => array:2 [ "nombre" => "Cristina" "apellidos" => "Vázquez López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X12002709" "doi" => "10.1016/j.ciresp.2012.07.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0009739X12002709?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507714002919?idApp=UINPBA00004N" "url" => "/21735077/0000009200000006/v1_201406190027/S2173507714002919/v1_201406190027/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Primary Adenocarcinoma of the Navel: An Uncommon Entity" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "436" "paginaFinal" => "438" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Beatriz Febrero, David Ruiz de Angulo, M. Ángeles Ortiz, M. José López, Pascual Parrilla" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Beatriz" "apellidos" => "Febrero" "email" => array:1 [ 0 => "beatrizfebrero@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "David" "apellidos" => "Ruiz de Angulo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Ángeles Ortiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "José López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Pascual" "apellidos" => "Parrilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía General, Hospital Universitario Virgen de la Arrixaca, Murcia, España, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD)" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario Virgen de la Arrixaca, Murcia, España, Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBEREHD)" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Adenocarcinoma primario del ombligo: una entidad poco frecuente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 477 "Ancho" => 1300 "Tamanyo" => 247080 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Microscopic study of the surgical specimen: (a) a neoplasm is observed composed of glandular structures with a tendency toward cystification without significant signs of complexity, covered for the most part by a cuboidal, cylindrical or (less frequently) flat epithelial monolayer. The cells show mild cytological atypia with a limited number of mitoses. In the lumen of the glands, there is presence of a material with proteinaceous content (asterisk). The stroma surrounding the gland structures is intensely desmoplastic (arrow), and some lymphocytic inflammatory infiltrate is also observed, sometimes with formation of clear centers (two arrows) (HE, 50×); (b) the proliferation rate (ki-67) was approximately 30%.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Malignant tumors in the umbilical region are uncommon, although they represent more than 10% of malignant neoplasms that affect the skin of the anterior wall of the abdomen.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This anatomical region is home to numerous vascular and embryological connections with the abdominal organs, which favors the appearance of metastases derived from different visceral tumors.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> Nonetheless, primary umbilical tumors make up only 20% of the malignant tumors in that location, and very few cases have been reported to date.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the diagnostic/therapeutic sequence followed in a patient with a primary adenocarcinoma in the umbilical region, and also review the limited related scientific literature.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 60-year-old male who presented with a painless non-reducible nodule in the umbilical region that had been progressively growing over the course of the previous year. Upon physical examination, we observed a round tumor formation that was attached to deep planes and measured some 3<span class="elsevierStyleHsp" style=""></span>cm in diameter. Abdominal ultrasound revealed a solid umbilical mass measuring 3<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm affecting the left anterior rectus. The fine needle aspiration (FNA) sample was compatible with adenocarcinoma. The cytology report, including immunohistochemistry study, showed a possible biliopancreatic origin as the first option and proposed that the lesion could possibly be a primary umbilical adenocarcinoma if no other origin was found (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient underwent gastroscopy, colonoscopy, thoracic and abdominal computed axial tomography (CT) scans (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), magnetic resonance cholangiopancreatography and even positron-emission tomography (PET) with the intention to rule out the presence of a primary tumor in another location. All of the tests came back normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">We performed a midline laparotomy with <span class="elsevierStyleItalic">en bloc</span> resection of the navel, tumor and a portion of the left anterior rectus muscle that was affected. We explored the rest of the abdominal cavity, with normal findings. Postoperative recovery was favorable, and the patient was discharged from the hospital 48<span class="elsevierStyleHsp" style=""></span>h after the intervention. The pathology study reported findings compatible with well-differentiated infiltrating adenocarcinoma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). As no internal adenocarcinoma was found, it was concluded that the mass was a primary umbilical adenocarcinoma arising from the urachus. Seven months after the intervention, the patient is asymptomatic, with normal tumor marker levels and no evidence of locoregional or distant disease.