Stage IV Ovarian Cancer First Found Through an Umbilical Metastasis

What happened, in summary

A 68-year-old woman sought care after noticing an abdominal nodule that had been growing for about 3 months. Examination found a 3 cm umbilical mass with a necrotic surface. Imaging showed a large cystic mass in the right ovary, another abdominopelvic lesion extending toward the umbilicus, and enlarged pelvic and inguinal lymph nodes. Biopsy of the umbilical nodule showed moderately differentiated serous adenocarcinoma with an immunohistochemical profile supporting ovarian origin. Her CA-125 level was 321 U/mL. Because the umbilical lesion represented distant spread, the ovarian cancer was classified as Stage IV. She received 6 cycles of paclitaxel and carboplatin. After chemotherapy, the umbilical mass disappeared, the lymph nodes became smaller, and CA-125 fell to 30 U/mL. She then underwent debulking surgery that included hysterectomy, removal of both ovaries and fallopian tubes, omentectomy, and peritonectomy. After surgery, she began maintenance bevacizumab. At 9 months on maintenance treatment, her clinical assessment and imaging remained stable. Her case shows how an unusual skin finding at the umbilicus can be the first sign of advanced ovarian cancer and how the treatment pathway moved from chemotherapy to cytoreductive surgery and maintenance therapy.