IDDF2018-ABS-0254 Response in sister mary joseph node- can it be a marker of response to therapy in metastatic carcinoma gall bladder

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Abstract

Background

Sister Mary Joseph Nodule, a rare presentation of gastrointestinal Malignancy usually signifies a poor prognosis. We present a case of Metastatic carcinoma of the gallbladder which was diagnosed with this unusual presentation. The patient was treated with palliative chemotherapy. Post three cycles of chemotherapy patient showed necrosis in Sister Mary Joseph Nodule. After 6 cycles of palliative chemotherapy patient had stable disease and until seven months of follow up patient was alive.

Methods

A 45 year female was diagnosed with metastatic carcinoma gallbladder. On clinical examination, the patient had enlarged gallbladder with an umbellical nodule. FNAC of the Gallbladder mass and umbelllical nodule showed poorly differentiated adenocarcinoma and metastatic adenocarcinoma respectively. The patient was given palliative chemotherapy Gemcitabine on Day1 and Day8. Post 3 such cycles patient was evaluated radiologically and clinically and was found to have stable disease through the umbellical nodule had turned black suggesting necrosis. The patient was given 6 cycles of chemotherapy and then followed every monthly clinically and radiologically.

Results

After 7 months of follow up, the patient was alive. There was no recurrence radiologically or clinically and no disease-related Morbidity.

Conclusions

A good response to chemotherapy can result in acceptable survival in metastatic carcinoma Gall Bladder. Necrotic change in Sister Mary Joseph Nodule can be a surrogate marker of such response.

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