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The navel region can be a host to a large variety of benign tumors.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6</span></a> Malignant tumors, which are much less frequent, are mostly metastases of an abdominal neoplasm and, to a lesser degree, they can be primary umbilical tumors, representing only 20% of malignant tumors of the navel. They are mainly adenocarcinomas although other histologic types, such as sarcomas and melanomas, have also been described. The glandular epithelium is normally not present in the umbilical area, but it can appear derived from the metaplasia of the squamous epithelium or embryological remains of the omphalomesenteric duct or the urachus.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,6–8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Therefore, given an umbilical nodule with histological characteristics of adenocarcinoma in an FNA sample, the main problem is determining the origin. Immunohistochemistry can guide the diagnosis, but it is essential to complete a series of tests to rule out the existence of an extra-umbilical primary tumor (thyroid ultrasound, abdominal ultrasound, abdominal CT scan, colonoscopy, chest radiography, etc.).<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> In our case, we also carried out a PET and a gastroscopy, since gastric adenocarcinoma is the tumor that most frequently metastasizes in the navel.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Metastases of other tumors in the navel are known as “Sister Mary Joseph nodules” and are found in from 1 to 3% of digestive tumors.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> The embryological connection between this region and the abdominal organs, as well as the extensive lymphatic network that connects the navel with the inguinal and axillary areas, explains this predisposition. The primary tumor is usually found in the gastro-intestinal tract (stomach, pancreas, intestine, cecal appendix, etc.) although they may also be gynecological tumors, sarcomas and other neoplasms originating outside the abdominal cavity (breast, lung, penis).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3,5,6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Treatment of primary tumors of the navel is radical resection.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> During surgery, all the abdominal organs should be examined, as in our case, in order to rule out the existence of a primary tumor that had not been detected previously. Besides complete resection of the tumor, it is necessary to follow-up these patients since relapse in the umbilical area has been reported in the literature<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> as well as the later appearance of liver metastases<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and lymphadenopathies in the inguinal region<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> in the mid- and long-terms. This could indicate the need for adjuvant treatment with chemotherapy or radiotherapy in certain patients. Because of their poor prognosis, the treatment of metastatic umbilical tumors is more controversial, and radiotherapy is the treatment of choice in many cases.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, tumors in the umbilical region require a differential diagnosis in which it is essential to carry out a series of tests to rule out the existence of an extra-umbilical primary tumor, which can vary the therapy to be followed. There are few cases described in the literature of primary malignant neoplasms affecting the umbilicus, and it is therefore necessary to study each case in detail and to closely follow up the patients after they have been treated surgically since the prognosis is still not well defined.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Febrero B, Ruiz de Angulo D, Ortiz MÁ, López MJ, Parrilla P. Adenocarcinoma primario del ombligo: una entidad poco frecuente. Cir Esp. 2014;92(6):436–438.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 982 "Ancho" => 1300 "Tamanyo" => 198945 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Results of fine-needle aspiration: (a) hematoxylin–eosin stain (HE, 400×); (b) immunohistochemistry study ruling out expression of cytokeratin 20; (c) confirmed expression of cytokeratin 19; (d) confirmed expression of cytokeratin 7.