Working here in Northern Ghana, I have seen conditions and tumors that I have never seen elsewhere. Sometimes, I have to refer patients to the larger teaching institutions for further investigations. Other times, I just have to approach a problem in a stepwise fashion until a conclusion is found. This case is a good example of the latter.
A middle-aged man came to my clinic in March 2018 complaining of a mass in his umbilicus for many months. Fluid was draining from a small wound on the mass. He also had vague abdominal pains, but nothing significant. He denied weight loss. On exam, he appeared well except for this 4cm x 3cm mass emerging from his umbilicus that was draining clear fluid.
On ultrasound, the mass had a very strange appearance. Part of it was solid tumor. Part of it was fluid with other small cysts inside.
Honestly, I had never seen anything quite like it. It reminded me of a “Sister Mary Joseph Node” – which is a lymph node found at the umbilicus indicating an intra-abdominal cancer in its later stages. I sent pictures to colleagues in the States for their recommendations. Because I thought it was just the tip of the iceberg, I only took a small biopsy and sent it for pathology. The report actually came back as a “skin adnexal tumor” without mention of any malignancy. The patient, however, didn’t come back until 8 months later.
When the patient came back, he did not appear to be in the end stages of any cancer. He had actually gained weight. He was still complaining of the mass and the discomfort it was giving him. I was able to excise the mass in its entirety and send it for pathology for confirmation.
Again, no malignancy was seen and it was labeled as an Eccrine Acrospiroma (a first for me!). The patient was very happy to finally be rid of the mass and to know it was not a sign of cancer lurking below.