Clinical Features

• Often asymptomatic

• Loss of appetite, nausea

• Weight loss (may be aggravated by reduced calorie intake due to abdominal pain after meals)

• Signs of chronic iron deficiency anemia

• Palpable tumor in epigastric region

• Dysphagia

• Abdominal pain

• Early satiety

• Vomiting

• Hematemesis

• Melena

• Hepatomegaly

• Ascites

• Left supraclavicular adenopathy (Virchow node)

• Palpable umbilical nodule (Sister Mary Joseph node)

• Palpable mass on digital rectal examination (Blumer shelf)

• Ovarian mass (Krukenberg tumor)

• Leser-Trélat sign

• Malignant acanthosis nigricans

Sister Mary Joseph nodule

—> A 2-cm, well-demarcated, protuberant, round, purple nodule is visible in the umbilicus. The lesion shows central ulceration and an accumulation of fluid can be seen in the umbilical crease.

This finding suggests a metastatic lesion of an intraabdominal or pelvic malignancy, referred to as a Sister Mary Joseph nodule. Blood tests, imaging, and histopathological analyses of biopsy materials are required to confirm the diagnosis.

Acanthosis nigricans

Hyperpigmentation, hyperkeratosis, and numerous skin tags (papillomatosis) are visible on the right axilla.

These findings are consistent with acanthosis nigricans.

Virchow node

A swelling is visible at the left supraclavicular fossa.

This finding is due to enlarged lymph nodes and is typical for lymph node metastasis from gastric cancer. It can also be found in other abdominopelvic malignancies.

Leser–Trélat sign

Back of a patient with colon cancer

Numerous light brown, raised lesions of different shapes and sizes are visible. A few spots show a scaly surface with a stuck-on appearance while others are smooth.

The sudden development of multiple seborrheic keratoses in association with paraneoplastic syndrome, as is the case here, is referred to as “Leser-Trélat sign.” Seborrheic keratosis can also occur naturally in the process of aging.