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 752 "Ancho" => 996 "Tamanyo" => 122281 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Abdominal computed tomography showing a mass in the left anterior rectus muscle measuring 3<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2.7<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm (CC<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>AP<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>T) with heterogenous contrast uptake, compatible with a tumor process (arrow).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 477 "Ancho" => 1300 "Tamanyo" => 247080 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Microscopic study of the surgical specimen: (a) a neoplasm is observed composed of glandular structures with a tendency toward cystification without significant signs of complexity, covered for the most part by a cuboidal, cylindrical or (less frequently) flat epithelial monolayer. The cells show mild cytological atypia with a limited number of mitoses. In the lumen of the glands, there is presence of a material with proteinaceous content (asterisk). The stroma surrounding the gland structures is intensely desmoplastic (arrow), and some lymphocytic inflammatory infiltrate is also observed, sometimes with formation of clear centers (two arrows) (HE, 50×); (b) the proliferation rate (ki-67) was approximately 30%.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumors of the umbilicus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.D. Steck" 1 => "E.B. Helwing" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "1965" "volumen" => "18" "paginaInicial" => "907" "paginaFinal" => "915" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14308240" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary umbilical adenocarcinoma. A case report and review of literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.E. Ross" 1 => "R.B. Hill Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Pathol" "fecha" => "1975" "volumen" => "99" "paginaInicial" => "327" "paginaFinal" => "329" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1088857" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary umbilical adenocarcinoma: case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "O. Alver" 1 => "Y.E. Ersoy" 2 => "G. Dogusoy" 3 => "S. Erguney" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Surg" "fecha" => "2007" "volumen" => "73" "paginaInicial" => "923" "paginaFinal" => "925" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17939428" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary papillary psammomatous adenocarcinoma of the umbilicus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Hernández" 1 => "V. Medina" 2 => "H. Alvarez-Arguelles" 3 => "R. Gutiérrez" 4 => "J. Pérez-Palma" 5 => "L. Díaz-Flores" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Histol Histopathol" "fecha" => "1993" "volumen" => "8" "paginaInicial" => "593" "paginaFinal" => "598" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7508300" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary melanoma of the umbilicus: report of a case and review of the relevant anatomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.G. Meine" 1 => "P.L. Bailin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2003" "volumen" => "29" "paginaInicial" => "405" "paginaFinal" => "407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12656822" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of an umbilical lesion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.A. Koler" 1 => "M.K. Mather" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Fam Physician" "fecha" => "2000" "volumen" => "62" "paginaInicial" => "623" "paginaFinal" => "624" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10950217" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adenocarcinoma of the umbilicus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Fourati" 1 => "D. El Euch" 2 => "H. Haouet" 3 => "H. Boussen" 4 => "S. Haouet" 5 => "M. Mokni" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Dermatol Venereol" "fecha" => "2004" "volumen" => "131" "paginaInicial" => "379" "paginaFinal" => "381" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15258514" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary adenocarcinoma arising in a vitello-intestinal duct remnant at the umbilicus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Glazer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Surg" "fecha" => "1973" "volumen" => "60" "paginaInicial" => "247" "paginaFinal" => "249" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4693580" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sister Mary Joseph's nodule of the umbilicus: is it always of gastric origin? A review of eight cases at different sites of origin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Al-Mashat" 1 => "A.M. Sibiany" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0019-509X.58862" "Revista" => array:6 [ "tituloSerie" => "Indian J Cancer" "fecha" => "2010" "volumen" => "47" "paginaInicial" => "65" "paginaFinal" => "69" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20071793" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of Sister Mary Joseph's nodule as a presenting sign of gastric cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.K. Lee" 1 => "Y.W. Chang" 2 => "S.H. Jung" 3 => "J.Y. Jang" 4 => "S.H. Dong" 5 => "H.J. