Diagnosis of Carcinosarcoma Metastatic to the Umbilicus by Fine Needle Aspiration Biopsy A Case Report

Background Metastasis to the umbilicus, known as Sister Mary Joseph's nodule; sometimes represents the first clinical manifestation of an internal malignancy. These nodules are infrequent, and their discovery has prognostic implications. Case An 86-year-old woman presented with an ultrasound diagnosis of peritoneal carcinomatosis and the presence of a round lesion in the umbilical area. A fine needle aspiration biopsy was performed. The cytologic smears showed a biphasic neoplasm composed of malignant epithelial cells with a glandular appearance and randomly scattered spindle cells in a necrotic base. Immunohistochemical staining was performed to confirm the diagnosis. Conclusion After an extensive search of the literature, we discovered that this is the first report of a metastatic carcinosarcoma diagnosed by fine needle aspiration biopsy. The diagnosis of carcinosarcoma requires a clear definition of the 2 components, which is why immunohistochemical staining is very useful. The presence of an umbilical nodule should raise suspicion of an underlying malignant neoplasm. Needle aspiration biopsy should be considered as the most effective, simple, uncomplicated method of diagnosing these lesions. (Acta Cytol 2010;54:819-822)