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Korean J Gastroenterol" "fecha" => "2008" "volumen" => "51" "paginaInicial" => "132" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18349576" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009200000006/v1_201406190027/S2173507714002907/v1_201406190027/en/main.assets" "Apartado" => array:4 [ "identificador" => "24081" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009200000006/v1_201406190027/S2173507714002907/v1_201406190027/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507714002907?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 0 | 6 |
| 2024 October | 56 | 3 | 59 |
| 2024 September | 68 | 1 | 69 |
| 2024 August | 47 | 3 | 50 |
| 2024 July | 47 | 5 | 52 |
| 2024 June | 45 | 3 | 48 |
| 2024 May | 48 | 5 | 53 |
| 2024 April | 40 | 5 | 45 |
| 2024 March | 47 | 9 | 56 |
| 2024 February | 41 | 4 | 45 |
| 2024 January | 52 | 2 | 54 |
| 2023 December | 49 | 5 | 54 |
| 2023 November | 57 | 3 | 60 |
| 2023 October | 52 | 2 | 54 |
| 2023 September | 44 | 1 | 45 |
| 2023 August | 41 | 1 | 42 |
| 2023 July | 81 | 6 | 87 |
| 2023 June | 64 | 3 | 67 |
| 2023 May | 63 | 2 | 65 |
| 2023 April | 56 | 2 | 58 |
| 2023 March | 74 | 3 | 77 |
| 2023 February | 81 | 6 | 87 |
| 2023 January | 68 | 19 | 87 |
| 2022 December | 48 | 6 | 54 |
| 2022 November | 37 | 8 | 45 |
| 2022 October | 47 | 7 | 54 |
| 2022 September | 47 | 10 | 57 |
| 2022 August | 56 | 13 | 69 |
| 2022 July | 43 | 11 | 54 |
| 2022 June | 41 | 10 | 51 |
| 2022 May | 34 | 7 | 41 |
| 2022 April | 32 | 14 | 46 |
| 2022 March | 37 | 6 | 43 |
| 2022 February | 45 | 7 | 52 |
| 2022 January | 68 | 8 | 76 |
| 2021 December | 92 | 6 | 98 |
| 2021 November | 74 | 15 | 89 |
| 2021 October | 77 | 8 | 85 |
| 2021 September | 69 | 11 | 80 |
| 2021 August | 61 | 16 | 77 |
| 2021 July | 59 | 11 | 70 |
| 2021 June | 41 | 12 | 53 |
| 2021 May | 39 | 9 | 48 |
| 2021 April | 136 | 11 | 147 |
| 2021 March | 55 | 8 | 63 |
| 2021 February | 58 | 9 | 67 |
| 2021 January | 83 | 20 | 103 |
| 2020 December | 38 | 8 | 46 |
| 2020 November | 98 | 11 | 109 |
| 2020 October | 35 | 8 | 43 |
| 2020 September | 43 | 12 | 55 |
| 2020 August | 23 | 7 | 30 |
| 2020 July | 35 | 6 | 41 |
| 2020 June | 23 | 11 | 34 |
| 2020 May | 32 | 17 | 49 |
| 2020 April | 25 | 6 | 31 |
| 2020 March | 25 | 5 | 30 |
| 2020 February | 33 | 8 | 41 |
| 2020 January | 29 | 7 | 36 |
| 2019 December | 50 | 8 | 58 |
| 2019 November | 40 | 3 | 43 |
| 2019 October | 36 | 4 | 40 |
| 2019 September | 30 | 6 | 36 |
| 2019 August | 27 | 5 | 32 |
| 2019 July | 41 | 14 | 55 |
| 2019 June | 52 | 16 | 68 |
| 2019 May | 152 | 67 | 219 |
| 2019 April | 66 | 10 | 76 |
| 2019 March | 14 | 4 | 18 |
| 2019 February | 19 | 8 | 27 |
| 2019 January | 12 | 4 | 16 |
| 2018 December | 10 | 1 | 11 |
| 2018 November | 15 | 4 | 19 |
| 2018 October | 15 | 5 | 20 |
| 2018 September | 6 | 0 | 6 |
| 2018 August | 5 | 1 | 6 |
| 2018 July | 10 | 3 | 13 |
| 2018 June | 5 | 1 | 6 |
| 2018 May | 6 | 1 | 7 |
| 2018 April | 2 | 1 | 3 |
| 2018 March | 7 | 1 | 8 |
| 2018 February | 3 | 1 | 4 |
| 2018 January | 17 | 9 | 26 |
| 2017 December | 5 | 0 | 5 |
| 2017 November | 17 | 4 | 21 |
| 2017 October | 6 | 6 | 12 |
| 2017 September | 13 | 5 | 18 |
| 2017 August | 23 | 1 | 24 |
| 2017 July | 14 | 1 | 15 |
| 2017 June | 24 | 15 | 39 |
| 2017 May | 20 | 3 | 23 |
| 2017 April | 24 | 4 | 28 |
| 2017 March | 45 | 51 | 96 |
| 2017 February | 22 | 3 | 25 |
| 2017 January | 21 | 4 | 25 |
| 2016 December | 16 | 9 | 25 |
| 2016 November | 23 | 14 | 37 |
| 2016 October | 32 | 7 | 39 |
| 2016 September | 49 | 7 | 56 |
| 2016 August | 37 | 10 | 47 |
| 2016 July | 18 | 2 | 20 |
| 2016 June | 21 | 10 | 31 |
| 2016 May | 25 | 10 | 35 |
| 2016 April | 31 | 13 | 44 |
| 2016 March | 26 | 27 | 53 |
| 2016 February | 16 | 14 | 30 |
| 2016 January | 14 | 14 | 28 |
| 2015 December | 17 | 16 | 33 |
| 2015 November | 17 | 11 | 28 |
| 2015 October | 19 | 7 | 26 |
| 2015 September | 30 | 3 | 33 |
| 2015 August | 19 | 4 | 23 |
| 2015 July | 12 | 4 | 16 |
| 2015 June | 9 | 0 | 9 |
| 2015 May | 12 | 1 | 13 |
| 2015 April | 23 | 8 | 31 |
| 2015 March | 14 | 7 | 21 |
| 2015 February | 31 | 6 | 37 |
| 2015 January | 29 | 4 | 33 |
| 2014 December | 25 | 13 | 38 |
| 2014 November | 57 | 9 | 66 |
| 2014 October | 62 | 20 | 82 |
| 2014 September | 15 | 8 | 23 |
| 2014 July | 0 | 1 | 1 |
Show all
